One of the things that makes work worthwhile is the opportunity to make a difference. In my experience, this is a factor which is often underestimated, or perhaps undervalued, by managers. It goes part of the way to explain why throwing money at remote health jobs does little to resolve the chronic shortage of personnel. In fact, in some ways throwing increased money at remote staff has the effect of attracting mercenaries who are only ‘in it for the money’.
So if it’s not the money, and let’s face it, the salary package for a Remote Area Nurse is among the best you can get in the profession, then what is it that keeps people in the field? Well, my opinion is based on my experience as a Remote Area Nurse, as a remote Health Centre Manager, and as a manager of volunteers. I think it depends to a large extent on the ability to make a difference, and to see and feel that you are doing so. For many nurses, life is one of boredom and drudgery, doing the same work over and over again in a never-ending cycle until their backs pack up or they burn out physically and emotionally. For a few, the rewards that come from helping a patient to find the road to health and follow it make up for all the failures. It’s all very well to patronise struggling nurses and tell them to ‘focus on the successes and let the rest slide by’. Unfortunately that ignores the reality of human nature, where we feel deeply our failures and they erode our confidence underneath the veneer of professional cheerfulness. Making a difference to people is what makes the difference to us. This is true of many endeavours, but I think it is most relevant when caring is part of the job description.
During my time in the SA Country Fire Service, I came to realise that most volunteers were giving their time and energy to the organisation because they could make a difference, and that met a need within themselves for their lives to mean something. This was true even, or perhaps especially, of those who professed to believe religious dogma which was supposed to meet this need. I used to think it was about the need to belong, and maybe in some ways that’s a frequent starting point. Now I think it is more about making a difference, and being recognised for doing so, that keeps people doing things that others find amazing. Whether it is fighting fires in your own time, or living and working in a remote community away from family and friends, it is the opportunity to make a difference, and the recognition for doing so that is a potent driver for people sticking with it.
What this means for remote health is that if managers want to be serious about attracting and retaining good staff in the field, they need to stop their senseless bickering and bitchiness about little things that don’t make a difference. They need to focus on making it possible for staff to make a difference. In Aboriginal communities, this means making a real effort, not the usual token gesture, to include Aboriginal Health Workers as part of the team. Remote Area Nurses are hampered in their drive to make a difference if they don’t have the tools and support they need, and a big part of this is the Aboriginal Health Workers. Any RAN who doesn’t see this needs to do themselves a favour and get the hell out of Aboriginal health ASAP.
To stop the soul-destroying revolving door of acute health care, the health system needs to be reformed to put more money into prevention than it does into cure. Most of the work in remote Health Centres is acute care arising from preventable causes, yet bugger all is spent on prevention. Managers tend to express their awareness of this stupidity by blaming the Remote Area Nurses for neglecting prevention, when it is the almost total lack of support and funding for prevention activities that stops it from happening. You can’t make a difference when the cards are stacked against you, and when your own employer is doing the stacking and then blaming you for it, it is not long before no amount of money will compensate for the disillusionment.
So what’s the solution? Give remote health professionals the tools they nned and the support they need to do what most of them are there for, to make a difference. If you can’t do that, or don’t know how, then do everyone a favour and get out of remote health and give the job to someone who can. Either that, or stop pretending that we are in the business of Primary Health Care and rename the health centres “Remote Band-Aid Stations”. Then we can keep wasting time and money and dedicated staff for another 50 years!