What do you need to be able to thrive in remote nursing? The key lies in equipping yourself with an open mind and a sense of adventure, writes Karen Keast.

Natalie Birt wakes up to sunshine every day in outback Australia.

The 41-year-old registered nurse loves the whistling kites swooping in the skies, the red sunsets and the even redder dirt.

Most of all, she loves the smiles on the faces of the Indigenous children at the school in Wadeye, 394 kilometres south-west of Darwin, where she works as the school’s first and only nurse.

“Good morning nurse Nat,” the kids greet her every day, smiling.

Natalie began work at the school, which has up to 600 primary and secondary school students, at the start of this year.

Originally from Gippsland in Victoria, Natalie, a division two nurse for 17 years, worked in a variety of roles and locations before completing her division one qualification in 2008 and going on to work in emergency department nursing.

It wasn’t enough. Natalie wanted a new challenge – a move into nursing Indigenous people.

“They have different challenges and illnesses to what non-Indigenous people do,” she says.

“I also love the bush and the outback and fishing and camping. I thought I could do all of that as well as nurse.”

A friend of Natalie’s, who had ventured into remote nursing at Timber Creek in the Northern Territory, encouraged Natalie to give it a go, so Natalie searched online for nursing agencies and came across Medacs Healthcare (Australia) operations manager Donna Gould.

Donna found Natalie her first position – an eight week contract in the emergency department at the Alice Springs Hospital in January 2010, where she was able to find her feet and become familiar with the different surroundings, people and culture.

Natalie’s next position was a three-month posting at Minyerri, a dry community of about 700 people located 270 kilometres south-east of Katherine.

It was the wet season and to get there Natalie experienced her first ride in a “Troopy” 4WD.

“They are like a big 4WD and they have got the side seats, you can sit five people on each side; they are their ambulances,” she says.

“They picked me up from Katherine and drove three and a half hours in flood water to get to the community.

“I thought – what am I in for? The roads were washed away and I knew I was stuck in this community. I could access a landline but there was no mobile phone reception.

“Donna said it was a sink or swim situation and thankfully I swam. The people out there are very friendly and they welcomed me with open arms.

“I learnt so much about their culture. We had a man come in one day and he had stabbed himself in the arm.

“That’s what they do when someone dies; they self-harm. I had to adjust myself to that.”

Natalie thrived in her remote experience and when her post was completed, she went home to Victoria, packed up her house and made the move to Darwin.

Once there, she did agency nursing for eight weeks and then got her first job in research at the Menzies School of Health Research.

The job was an 18 month contract that saw Natalie embark on weekly small charter plane flights to Tiwi Island, Wadeye and Kununurra researching two pneumococcal vaccines, aimed at reducing the incidence of otitis media in Indigenous children.

“I gained many skills from this job and worked very closely with midwives in the remote clinics and new Indigenous mothers,” she says.

“It was a huge challenge…and on finishing my contract I felt very passionate about nursing the Indigenous people in the NT.”

Natalie wasn’t ready to return home, so when she saw a position advertised for a school nurse at Wadeye, the sixth most populated town in the Territory and the largest Indigenous community, she applied for it.

It was also one of the communities Natalie had been flying in and out of, and she was familiar with its challenges and issues.

Natalie obtained the position and has since set up her own small clinic at the school, where she looks after the health of the children and also its Indigenous staff members.

She works with visiting health professionals and liaises with the town clinic for serious injuries, runs health promotion, has begun writing policies and procedures, and provides much-needed health care for the Indigenous students.

“I have had 150 kids through the clinic so far,” she says.

“They have come in with scabies, school sores, cuts and bites and head injuries.”

Natalie says with Darwin a seven-hour drive away, there are the obvious challenges to cope with, such as the heat, which she is now acclimatised to, and the isolation.

There’s also a few unusual challenges.

“You have also got to deal with snakes, green tree frogs, the dust that gets everywhere and the camp dogs that can be quite aggressive,” she says.

“We live in places with eight to nine foot high fences because of the dogs.

“It’s also a troubled community in the Northern Territory. There are 26 different tribes that live within the community and there’s lots of tribal fighting.”

There are also many positives, from the pay package which includes Natalie’s accommodation costs, and covers her water and electricity, while she also receives three return flights to Darwin each year.

Plus the hours are great. Natalie works Monday to Friday, from 8am to 4pm, and has the school holidays off.

She has also enjoyed exploring the outback, experiencing the local culture and making friends in the community.

Natalie made the move to the outback on her own, as her partner Howard was unable to leave his position.

While Natalie says she couldn’t have made the move without the support of Howard and her two children, she says it is possible to venture to remote communities without moving your family.

“Some nurses might think their partner has to leave their job but they can actually go up alone and achieve their dream,” she says.

For nurses interested in taking the leap into remote nursing, Medacs Healthcare regularly has contract and permanent positions available.

Most contract positions range in length from four to 13 weeks, in locations as diverse as regional New South Wales and Queensland to the middle of the Western Australian desert, with opportunities to work for state health services and Aboriginal health services to one-nurse clinics and rural hospitals with less than 20 beds.

Donna, who helped Natalie move into remote nursing, says many nurses are interested in Indigenous health and want to experience it first-hand.

“We have nurses who just want a new adventure away from a large hospital environment, nurses who work best in small teams and those who do it for monetary reasons,” she says.

“We rarely struggle to find nurses who are interested in working in rural and remote locations.”

Donna says Medacs Healthcare requires nurses to have a broad range of nursing skills and experience before being sent to rural and remote locations, with nurses needing at least two years’ experience in an emergency setting before being posted at very remote locations.

She also advises nurses wanting to work remotely to “be prepared to roll with anything that may happen”.

“Every day will be different and you will experience things you have never experienced before,” she says.

“Go into rural and remote nursing with an open mind and a sense of adventure.

“The remote nurses I have dealt with over the years generally fall into two categories – those who try it and never want to do it again and those who fall in love with the remote locations, the people and the nature of the job.

“It is a job that takes a special person.”

Remote nursing has certainly been a life-changing experience for Natalie.

She concedes it’s changed her both personally and professionally.

While Natalie plans to return home to Victoria next year to be closer to family, it will be a short-term stint. Remote nursing is now in her blood.

“People have said to me I have grown so much more confident in myself and my whole attitude has changed,” she says.

“I would say to others interested in remote nursing to go and talk to as many people as you can that have been there.

“It will change your life. It certainly changed mine.”