Remote and isolated health practitioners should always be accompanied after hours or when possibly at risk, prepared for remote practice through orientation, and equipped with effective communication, prevention and de-escalation skills.

These recommendations form some of the key priority areas highlighted in the recently released Safety and Security Guidelines for Remote and Isolated Health.

The guidelines are an integral part of the Remote Area Workforce Safety and Security Project - a CRANAplus initiative, funded by the Commonwealth Government, to improve the safety and security of the remote health workforce after assaults on Remote Area Nurses (RANs) and the murder of RAN Gayle Woodford in 2016.

CRANAplus CEO Christopher Cliffe says the remote health workforce has reflected on long-held practices since the tragic murder, and will no longer accept the risks once considered part of working remote.

“What we tolerate now and what we see as risk is different - we’ve had our eyes opened,” he says.

“I think because it’s been such a fast and fundamental change on what sort of risk we’re prepared to take as a workforce, employers are struggling to catch up.

“That’s just change - it’s a significant change and I think it’s much better that we are working positively with everybody, so that we are never going back.

“We now want a much safer workplace and that’s a good thing. It’s just a matter of giving everybody the tools that they need to be able to get there.”

The guidelines were released after an extensive conversation with industry, a review of literature, and the input of a national expert advisory group.

The document covers seven safety and security priority areas and outlines actions that clinicians, employers, service providers, communities and other stakeholders can implement to establish and maintain safe and effective operating systems in remote and isolated health services.

The guidelines’ priority areas include:

• Always work accompanied when attending call-outs after hours or during business hours if attending an unknown event or when clinicians have concerns for their safety
• Education to professionally and personally prepare clinicians for remote and isolated practice
• Ensure staff resilience and manage fatigue. Fatigue can be minimised through workload management, supportive supervision, timely use of leave, and prioritising self-care
• Create a stable workforce. Maintain a regular and reliable workforce while also working to reduce and manage staff turnover to promote safe, quality and reliable remote service provision
• Communication and connectivity through reliable and effective communication and transport to mitigate risks for remote clinicians
• Prevention and de-escalation skills. Equipping clinicians with the skills to manage bullying and harassment, and to reduce the incidence of events escalating to violence, and
• Identifying hazards and managing risks through a proactive schedule of monitoring, evaluation and workplace audits to highlight and respond to hazards and risks.

Mr Cliffe says the guideline for clinicians to always work accompanied was “a no-brainer”.

“When we looked around at all of our contemporaries, so the fire brigade or the ambulance service or the police service or even home-visiting type services, all sort of had a buddy system,” he says.

“It also seemed to be something that could be implemented very quickly to address a lot of the risks that we knew were going to take a much longer period of time to fix - some of the structural reforms that were required, some of the environmental changes that were needed, some of the educational requirements that were going to be required - but a real quick fix to just make sure that people tomorrow are safe.”

Mr Cliffe says while a number of services are working to improve safety and security measures for employees, some clinicians feel their safety and security is still being compromised.

“There are still examples happening almost on a daily basis where people don’t feel that their employer necessarily, or the system around them, is protecting them adequately,” he says.

“If they feel unsafe, I think they immediately should be letting their employer know and if they’re not getting a good hearing from their line manager, then they should escalate and keep escalating.

“It’s an industrial issue and if they’re not safe at work then their employer is not compliant with their obligations under the Workplace Health and Safety legislations of the state and territory or of the federal government, so this is the time when you can go to a union.

“Ultimately, I think as a workforce, we vote with our feet. And if an employer isn’t coming up to speed, then seek another employer - there’s plenty of work out there for good, highly-skilled remote health professionals.”

Mr Cliffe encouraged all remote and isolated clinicians, service providers and stakeholders to read the guidelines.

“But remember that they are not the panacea - they are not going to fix everything, and that safety comes down to you as an individual as well,” he says.

“If you don’t feel safe and you don’t feel comfortable, then trust your gut, and do something about it.”

The guidelines follow the release of the National Remote Health Workforce Safety and Security Report in January 2017.

As part of the Remote Area Workforce Safety and Security Project, CRANAplus will also develop a range of practical resources, including an app, an industry resource book, and online training for working safe in remote practice.