If Di Thornton could hire another nurse practitioner for her border town multidisciplinary practice, she’d do it on the spot! There are simply not enough nurse practitioners in the community – and it’s critical.

“If I could attract another nurse practitioner tomorrow, I would employ them! We have more than enough work. Every day is busy and fully booked,” says Ms Thornton.

It’s a predicament that might be remedied following the Federal Government’s HELP debt scheme, which could be a game-changer for rural and remote communities.

“There are significant barriers to healthcare in rural and remote Australia, and this new legislation will hopefully attract more nurse practitioners.”

The Australian College of Nurse Practitioners estimates that the new legislation could attract approximately 850 nurse practitioners and doctors every year to remote and rural areas of Australia.

“What an absolute godsend! This will help nurse practitioners complete their training and address barriers to practice and issues for patients accessing health care.”

The journey to remote practice ownership

Witnessing the disparities experienced in remote Australian communities, Ms Thornton made it her mission to improve health care access in disadvantaged areas.

“I wanted to make a difference in our community’s health care. So, I went to university and studied and worked full time to gain my Masters of Nurse Practitioner – Rural & Remote. 

“As soon as I became an endorsed nurse practitioner, I worked with the local health network and trialled the position in the local medical practice for twelve months.”

Soon after, Ms Thornton established the Mallee Border Health Centre, located on the border of South Australia and Victoria, to improve community health care further.

Now in its fifth successful year, the multidisciplinary practice employs a general practitioner, physiotherapist, practice nurse, skin cancer specialist, psychiatrist, diabetes educator, podiatrist and a mental health care worker.

The reality of remote health care

Providing continuity of care and making a difference in the community is hugely rewarding, but Ms Thornton says financial challenges and succession planning are significant obstacles.

“The financial challenge is real, and we are trying to make ends meet every month.  Nurse practitioners can claim only four Medicare item numbers and four equivalent telehealth item numbers. 

“We can’t claim the MC Practice Incentive Payments or Service Incentive Payments that GPs are entitled to if they work in an accredited practice.” 

There’s also the challenge of recruitment of nurse practitioner and other health professionals, making succession planning near impossible.

“Although I’m happy to continue working for the foreseeable future, there will be a time when I will want and need to step back.

“I am hopeful that wiping HECS debt for nurse practitioners will ensure that I have a better chance of recruiting someone to take over my practice in the future.”

The burden of having to be the bearer of bad news is difficult, says Ms Thornton, but it’s also a blessing in disguise.

“Another challenge is telling someone you know they have cancer or a chronic illness that will dramatically affect their lives. 

“This comes with an upside, which is that you can also provide the best care for them, so it can be a double-edged sword.

“Some would say knowing the people you treat is awkward, but I enjoy it. You can tell if there is something wrong because you know them.

“I work with the best team and am thankful and humbled by the colleagues that have chosen to work with me.” 

Accentuate the positives

There are many positives to living and working in a remote area, but the most rewarding experience is providing in-home palliative care, explains Ms Thornton. 

“I think some of my most memorable days have been spent providing palliative care for clients in their homes until their death. 

“This is what they want, so this is what I have provided on several occasions in all three locations. 

“I do this in conjunction with my GP because, at the end of the day, nurse practitioners cannot sign death certificates, so it’s imperative the GP is in the loop.” 

In-home palliative care requires out-of-hours and weekend work that cannot be claimed through Medicare, but Ms Thornton isn’t discouraged.   

“At the end of the day, it is an absolute privilege for these patients to put their trust in me and for me to be able to keep them at home where they wish to spend their last days surrounded by family and friends.

“[There are] fabulous 24-hour on-call palliative care services that I can access for guidance and advice if the going gets tough. 

“One weekend in Victoria, the palliative care specialist on call was the head of Peter McCallum Cancer Centre, and he was very complimentary about the work I was doing to keep the patients at home where they wanted to be.”

Dealing with disparity

The most significant disparity in remote health care is the costs associated with travel, but technology has helped ease the burden.

“I try and engage in video consultations with specialists as much as possible to alleviate the need to travel. 

“I also engage the services of the RFDS specialist telehealth services, which I can access in all three locations, which is great for the patients. 

“These telehealth consultations have included endocrinologists, geriatricians, respiratory specialists, psychiatry and chronic pain management clinics.”

The biggest frustration comes not from the long hours or the travel, but a lack of understanding of what a nurse practitioner can do, says Ms Thornton.

“I had one of my regular patients ask me if I could do a referral for them.

“I think there needs to be more community education on the training and skills that nurse practitioners have. 

“We are highly trained nurses who can diagnose, prescribe, and order investigations such as pathology, X-rays and ultrasounds. 

“We all have a scope of practice within our field that we work within, but that scope isn’t static as we gain further education and experience throughout the years.”


Day in the life of Di Thornton

We asked what a typical day looks like for a remote nurse practitioner (anything like Virgin River?) and, as expected, the hours are long!

5.30 am
I log on remotely from home and check pathology results that have come in overnight. I don’t have much time during the day to do this, so I have found this is the easiest way to get the day rolling smoothly.  I then know if anyone needs to be recalled urgently for abnormal results. 

6 am
Drive to whichever location I am in for the day.

8.30 am
Start consulting.

I see anyone who presents, much as a GP would.  So, it can be anything from chronic disease management, mental health, and acute illnesses, including cuts, injuries, fractures and flu, to pregnancy monitoring between visits from our GP.

We also have a remote system set up with Flinders Medical Centre – Virtual Clinical Care for monitoring heart failure patients in our community. 

5 pm
Finish consulting, but I don’t usually leave until about 6 pm.


If you’re considering training to be a nurse practitioner, Ms Thornton says you won’t regret it, but be sure to find a mentor!

“There are plenty of well-experienced nurse practitioners on the ground who are more than willing and able to mentor you.

“I’ve had visiting nurse practitioners work with me to get a feel for what it’s like.

“I love being able to show them the breadth of presentations in a general rural and remote practice setting but also the difference you can make for the health of your community.”

If you need more inspiration to join the force for good in the bush, think of immersing yourself in nature!

“We live close to many national parks, including Ngarkat National Park, Hattah-Sunset National Park and the Big Desert.

“There is nothing better to clear the cobwebs than to go for a drive and see the wildlife and the flora, which is superb following all of the spring rains - the wildflowers are spectacular!”