CRANAplus framework for remote and isolated practice · isolated areas. Remote health professionals are an integral part of the health care system in Australia. Remoteness, in and

officeofsupportandprofessionalservices|revisedAugust2018 1

CRANAplusframeworkforremoteandisolatedpractice

version5|revisedAugust2018

improvingremote health

2 CRANAplusframeworkforremoteandisolatedpractice

FrameworkforRemoteandIsolatedPractice,CRANAplus,2012

OriginalAuthors:GeriMaloneandChristopherCliffe

Reviewed2013,andWholeDocumentRevised2014,and2018


Contents

Introduction 4

FrameworkforRemoteandIsolatedPractice 4

Definitionofremoteness 4

Remoteandisolatedworkplacesettings 6

Characteristicsofremotehealthservices 8

PathwaytoRemotePracticeforNurses/Midwives 10

Positivesafetypractices 14

RANcertificationprogram 15

References 17


introduction

CRANAplusisthepeakprofessionalbodyforremoteandisolatedhealth,providingadvicetoGovernment,serviceproviders,clinicians,andconsumersonequitableaccesstosafe,highqualityhealthcare.

CRANAplusbelievesitisessentialtohavenationallyconsistentstandardsofpracticefortheremotehealthworkforcetoimprovethehealthoutcomesforthoselivingandworkinginremoteareas.Asaresult,this‘FrameworkforRemoteandIsolatedPractice’hasbeendeveloped.

frameworkforremoteandisolatedpractice

Theframeworkconsistsoffiveelementswhichareaimedatallhealthprofessionalsprovidingcareinthecommunity,regardlessofthemodelofservicedelivery.

FrameworkforRemoteandIsolatedPractice

● Definitionofremoteness

● Remoteandisolatedworkplacesettings

● Characteristicsofhealthservices

● PathwaytoRemotePracticeforNurses/Midwives

● RANCertification

definitionofremoteness

CRANAplus defines remoteness as a complex subjective state, the causal factors are:

● geographyandterrainlimitingaccessandegress

● beingsociallyandculturallyisolated

● environmentalandweatherconditionsresultinginisolation

● isolationduetodistances

● beingisolatedfromprofessionalpeersandsupports

● isolationasaresultofinfrastructure,communicationsandresources


Defining remote areas is often based on Commonwealth Government categories of remoteness, using a range of classifications including:

● RRMA(Rural,RemoteandMetropolitanAreas)classification

● ARIA(Accessibility/RemotenessIndexofAustralia)classification(basedonARIAindexvalues)

● ASGC(AustralianStandardGeographicalClassification)RemotenessAreas(basedonARIA+indexvalues–anenhancedversionoftheARIAindexvalues)

● MMM(ModifiedMonashModel)

CRANAplus believes the following factors need to be considered:

● Geography and terrain limiting access and egress Mountainousterrainsandislandscanresultinisolationfromresourcesandlimitaccessbutstillbewithinanareadesignatedthroughtheclassificationsystemasnon-remotee.g.BrunyIsland(TAS).

● Being socially and culturally isolated Livingandworkinginaculturallydifferentcommunitydifferenttoyourownculture,andsocialnetworksarelimitedordifferenttoyourusualsupportsandnetworks.

● Environmental and weather conditions resulting in isolation Naturaldisasterssuchasfloodingorinclementweatherlikesnowandstorms,resultofothernaturaldisasters.

● Isolation Thevastdistances,distanceandthetimetoaccessservicescanvaryduetothemodeoftransportorthequalityoftheroads.

● Setting for practice Operatingintheaeromedicalenvironmentwherealtitudeistheisolationfactoralongwithlimitedresources,orwheresecurityproceduresisanisolatingfactore.g.prisons.

● Being isolated from professional peers and supports Inclusiveofhealthprofessionalsworkinginnon-healthorganisationse.g.detentioncentres,tourism,mining,industry.

● Isolation as a result of infrastructure, communications, security processes that limit accessForexampleDefenseForces,internationaldevelopment(AIDworkers).Unreliabilityofcommunicationsystemsandreferralpathways.


remoteandisolatedworkplacesettings

RemotehealthprofessionalsworkinavarietyofsettingsasdescribedinCRANAplus’definitionofRemoteandisolatedareas.RemotehealthprofessionalsareanintegralpartofthehealthcaresysteminAustralia.Remoteness,inandofitself,isadeterminantofhealth.

Remote and isolated practice areas present particular challenges to the delivery of quality services, including:

● Smalland/ordispersedpopulations

● Poorerhealthstatus

● Diversecultures

● Socialerosion

● Geographicalisolation

● Challengingaccessandegress

● Limitedandaginginfrastructure

● Smallereconomicpotential,poverty,higherunemployment

● Limitedpoliticalinfluence

● Harshextremesofclimate

● Highworkforceturnoveracrossalldisciplines

● Limitedopportunitiesforprivatemodelsofhealthcare

Remote health professionals are employed in a range of settings including, but not limited to:

● StateandTerritoryGovernmentrunhealthservices

● Communitycontrolledhealthservices/AboriginalMedicalServices

● PrimaryHealthCareServices/Clinics

● CountryHospitals/Multi-purposeHospitals

● Generalpractices

● Miningandotherindustries

● Mobileandfly-infly-out(FIFO)services

● Non-GovernmentandNot-For-profitOrganisations

ItiswidelyacknowledgedthattheremoteandIndigenouspopulationsofAustraliahaveahigherburdenofdiseasesandsubsequentreducedlifeexpectancy,yetpooreraccesstoequitablehealthservicescomparedtotherestoftheAustralianpopulation.


TheWorkforce

ThereislimiteddatacurrentlyavailablearoundtheremoteandisolatedhealthworkforceinAustraliathataccuratelyreflectsthenumbers,vacancyrates,characteristicsandsettings/facilitiesinwhichtheywork.InaseriesofpapersbyLenthallet.al(2011)1thecharacteristicsofthenursingworkforceinremotehasbeendescribed.ThedataavailablereflectsthatremoteAustraliahasadisproportionatelylowernumberofhealthprofessionalsperheadofpopulation,incomparisontourbanandruralAustralia.

Thismal-distributionisacrossallhealthprofessionalgroupsandwhilstnursesarethemostevenlydistributedacrossallgeographicalareasandcomprises50%oftotalworkforcetheirnumbersandthoseofmidwivesaredecreasinginremoteareas.Remotehealthworkforceworklongerhoursandareoldercomparativetotheurbanworkforce.Theremotecommunitiesarebecomingincreasinglyreliantonoverseastrainedprofessionals,short-termplacementsandflyinflyoutservice2.

Remotehealthprofessionalsaretypically‘hard-working’,flexible,adaptable,resourcefulandpassionateabouttheirwork.Theirpracticeencompassesallofthechallenges,andtheconsiderablerewards,ofthisuniqueandspecialisedfieldofhealthcare.

Remotehealthprofessionalsareguidedby‘health’asbeingawhole-of-lifeconcept,encompassingphysical,spiritualandemotionalwell-beingofindividuals,family,communityandtheenvironment.

Remotehealthprofessionalsinaccordancewiththeirscopeofpractice,arespecialistpractitionerswhoprovideand/orcoordinateadiverserangeofhealthcareservicesfortheentirepopulation.

ScopeofPractice

CRANAplus supports the following definition of Scope of Practice:

Aprofession’sscopeofpracticeisthefullspectrumofroles,functions,responsibilities,activitiesanddecision-makingcapacitywhichindividualswithintheprofessionareeducated,competentandauthorisedtoperform.

Thescopeofprofessionalpracticeissetbylegislation–professionalstandardssuchascompetencystandards,codesofethics,conductandpracticeandpublicneed,demandandexpectation.Itmaythereforebebroaderthanthatofanyindividualwithintheprofession.

The actual scope of an individual’s practice is influenced by the:

● contextinwhichtheypractice

● consumers’healthneeds

● levelofcompetence

● education,qualificationsandexperienceoftheindividual

● serviceprovider’spolicy,qualityandriskmanagementframework

● organisationalculture3


characteristicsofremotehealthservices

CRANAplus identifies two key principles, which are essential for a robust, safe and sustainable remote and isolated health service:

● Comprehensiveprimaryhealthcaremodelofcare

● Robustclinicalgovernanceframework.

CRANAplus supports the following definition of Primary Health Care:

Primaryhealthcareissociallyappropriate,universallyaccessible,scientificallysoundfirstlevelcareprovidedbyhealthservicesandsystemswithasuitablytrainedworkforcecomprisedofmulti-disciplinaryteamssupportedbyintegratedreferralsystemsinawaythat:givesprioritytothosemostinneedandaddresseshealthinequalities;maximisescommunityandindividualself-reliance,participationandcontrol;andinvolvescollaborationandpartnershipwithothersectorstopromotepublichealth.Comprehensiveprimaryhealthcareincludeshealthpromotion,illnessprevention,treatmentandcareofthesick,communitydevelopment,andadvocacyandrehabilitation4.

CRANAplus supports the following definition of Clinical Governance:

ThedefinitionofclinicalgovernancethatunderpinstheClinicalGovernanceFrameworkisasfollows:

Clinicalgovernanceisthesetofrelationshipsandresponsibilitiesestablishedbyahealthserviceorganisationbetweenitsstateorterritorydepartmentofhealth(forthepublicsector),governingbody,executive,clinicians,patients,consumersandotherstakeholderstoensuregoodclinicaloutcomes.Itensuresthatthecommunityandhealthserviceorganisationscanbeconfidentthatsystemsareinplacetodeliversafeandhigh-qualityhealthcare,andcontinuouslyimproveservices.

Clinicalgovernanceisanintegratedcomponentofcorporategovernanceofhealthserviceorganisations.Itensuresthateveryone–fromfrontlineclinicianstomanagersandmembersofgoverningbodies,suchasboards–isaccountabletopatientsandthecommunityforassuringthedeliveryofhealthservicesthataresafe,effective,integrated,highqualityandcontinuouslyimproving5.

Staffing

CRANAplussupportstheconceptofminimumratiosofstaffinginremotePHCservices,takingintoconsiderationthepopulation,sizeofthecommunity,remotenessfromothersignificanthealthservicesandtheill-healthburdenexperiencedbyitspopulation.


Table 1: Standard of Health Service Staff to Population Ratios by Community Size

Pop range AHWs Nurses Doctors

>3,000 1:350(9) 1:500(6) 1:1,000(3)

1,300–2,999 1:250(5–9) 1:450(3–6) 1:1,000(1.5–3)

800–1,299 1:200(4–6) 1:300(2.5–4.5) 1:800(1–1.5)

400–799 1:100(4–8) 1:200(2–4) 1:600(1)

250–399 1:75(3.5–5.5) 1:200(1.5–2) 1:400(1)

(Numbersinbracketsestimatednumber)

ThetableaboveusesthebasicstafftopopulationratiosofAHW1:50,Nurses1:200andDoctors1:400andmodifiesaccordingtosizeofcommunities,wherebyinlargercommunities,economiesofscaleandaccesstootherhumanservices(healthandotherwise)meansthatfewernumberscanbeeffectiveasopposedtothesmallercommunitieswithsmallerpopulationnumbers6.

Inadditiontothisnarrowmixofhealthcareproviders,CRANAplushighlightstheneedforinclusionofasystemtoensureaccesstoMidwives,OralHealthProfessionals,NursePractitioners,AlliedHealthProfessionals,mentalhealthworkersandSpecialistsmedicalservicesinanymodel.

RemoteandIsolatedPracticewithinaHealthContext

Thedefinitionbelowprovidesasuccinctsummaryofthecharacteristics,differentsettingsandmodelsofcare,differentiatingremoteworkforcepracticefromruralandurbanworkforcepractices.

RemoteHealthiscarriedoutincontextuallydifferentsettings,includingbutnotlimitedto:governmenthealthservices;community-controlledhealthservices;aboriginalmedicalservices;primaryhealthcarecentres;multi-purposecentres;privategeneralpractices;mining;andotherindustriesliketourism;mobileandfly-in/fly-outservices;aswellasprivate,andnon-governmentorganisationhealthservices.

Remote Health practice is delivered through:

● healthservicemodelscateringforhighlymobilepopulations

● predominantlynurse-ledmodelsofcare

● collaborativemultidisciplinaryapproaches,inpartnershipwithcommunityandstakeholders

● anunderstandingofthecommunitywithinitsculturalcontext

● overlapping,andevolvingadvancedandextendedrolesofteammembers

● integratedcomprehensiveprimaryhealthcareapproach,inclusiveofacuteandemergencycare,chronicdiseaseandpublichealthacrossthelifespan

● scopesofpracticethatareinformedbytheidentifiedneedsof,andengagementwiththecommunity.


pathwaytoremotepracticefornurses/midwives

CRANAplusbelievesthatNursesandMidwiveswhoworkinremoteandisolatedpracticeneedageneralistapproachusingabroadscopeofpractice,toaddressthediverseneedsoftheirentirecommunity.

A Remote Area Nurse/Midwife is defined as:

Aregisterednurse/midwifewhosescopeofpracticeencompassesbroadaspectsofPrimaryHealthCareandrequiresageneralistapproach.Thispracticemostoftenoccursinanisolatedorgeographicallyremotelocation.TheRAN/Misresponsible,incollaborationwithothers,forthecontinuous,coordinatedandcomprehensivehealthcareforindividualsandtheircommunity7.

Experience gained in following areas of practice may help prepare for the generalist skill set required to deliver Comprehensive Primary health Care in a remote context:

● Ruralandregionalhealthsettings

● Communitynursingorpracticenursingroles

● Emergencycare

● Internationaldevelopment

Newlyqualifiedregisterednursesmayentertheremotehealthworkforcethroughadedicatedtransitiontopracticeprogramwithaspecificfocusonpreparingforaruralandremotecontext.

Eachremoteprofessionalhealthrolewilldiffer,dependingontheuniqueneedsofeachcommunity.

Specific roles and scope of practice may require preparation in:

● MaternalandChildHealth

● MentalHealth

● Women’sandMen’sHealth

● CommunityCapacityBuilding/Healthpromotion

● Chronicdiseasemanagement

● Emergencycare

● WorkplaceHealthandSafety

Tomaintaincompetencyintheworkplace,nursesandmidwivesmustembracetheconceptof‘lifelonglearning’toensuretheyhavethenecessaryknowledge,skills,attitudesandbehaviorstomeettheirobligationtoprovideethical,effective,safeandcompetentcare.

Continuingprofessionaldevelopment(CPD),isthemeansbywhichmembersoftheprofessionmaintain,improveandbroadentheirknowledge,expertiseandcompetence,anddevelopthepersonalandprofessionalqualitiesneededthroughouttheirprofessionallives8.


CPD activities may be informal and formal, broad and varied to maintain competence in the workplace. Possible examples may include, but not limited to:

● Post graduate education

● Short courses

● Conferences

● Webinars

● Forums

● Journal club

● Mandatory workplace activities – basic life support, fire training

Continuing professional development activities must have relevance to the individual’s scope of practice with clear aims and objectives that meet the individual’s self-assessed requirements.

Minimum CPD required for annual renew of registration by NMBA8

Type of Registration Minimum Hours Total Hours

Registered nurse or Enrolled nurse 20 hours 20 hours

Midwife 20 hours 20 hours

Registered nurse and midwife Registered nurse – 20 hours/Midwife – 20 hours 40 hours

Nurse practitioner Registered nurse – 20 hoursNurse practioner endorsement – 10 additional hours relating to prescribing and administration of medicines, diagnostics investigations, consultation and referral

30 hours

Midwife practitioner Midwife – 20 hoursMidwife practioner endorsement – 10 additional hours relating to context of practice, prescribing and administration of medicines, diagnostics investigations, consultation and referral

30 hours

Registered nurse with scheduled medicines endorsement(Rural and remote)

Registered nurse – 20 hoursScheduled medicines endorsement – 10 additional hours relating to obtaining, supplying and administration of scheduled medicines

30 hours

Midwife with scheduled medicines endorsement

Midwife – 20 hoursScheduled medicines endorsement – 10 additional hours relating to context of practice, prescribing and administration of medicines, diagnostics investigations, consultation and referral

30 hours

Registered nurse and midwife with scheduled medicines endorsement

Registered nurse – 20 hours/Midwife – 20 hoursScheduled medicines endorsement – 10 additional hours relating to context of practice, prescribing and administration of medicines, diagnostics investigations, consultation and referral

50 hours


Topicsrelevanttoremoteandisolatedpractice

The Topics relevant to remote practice may include, but not limited to:

● CulturalSafety

● EmergencyCare

● PrimaryHealthCare

● Immunisation

● Pharmacology

● Chronicdiseasecoursesi.e.Diabetes,Asthma,Renal

● WorkplaceHealthandSafety

Postgraduateeducationorqualificationsarebeneficialforremoteandisolatedpractice.

Courses, which are more relevant to the remote context include:

● Remote/ruralhealthpractice

● Publichealth

● Primaryhealthcare

● Healthpromotion

● Criticalcare(Emergencycare)

CRANAplusrecommendsallnursesandmidwivesworkinginremoteandisolatedhealthservices,beprovidedtheopportunitytoundertakeacomprehensiveintroductoryandorientationprogram(s)inclusiveofpersonalandprofessionalsafetyandsecurity.


* Recommended courses that can be undertaken pre-employment or within the first year:

● StaySafeandSecure*

● RemoteEmergencyCare(REC)orequivalent*

● AdvancedLifeSupport(ALS)*

● PharmacotherapeuticsforRAN/M’s*

● Maternalemergencycare(MEC)fornon-midwivesorequivalent*

● Midwiferyupskilling(MIDUS)orequivalent**

● Immunisation*

● Drivereducationcourses4x4*

● CulturalSafety**

● AnnualCoreMandatorycompetencies–througheRemoteorequivalent

• FireandEvacuation

• ManualHandling

• DrugCalculation

• BasicLifesupport

Thefrequencyofre-certificationwillbedependentuponhealthservicerequirements,personalCPDneedsandprofessionalrecommendations.

It is important to note:

● AdvancedLifeSupportcoursetobeundertakenwithamaximumintervalof2years,tomaintaincompetence.

● Emergencycoursetobeundertakenwithamaximumintervalof2years,tomaintaincompetence.

● Jurisdictionaloremployerspecificrequirements,suchas:

• QueenslandHealthandVictoriaHealth,RemoteandIsolatedPracticeRegisteredNurse(RIPRN)Course

• NorthernTerritory,DepartmentofHealth,prerequisitesforRemoteHealthnursing/midwiferyemployment.


positivesafetypractices

Thedeliveryofqualityhealthcareisintrinsicallylinkedtothehealth,safetyandwellbeingofallpeopleinvolvedincludingworkers,visitors,familyandclients.RemoteandIsolatedpractitionersmaybevulnerabletopsychologicalorpsychologicalharmifexposedtounfamiliaranduncertainsituationsoreventsincludingbutnotlimitedtoalackofsecurefood,peopleexperiencingextremepoverty,inter-generationaltrauma,aggressionandviolence,roamingdogs,extremetemperatures,conflictingexpectationsandextremedrivingconditions.

Whenworkinginremoteandisolation,howdoyouincorporatesafety,securityandwellbeingpracticesintoyoureverydayworkthatareculturallyappropriateandeffective?

CRANAplus has identified seven domains to guide your safety practices in every-day work for remote and isolated health. These are reflected in further detail in the CRANAplus Safety and Security Guidelines9 and include:

1. Accompanied–neveraloneifattendingcall-outsafterhoursorduringbusinesshoursifthereisanunknowneventconcernsforsafety.

2. Prepared–necessaryeducationtobebothprofessionallyandpersonallypreparedforaroleinremoteandisolatedpractice

3. Resilient and prevent fatigue–abilitytorespondtothechallengesofremotepracticeincludingminimisingfatiguethoughworkloadmanagementandprioritisingself-care.

4. Workforce and career–planandbalanceworkwithlife

5. Communication and connectivity–ensurereliableandeffectivecommunicationandtransport

6. Prevention and De-escalate–preventionandde-escalationskills

7. Identify Hazards and manage risks–identify,reportandcontributetothemanagementofhazardsandrisks

CRANAplusbelievesthatitiscriticallyimportantforthoseworkinginremoteandisolatedpracticetogainadditionalskillsandknowledgetomanagesafetyincomplexandculturallydiverseenvironments.ThisincludesbepreparedforknowneventsthatmaythreatensafetyincludingbeingproficientinmaintainingoptimalsafetybyapplyingariskmanagementapproachandsafetytoolssuchasthoselocatedwithintheWorkingSafeinRemoteandIsolatedPracticeHandbook10.

Akeymeasuretobuildyourcapabilityandconfidenceinthepreventandcontrolworkrelatedviolenceiseducation11.Typically,trainingisbasedonanassessmentofriskinyourworkarea.Intheremoteandisolatedhealth,itshouldbealignedwithworkingwithinacomprehensivePrimaryHealthCaremodelofservicedelivery.Thiscoverstheory,tounderstandwork-relatedaggressionandviolence,prevention(howtoassessandtakeprecautions),Interaction(dealwithanaggressionorviolentperson)andresponse/recovery(postincidentactions).


RAN certification program

Certification Program

CRANAplus believes it is important to pursue a process for recognition of individual registered nurses who meet the Professionals Standards of Remote Practice that validates their status as a Remote Area Nurse (RAN).

A CRANAplus Certified RAN will be a nurse with the requisite skills, knowledge and experience to be responsive to the fundamental health needs to their remote, rural and/or isolated community, employer and patients. The Professional Standards of Remote Practices for nurses is the foundation that guides the minimum standards for high quality and safe nursing care in isolated areas12.

Benefits of undertaking a Certification process will be:

Nurse

● Professional recognition

● Driven by our profession

● Aspirational career development opportunity

● Ability to move between employers/jurisdiction without having to ‘re-do’

● Defines a minimum standard for the provision of competent, safe, quality care

● Clarity and confidence in scope of practice

● Clarity on educational preparation and study requirements

Patient

● Clear expectations of the standard of care

● Comprehensive Primary health care approach

● Caring for individuals, families and entire community

● Access to safe, quality nursing care regardless of location

Health Service

● Nationally recognised

● Minimum Standard of knowledge and skill for the provision of competent, safe, quality care

● Improved Clinical Governance

● Retention (improved)


ProfessionalStandardsofRemotePractice

The‘ProfessionalStandardsofRemotePractice:NursingandMidwifery’isendorsedbyCRANAplusasaNationalStandard13.

Standard1HasappropriateregistrationandendorsementforpracticeandworksinaccordancewiththeprofessionalStandardsforRegisteredNurse/Midwife(NMBA).

Standard2Maintainsownhealth,wellbeingandresiliencewithinaprofessional,safeworkingenvironment.

Standard3Practiceswithinaculturallyrespectfulframework

Standard4PracticeswithinaComprehensivePrimaryHealthCaremodelofservicedelivery

Standard5Workswithincarepathwaysanddevelopsnetworksofcollaborativepractice.

Standard6Hasalevelofclinicalknowledgeandskillstosafelyundertaketherole.

Standard7Hasaperiodofrecentclinicalpracticeinaremoteandisolatedlocationwithinthepastfiveyears.

Standard8Hasanongoingcommitmenttoeducationrelevanttopracticeintheremoteenvironment.

Standard9PracticeswithinaSafetyandQualityFramework.


references

1. Lenthall S, Wakerman J, Opie T, Dunn S, MacLeod M, Dollard M, Rickard G, Knight S: Nursing workforce in very remote Australia: characteristics and key issues: Australian Journal of Rural Health 19(1): 32-37(2011).

2. AIHW Media Release: More doctors and nurses, but supply varies across regional and rural areas. (Ocober 2010): https://www.aihw.gov.au/news-media/media-releases/2010/2010-oct/more-doctors-and-nurses-but-supply-varies-across

3. Nursing and Midwifery Board of Australia: National Framework for the development of decision-making tools for nursing and midwifery practice, September 2007 – rebranded: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Frameworks.aspx

4. Australian Primary Health Care Research Institute (APHCRI) presentation given by Ms Caroline Nicholson: Development of a framework for integrated primary/secondary health care governance in Australia (17 July 2012): http://files.aphcri.anu.edu.au/resources/lectures-presentations/conversations-aphcri/ c_nicholson_presentation.pdf

5. Australian Commission on Health Care Standards: National Model Clinical Governance Framework (2017): https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Model-Clinical-Governance-Framework.pdf

6. Bartlettt b., Duncan P,: Top End Aboriginal Health Planning Study: Report to the Top End Regional Indigenous Health Planning Committee of the Northern Territory Aboriginal Health Forum. April 2000. PLANNED HEALTH Pty. Ltd. NSW.

7. CRANAplus: Definition of Remote Area Nurse/Midwife: Credentialing Pilot Project Advisory Group (2013)

8. Nurses and Midwifery Board of Australia: Fact sheet: Registration Standard: Continuing professional development (November 2016) website: https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Continuing-professional-development.aspx

9. CRANAplus Safety and Security Guidelines 2017: crana.org.au/uploads/pdfs/CRANAplus-Safety-Security-Guidelines.pdf

10. CRANAplus Work Safe in Remote and Isolated Handbook 2017: https://crana.org.au/uploads/pdfs/CRA_Safety_Booklet_online.pdf

11. WHO, Guidelines on Workplace Violence in the Health Sector 2003: http://www.who.int/violence_injury_prevention/violence/interpersonal/en/WV_ComparisonGuidelines.pdf

12. CRANAplus: RAN Certification: Nursing in remote and isolated practice: brochure: p2, 2017: https://crana.org.au/certification/ran-certification/

13. CRANAplus: Professional Standards of Remote Practice: Nuses/Midwives (2014): https://crana.org.au/resources/practice/standards/


Version Control Date Summary

Originaldocument June2012 Authors:GeriMalone,NationalCoordinatorofProfessionalServices,CRANAplus;andChristopherCliffe,PresidentofBoardofDirectorsCRANAplus

Reviewed–V2 February2013 Updated

Revised–V3 September2013 InclusionofCredentialingforNursesandMidwivesandProfessionalStandardsofRemotePractice:NursingandMidwifery

Revised–V4 August2014 Revisedwholedocument

Revised–V5 August2018 RevisedwholedocumentinclusionofPositiveSafetyPractices


Cairns office

Street address: Lot 2, Wallamurra Towers, 189–191 Abbott Street, Cairns, QLD 4870

Mailing address: PO Box 7410, Cairns, QLD 4870

Phone: (07) 4047 6400 Fax: (07) 4041 2661

Alice Springs office

Street address: c/- Centre for Remote Health, cnr Simpson and Skinner Streets, Alice Springs, NT 0870

Mailing address: PMB 203, Alice Springs, NT 0871

Phone: (08) 8955 5675

Adelaide office

Mailing address: PO Box 127, Prospect, SA 5082

Phone: (08) 8408 8200 Fax: (08) 8408 8222

Documents

CRANAplus framework for remote and isolated practice · isolated areas. Remote health professionals are an integral part of the health care system in Australia. Remoteness, in and