Remote Area Nurses (RANs) are employed by Bush Nursing Centres to provide small rural and remote communities access to essential primary health and nursing services. RANs, due to the remoteness of their communities, may be the only available health care professional to provide first line emergency care and stabilisation in the event of a medical or trauma emergency. The majority of RANs work independently and refer patients to other areas and disciplines for secondary and tertiary interventions.
The Drugs, Poisons and Controlled Substances Regulations 2006 5 (2) (b) provides a framework to issue a Health Permit that allows for the employment of RANs to have the delegated responsibility to provide emergency care if they have attended annual competency based training and been assessed as competent in the use of the Remote Area Nurses Emergency Guidelines (Victorian Government Department of Human Services: Melbourne). This delegation allows them to use the guidelines in the event that a medical practitioner cannot be contacted.
Remote Area Nurses Emergency Guidelines
The Remote Area Nurses Emergency Guidelines (RANEG) is an excellent resource and forms the foundation for the annual competency based training undertaken by Victorian RANs. This ensures that they have a sound knowledge of the primary and secondary survey model of care and the most common interventions expected to be implemented in an emergency situation.
The RANEG are reviewed and updated on an annual basis. They have undergone rigorous review by the AV Medical Standards Committee and stakeholder representation. They reflect current medical, nursing and pharmacological practice and provide an evidence-based text to reinforce safe and effective nursing practice. The RANEG are closely aligned with the evidence based AV Clinical Practice Guidelines.
Training
RANs require annual competency based assessment to enable them to initiate and undertake emergency care procedures and administer pharmacological agents in an emergency by following treatment protocols specified in the RANEG, when contact with a medical practitioner is not possible.
AV have been contracted to undertake the training since 2005. The program combines comprehensive distance learning support resource material and workbooks in a modular format covering core information related to RAN practice. This is supplemented by a competency based two day workshop focusing on the acquisition, practice and assessment of emergency care skills.
The workbooks comprise the assessment components of each of the modules and are self paced requiring self directed learning. Written assessments are based on an understanding of the concepts of providing emergency care.
The two day workshop combines lectures and skills based scenario training utilising AV Advanced Life Support (ALS) manikins and are conducted by senior ALS and Mobile Intensive Care Ambulance (MICA) paramedics with content expertise in the areas being delivered. AV contracted emergency medicine specialists are also involved subject to availability. A minimum ratio of one instructor to three nurses is provided for all practical sessions.
AV also provides RANs with access to ongoing professional support by way of contact with mentor support and clinical debriefings by local MICA Clinical Education Services Team members and Ambulance Area Medical Officers. This minimises the feeling of isolation and provides local support by expanding the RANs professional multidisciplinary network. RANs also have free access to appropriate AV educational opportunities.