An Introduction to Community and Primary Health Care

Introduction

In New Zealand, the rural nurse specialist (RNS) has developed in response to the declining numbers of general practitioners (GPs) who practice in rural areas (Bell, 2015). People who live in rural and remote areas in Australia are more likely to receive health care from a registered nurse than any other health professional, as nurses are the best distributed and largest professional group in the rural health workforce (Bragg & Bonner, 2015; Gardner & Duffield, 2013). Usually rural health nurses have well-defined catchment areas or communities in which they practice. An increased scope of practice and greater reliance on collaboration, interdisciplinary and transdisciplinary practice is common. Rural health nurses may be sole practitioners, providing health care on their own, or as part of a small team that sometimes may include doctors.

Rural nurses who practise in remote areas, such as those employed by the Royal Flying Doctor Service of Australia (RFDS), with Indigenous communities, in isolated towns or sometimes as part of the fly-in fly-out (FIFO) medical services provided by mining companies and other organisations, are known as remote area nurses (RANs). In New Zealand, the term ‘remote’ does not really apply, but rural nursing is common in New Zealand, and the principles and issues are similar to the Australian context. The emphasis of discussion in this chapter is more generally on rural health nurses, with acknowledgement that RANs face similar issues which are exacerbated by community size and composition, environmental challenges, greater geographical isolation and increased difficulty in accessing resources.

There has been an increased emphasis on primary health care (PHC), rather than the traditional focus on acute care service delivery in hospitals evident in rural areas, to better address the inequities in access and outcomes for rural and remote residents (Henderson et al., 2014). However, a number of barriers in relation to funding arrangements, resources and educational opportunities must also be recognised. Lack of access to other health care providers and generalist role rural health nurses necessitate an increased emphasis on promoting health and well-being (Henderson et al., 2014; Mills, Birks & Hegney, 2010). Rural health nurses have a positive effect on both individual outcomes and the health outcomes of entire communities (Winters, 2013).