We chat with Victoria Carr, a senior ED nurse who went from Victoria to the Northern Territory and got addicted to Rural and Remote nursing. If you’ve ever thought of Rural and Remote nursing then you MUST READ on.

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My name is Victoria Carr and I have been a nurse for over 10 years with most of my career in emergency nursing. I have been R&R nursing since 2018 and continue this pathway.  

A spark of curiosity for the outback

I first started as a graduate nurse in metropolitan Victoria within busy medical and surgical wards where I consolidated fundamental nursing skills before progressing into emergency nursing.

The emergency department is where I have remained, thrived, and loved! After my graduate nurse program, I was set on applying for the emergency transition course, however a lap of Australia in 2012 trumped that idea. Off I set in a caravan as a young vivacious 22-year-old fresh out of my graduate nurse program into the unknown.

When I arrived in Perth, I was able to join a nursing agency, working shifts in just about every hospital across the city and loved the experience of a different ward every day. I kept traveling and ended up in Darwin and joined another nursing agency. Before I knew it, I was working at The Royal Darwin (RDH) in the ED for the first time ever, just to “give it a go.”

It was working there that sparked my curiosity of becoming an ED nurse as I enjoyed the acuity and soon realised that I wanted to pursue my career in this direction. When I returned home to Victoria, I eventually secured a permanent job in ED and was supported through my learning by the education team. I then returned to the RDH, that then became home for three years.

My emergency experience was further facilitated, and I achieved my post graduate certificate in emergency nursing. I loved the busy chaotic environment and high acuity presentations at RDH and caring for our indigenous population who are so integral to this country! I did eventually resign as I was seeking change, travel and the R&R nursing experience, this time feeling prepared!

I joined an agency and completed contracts within the Pilbara and the Wheatbelt – both unique and beautiful places to live and work! I found myself back in Perth again, however I soon realised that the metro life isn’t really for me, so I headed up north to the Kimberley where Kununurra became home for over 2 years! 

I felt like I was a local living and working there and I believe that is the most rewarding aspect of R&R nursing because you know the patients that present to you, and they know you too! There is this mutual respect, companionship and connection between you and the community members, it’s a beautiful and rewarding thing!

Also, the good mates you make along the way are something special as you are bonded by the unique R&R experiences that you share! I soon progressed to Clinical Nurse in emergency and had the opportunity to join the education team, teaching nursing staff basic life support, adult, and paediatric advanced life support.

I am passionate about nursing education so that we can provide best practice and up to date safe nursing care delivery to all patients whilst also empowering nurses! It’s a very rewarding role to be able to teach staff and observe them in the workplace as highly skilled, competent, and confident nurses that they are!

I’m currently travelling WA again and working towards my RAN (remote area nurse) certificate to continue this R&R nursing experience. I have since completed contracts within the Goldfields and Midwest regions now and I endeavour to continue to explore further R&R nursing opportunities.

I am also in the process of completing my cert IV in training and assessment to further my skills in nursing education and become a first aid trainer for the wider community! My biggest advice to all the ambitious young nurses out there would be to keep setting achievable goals – you will get there, I promise!

What inspired you to go R&R? 

There were many motives that inspired me to do R&R nursing, firstly the attraction of being able to travel and work, a “travel nurse” ideology! I travelled Australia in a caravan 10 years ago as a junior nurse with the intention of a working holiday! I was nursing within the city hospitals as it was all I knew, but I soon realised what opportunities were out there in the world of R&R nursing on my travels.

I felt as though I didn’t have the experience to be in R&R nursing and never pursued going R&R but I wondered what it would be like. On return home from my travels to Victoria, my mind set was then focused on becoming an emergency nurse as it seemed to be the most versatile nursing role to be able to fulfil this travel nurse R&R lifestyle.

After years of working in busy metro hospitals and acquiring core emergency nursing skills, I was feeling burnt out and even unsure if nursing was for me anymore. I soon realised I needed to make a change and that the travel nurse lifestyle seemed more appealing than ever, so I gave it a crack!

I was seeking opportunities to work in smaller settings within close knit communities and slower paced environments with different challenges. Four years on from then I’m still going, and I continue to seek new nursing experiences!  

 What are things you wish you knew before you started R&R?

How completely different in every aspect it really is from the metro hospitals. That when you are in a critical situation – you and your colleagues are it! No backup teams no MET call teams, no specialists or ICU! The escalation process is completely different and just knowing that pathway – how and when to activate it is so important. Accessing emergency telehealth service (ETS) is game changer and a real asset to the R&R setting; use it to your advantage!

It can feel very isolating working in some places so having your down time and being involved in recreational activities to keep yourself occupied and engaged is important to maintain your mental health! So, bringing your much-loved hobbies or a project or some study material is a good idea!

What shocked you the most? 

Lack of resources and I mean, all resources! No Doctor, minimal nursing staff, no orderlies, no theatre, no path lab, no security guards, and no bloody idea what I was doing! However, it is something you adapt to very quickly and adjust accordingly. The staff in these places amaze me because they have been doing it the R&R way for years and years and have the utmost knowledge of the community and the facility; they are the greatest resource you have at hand.

What are some memorable moments you’ve had? 

I recall being on night shift some years ago and one of my regular patients came knocking at the ambulance door. I knew who it was immediately, 2am on a Thursday night intoxicated and experiencing some non-life-threatening mental health issues. Pouring her heart out to me about the hardships she has lived through, a melodramatic performance was all part of the storytelling and she would always have herself laughing and all of us too of course. She was quite the character!

Requesting cigarettes which she knows the nursing staff don’t have, but being familiar with this individual, I knew Nicorette would be the de-escalating and therapeutic treatment she needed. So together, we went searching for “bumpers” at the front of the hospital which is a common practice by many; it is basically finding second-hand cigarettes with a little left to give.

As my colleagues watched us on the CCTV out the front, I couldn’t believe my luck, I had found a full cigarette! I picked it up gleaming and said, “look what I have found for you!”

Her face lit up with immediate joy and her smile was impressive with the response “Oh Thank you sister!!” so we sat on the bench at the front of the hospital and continued our chat for some time under the full moon while she puffed away, I could see her feeling more at ease. The hospital was out of sandwiches, but I managed to find an orange in my bag and cut it up for her to eat and we continued to engage in conversation about her life.

It was a really nice moment with this patient, who is a remarkable indigenous woman. She was very happy with my treatment plan of a cigarette and an orange and made her way back to her camp, a fond moment with her that I will never forget.

After a stint of 4-night shifts at a quiet Pilbara hospital, myself and the other nurse decided that we deserved a cooked breakfast on our last night shift! There were no patients within the hospital so, at 5am we whipped up some pancakes with ice cream and maple syrup and sat at the back of the hospital on the veranda.

They were very much deserved and enjoyed as we watched the sunrise over that red Pilbara dirt. It was a spectacular sunrise in a beautiful location within a beautiful community, and I felt extremely lucky to be exactly where I was in that moment. I will never forget that sunrise I experienced on that morning in such a peaceful place of work.

It’s not all sunshine and good times in the R&R world.

Like in all nursing roles you are struck with grief and sadness as part of the job. I was working in an indigenous community where I was caring for an elder who was in end-of-life care after suffering a stroke. I cared for him in ED where he was intubated and due to poor prognosis, he was palliated.

As family needed to travel from near and far to say their goodbyes to their well respected elder, the patient was transferred to the ward on the ventilator, and I continued to care for him during his final hours. As I made this gentleman comfortable and cared for, his family were in and out throughout the day to say their final goodbyes and I answered their many questions.

The Doctor and I, with the consent of the family extubated him and a peaceful passing followed surrounded by his loved ones whilst we offered our support. It’s nearly impossible to put a halt on your emotions during these moments and soon enough I was grabbing the tissues as I witnessed the family grieve. The passing away of an indigenous community member is powerful as it unites them all as a culture and the normality of grief is palpable.

The corridors were soon filled with whaling, and first nations people came in by the dozen to express the grief of their great loss. I don’t think I stopped crying until I got home. I felt so out of place and impractical during their mourning however I was there as their nurse who answered all their questions and passed around the tissues. As I prepared his body, I looked out the window, I noticed the frangipani tree in full bloom and had a strong desire to pick one and bring it to him.

When the family came back to visit his body again for the final time, they were pleased with the frangipani laid on his chest. I am forever grateful to have had the privilege to care for our first nations people and experience their culture.

Top 5 pieces of advice for a nurse going out first time rural/remote? 

  1. Be prepared to the best of your ability by being up to date with current knowledge and skills as you never know when you will be faced with a critical situation with limited resources
  • Be open minded to the fact that many R&R facilities operate very differently to the metro hospitals and each one is unique within their establishment
  • Be flexible and adaptable to the R&R settling and adjust accordingly, you may be expected to jump in the ambulance for retrieval or call the ETS Doctor and provide a comprehensive assessment and hand over
  • Be involved in the community in whatever way you can – joining a local sporting club, art classes, social nights and even the going to the pub! Get to know the community that you’re in and you will thrive
  • Be willing to get out of your comfort zone and give it a go because if you don’t go, you won’t grow, and you will never know!

Any tips on choosing an employer/agency etc? 

There are many options out there for employment in R&R, my biggest advice would be to trust word of mouth! Talk to other nursing staff who have worked R&R as they are always happy to share their experiences; positive or negative. It gives you an idea of what facilities are like, the resources on site and the support available and what agencies trump others!

There is always the option to join one of the many agencies and word of mouth is the best way to find out who to join with and where to go. Of course, you can apply for short-term or long-term contacts directly through the hospitals if you know exactly where you want to go; then contact the hospital directly!