A bitter pill to swallow: registered nurses and medicines regulation in remote Australia.

INTRODUCTION: Access to essential medicines is a human right and an objective of the National Medicines Policy in Australia. Health workforce distribution characteristics in remote Australia implies registered nurses (RNs) may find themselves responsible for a broader range of activities in the medication management cycle than they would be elsewhere in the nation. The regulation of health professionals and their training requirements provides essential but complex protections for the public. These protections include the National Registration and Accreditation Scheme for health practitioners and the Australian Health Practitioner Regulation Agency. Other levels of control or regulation are also exerted over health professionals via mechanisms such as salaries and funding arrangements, insurance requirements, admitting rights to healthcare facilities, and legislation controlling the use of medicines and therapeutic devices. This study aimed to examine national legislation and regulations concerning the use of medications from a nursing perspective, focusing on the context of health service delivery in remote areas. METHODS: Australian state and territory medicines legislation and regulations was interrogated for answers to the questions 'Can an RN prescribe a medication?', 'Can an RN dispense a medication?', 'Can an RN supply or issue a medication?' and 'Can an RN administer a medication?' RESULTS: Inconsistencies were identified nationally in the names and general structure of the legislation, the location of information relating to authorised roles with regards to medications and key terms used to describe medicines and the elements of the medication management cycle. Administrations of Schedule 4 and 8 medicine according to an order from an authorised prescriber are the only nationally consistent roles RNs are authorised to undertake with regards to medicines. Twenty-eight variations were identified with regards to additional authorisations for RNs. CONCLUSION: RNs make up more than half of the registered Australian health professional workforce and are the most consistently distributed across the nation, yet their legislated responsibilities in relation to working with medicines are inconsistent. Given the inconsistencies, RNs providing health care in remote Australia may be unable to undertake aspects of the medication management cycle that their work environment demands in the best interest of their patients and absence of other healthcare providers. The lack of legislative consistency nationally for medicines in Australia is likely to impede timely access to medications for patients. Regulatory inconsistencies may also result in RNs working well below or beyond their legal scope of practice, thereby creating clinical and workforce risks. Such risks are a significant matter for remote health service provision. Resolving these issues will require a collaborative national approach with consideration given to how the health workforce is distributed, current nursing responsibilities and relevant service delivery models for remote Australia.

Making the best of the early years: the Tambellup way.

INTRODUCTION: Tambellup is a small rural town in the Great Southern region of Western Australia (WA), approximately 300 km south-east of state capital Perth. Tambellup has a much higher Aboriginal population than the national average and achieved very positive results for year one children in 2007 regional Australian Early Development Index testing. In 2009 the Great Southern GP Network (which has a facilitating role in providing early intervention strategies to families with young children at risk of disadvantage) requested that public health staff at Edith Cowan University, Perth, WA undertake an exploratory study to discover the factors protective of children's development in Tambellup. This article describes the subsequent research and its findings. METHODS: This 2009 qualitative study interviewed both adult members of the local Aboriginal community (Noongar people; n = 23), and non-Aboriginal leaders from a cross-section of organisations, services and the community (n = 14) to determine what made growing up in Tambellup a positive experience. Aboriginal participants were introduced to the researchers by a local cultural consultant. Non-Aboriginal participants were initially sourced from a list provided by the GSGPN and extended by asking those listed to identify other appropriate contacts. Face-to-face interviews were carried out with Aboriginal participants and telephone interviews were undertaken with non-Aboriginal participants. All interviews were conducted using a standard schedule of questions as a guide, supplemented by clarifying and broadening questions from research team members. Data were analysed in a multi-stage process of collation, extraction of common themes and verification of themes with study participants and other stakeholders. Findings were presented to local Aboriginal leaders at a community meeting and a final report was prepared and circulated to community members. RESULTS: There was substantial evidence of widespread trust and positive relationships in this close-knit community, where adults looked out for and supported both their own and others' children. The primary school played a key role in supporting children's development even before children started school. Good relations generally existed between Aboriginal and non-Aboriginal residents, contributing to the stability of the population and providing many role models in successful cross-cultural relationships. CONCLUSION: Aboriginal people in Tambellup played significant but often under-recognised roles in promoting child and youth wellbeing in the community. The community had the capacity to respond to local needs and challenges. Communication channels were effective and there was a sense of belonging, pride and 'connectedness' in the community that promoted and supported a safe environment for children. High quality services and staff (eg school and community health centre) reinforced children's developmental opportunities. The results suggest that small rural communities offer significant and untapped resources for enhancing the health and wellbeing of children in the critical early years of life.