Back from the edge: reducing stress among remote area nurses in the Northern Territory

Author: Sue Lenthall

Lenthall, Sue, 2015 Back from the edge: reducing stress among remote area nurses in the Northern Territory, Flinders University, School of Medicine

Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact with the details.


Occupational stress among remote area nurses is an emerging and important issue. Nurses working in very remote areas are the mainstay of health services in these regions. They work in complex and isolated settings that are often cross cultural, and for which they are usually inadequately prepared. The ‘Back from the edge: reducing occupational stress among remote area nurses in the Northern Territory’ study utilised an adapted ‘participatory action research/organisational development’ model to develop and implement occupational stress interventions.

From the considerable data gathered throughout the study, information was obtained that contributes to new knowledge in three main areas. Firstly, the development and attempted implementation of interventions provides a blueprint for action to reduce occupational stress among remote area nurses. The major job demands identified included emotional, the high responsibilities and expectations expected by the community and employers, social issues and the high workload.

The main interventions developed involved ensuring adequate staff, particularly additional Aboriginal staff, improving continuity of staff, and improving orientation and education of remote area nurses. To improve education, the employment of additional educators was seen as necessary by study participants as well as the development of a career structure for remote area nurses with an educational pathway. To improve infrastructure an increase in accommodation and appropriate vehicles were seen as important interventions.

Secondly, there were significant improvements in occupational stress among hospital nurses that did not occur for remote area nurses. The key differences between the two projects were the level of resources, with the hospitals allocated an additional budget of A$9 million due to the commitment by management and the level of political and public pressure. These triggers for change were not present in remote Northern Territory.

Thirdly, the process of developing the intervention and the implementation was evaluated with regard to the factors influencing the success or failure of the participatory action research/organisational development process. While employees were concerned about the issue of occupational stress and demonstrated a commitment to change, there was limited capacity for change within the Northern Territory Department of Health and Families. The study lacked resources and trust between staff and management. This was further complicated by the Northern Territory National Emergency Response?.

The study generated important evidence that will be of use to State, Territory and Commonwealth governments, employers and professionals groups, and will help to reduce occupational stress among remote area nurses and, by doing so, improve the health outcomes for residents of remote Australia.

Keywords: Remote area nurses, occupational stress, job demands /resources, remote health

Subject: Medicine thesis

Thesis type: Doctor of Philosophy
Completed: 2015
School: School of Medicine
Supervisor: John Wakerman