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Growing up rural I was always tempted to leave my small town and escape to the big smoke. Why not live somewhere more exciting, with more to do and more opportunities: at least that’s what teenage me believed.
Doesn’t everybody dream of growing up and leaving home and having grand adventures?
So, if this was my dream, why did I stay rural? Well, because I ended up loving rural nursing.
Who wrote this Guide?
Proud to be a registered nurse since the start of 2013. Early in my career I became a rural isolated practice (scheduled medicines) registered nurse (RIPRN), with advanced skills in cannulation and venipuncture, suturing and back slabbing. I completed my graduate certificate in emergency nursing, graduate certificate in leadership and management, masters of nurse practitioners and am studying a graduate certificate in orthopedics. As a clinical nurse (emergency and anaesthetics), I built my leadership and management skills as the after-hours facility manager. I even backfilled for a year as a clinical educator and an associate nurse unit manger! My nurse practitioner candidate time was split between my rural hospital with a senior medical officer mentor and our regional referral centre with a nurse practitioner mentor. This experience as it inspired my qualitative research project into nurse practitioner training which will be published late 2025.
It began with two weeks of year ten work experience at my local rural hospital, although at the time I wanted to be a doctor. The hospital allowed me to experience a variety of health care professions.
I am thankful for this as it helped me decide what I wanted to do with my life and gave me an important understanding of the contributions each health care team member makes to a patient’s care.
I experienced what it was like to work in medical imaging (x-ray was all we had back then), the pathology lab, allied health (including occupational therapy, dietetics, speech pathology and physiotherapy) and the emergency department—which I fell in love with.
Work experience had a great impact on me as I saw how nurses and doctors’ roles differed and how they worked together to enhance patient’s outcomes.
The skills these rural nurses had impressed me greatly and changed my idea of what nursing is. They were listening to patients’ chests, doing assessments, applying backslabs, and suturing; things I previously believed were “doctors’ jobs”.
I then realised nurses could do it all. Nurses could assess and manage patients, have advanced skills, monitor patients, advocate for them, comfort them, and improve their health literacy. Nurses can be the whole package.
Fast forward two years to me studying nursing at university. I was on my third placement and was now a bit confused about what nurses “do”.
The things that had attracted me to nursing—the autonomy and advanced clinical skills—were not universally available as I’d believed.
My placements exposed me to a mix of specialities in rural and regional sites. I finally asked a regional nurse why she didn't do the things I’d seen rural nurses do. She replied, “We don’t do that here, that’s a doctor’s job”.
I then found myself questioning my career decision and wondering if nursing was for me or should I have become a doctor?
At the end of my studies, I had applied for and was accepted into three graduate positions. Not really knowing if I was going to remain in nursing, I picked the one at my local rural hospital.
I knew from year 10 work experience that the people there were friendly, and it was the place I first fell in love with nursing, so maybe being there would help me decide my next move.
Turns out, returning to rural nursing was the best decision of my life.
The thing that I love most about rural nursing is the variety. I have spent a lot of my time as the after-hours facility manager, a role which saw me working in the emergency department, birth suite, the operating theatre and the acute medical ward; sometimes all in the one night shift!
In my first year of nursing, we had to rotate through the acute medical ward, the emergency department, and the nursing home. This allowed me to solidify my foundational nursing skills, work on my time management, and provided an opportunity to work out what I liked.
In my second year we were allowed to apply for roles in the operating theatre. I spent a day there observing the different roles, scrub, scout, anaesthetics nurse, recovery nurse, sterilising nurse, and operating theatre manager.
It offered so many opportunities, and many nurses were trained in more than one operating theatre skill. Some of these skills are also transferable to other areas; scrub and scout teach the ability to set up and work within the rules of a sterile field, applicable to catheter insertion and suturing.
Anaesthetics on the other hand supports advanced airway management, monitoring sedated patients, with anatomy and physiology knowledge applicable to emergency department care.
I applied to complete my anaesthetics training and was sent for two weeks to another rural hospital in our district. Upon return I did supernumerary time on scheduled theatre days and on call.
Some call ins during my first year of anaesthetics were real eye openers, they showed me what I was capable of and how much the human body can endure. There’s nothing like the rush of being woken from the depths of sleep to assisting in an intubation twenty minutes later.
Ten years of anaesthetics and on-call taught me a lot of clinical skills and built my confidence, but the scary moments, births, and missed moments of my life (like missing collecting the keys when I bought a house) sometimes left me with mixed feelings. Rural nursing, like any career, is a balancing act. Especially as life gets more complicated over time, especially when new responsibilities arrive like a partner and children.
What I enjoyed most about this time was working across the acute medical ward; the emergency department, and anaesthetics; learning to recognise the transferability of skills to other areas; and learning to manage my burnout.
If I was having a bad run or feeling overwhelmed in one area, I knew it wouldn’t be long until I’d be able to take a break and work in another area.
Later in my second year I was given the opportunity to work in a smaller rural facility. Here the medical officers were based out of the local general practice and were only on call for the hospital.
This inspired me to complete my rural isolated practice (scheduled medicines) registered nurse (RIPRN) training. This was another pivotal moment leading me to choose rural nursing.
I’m not sure what you know about RIPRN nurses, but they use this magical book called the Primary Clinical Care Manual (PCCM), to guide nurses through independent assessment and management of a variety of conditions.
The PCCM is a very useful tool, particularly for junior nurses, for performing a step-by-step assessment of a body system. It also highlights the “red flags” or critical features that may indicate you need to call for help.
The PCCM gives the RIPRN nurse some autonomy as it has health management protocols which allow them to administer and supply a treatment dose of medication.
For example, if a patient presented to the emergency department with symptoms of a urinary tract infection, the RIPRN nurse could use the PCCM as a guide to take a history and conduct an assessment, rule out more sinister causes, give antibiotics for the infection, and provide follow-up care information without contacting a doctor.
RIPRN nurses develop strong assessment skills and advanced pharmacology knowledge over time. However, RIPRN nurses can only utilise their skills in rural facilities where they are credentialled to practice.
My RIPRN qualification gave me a taste of what it was like to be an independent practitioner and use my own clinical skills, knowledge, and judgment to screen for red flags and treat patients from start to finish.
I began to regularly work nights in the emergency department, when the doctor was on call only, and loved the opportunity for autonomous practice—I was hooked.
The other thing about rural hospitals is there isn’t as much artificial segregation between the professions. I am friends with nurses, allied health professionals, hospital administrators, Indigenous health workers, and doctors.
Being friends with the doctors led me to hear how tired they were from constant overnight call ins; this further inspired me to become an even more independent practitioner.
I completed training for cannulation and venepuncture and then developed a love of suturing and back slabs: my favourite skills to perform.
There is nothing like seeing a wound come together after a thorough irrigation and a few well-placed sutures or the pain relief afforded by a carefully applied back slab.
Now, I am an endorsed emergency nurse practitioner. I still dabble in anaesthetics, work in an infusion clinic (due to my advanced skill in central venous access device management) and respond to emergencies in the acute medical ward, renal dialysis unit, and maternity ward.
If I had taken a regional or metropolitan graduate position I probably wouldn’t be where I am now.
I wouldn’t have developed my love of advanced clinical skills and independent practice, and I wouldn’t have become a nurse practitioner.
I wouldn’t be an after-hours facility manager and an acting associate nurse unit manager so early in my career, and my leadership and management skills would be less developed.
Being a rural nurse gives you the opportunity to grow your resume in so many directions, without having to be tied down to a single clinical area.
Working rural gives you the opportunity to fall in love with nursing again and discover what aspect of nursing fits you.
Everyone deserves the opportunity to try different areas, gain new and varied skills, and learn from friendly people from across all the healthcare streams.
So that all sounds pretty good right? I’ve sold you on the hospital aspect, but what about rural life?
It is true that day to day there may be fewer things to do. You may not be able to pop into a boutique, see a concert every week, or get gold-class cinema tickets.
However, there are some major benefits to rural living.
Rural does not mean boring or isolated, just get out and get involved!
If you have kids there is a convenience to being rural, finishing work at 3pm and being able to make it to school pick up by 3:07pm, a variety of playgroups at the local PCYC or library to enable you to meet other parents, and ease of facilitating after school and weekend activities.
I know a few weekends ago I was able to use my lunch break to pop out and watch part of my children’s swimming lessons.
It was amazing being able to be at work but not have the mum guilt associated with missing activities.
Going rural offers opportunity, variety, community, and the chance to discover what kind of nursing suits you.
You can gain new friends and professional mentors, acquire advanced knowledge and skills, and erase your commute.
In my opinion you have nothing to lose, so why not give it a try and see if it inspires you like it did for me?
Good luck on your nursing journey, whether you ultimately become a rural, regional or metropolitan nurse, nursing is a profession that has something for everyone, you just need to discover what kind of nursing sparks joy in you.
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