Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Summary
To develop the Rural and Remote Generalist (RRG) Registered Nurse (RN) Pathway, as a clear and valid career pathway for RNs interested in pursuing rural and remote generalist practice. The RRGRN pathway will build a contextually relevant skilled workforce through developing practice capability.
Dates: September 2024 - June 2025
Implementation sites: South West Hospital and Health Service
Partnerships: NWHHH, CWHHS, TCHHS, ORRH, JCU, CQU, SQU, USC
This project was presented as a Poster at CEQ Showcase 2026 (PDF, 4.8MB).
Aim
To offer a flexible, scaffolded training pathway with varying entry and exit points accommodating RNs regardless of expertise and years of experience, adding value to rural and remote nursing through professional recognition of the skills, knowledge, and scholarship required to practice.
Outcomes
- Standardised education expectations, processes and flexible training pathway options for RNs, educators, and their managers across the rural and remote corridor, and for other Modified Monash Model (MMM) category 4 - 7 locations with Clinical Service Capability Framework (CSCF) level 1, 2, and 3 facilities through the RRGRN Toolkit and conceptual model.
- A tangible, flexible training pathway which can accommodate individual RNs, organisations and communities' needs, ensuring contextually relevant knowledge, skill and attitudinal development required to contribute to consciously constructing a contextually relevant prepared workforce with the necessary capacity and capability to fill the organisations and communities' clinical demand.
Background
Ensuring consumer-centric healthcare access to rural and remote Queenslanders through a well-trained, engaged, and capable healthcare workforce are two of Queensland Health's strategic priorities. Nurses make up the largest part of the healthcare workforce in rural areas and are often the predominant providers of healthcare in rural and remote areas (Whiteing et al. 2022; Wakerman et al. 2019; Simth et al. 2020; McCullough et al. 2022; Rogers et al. 2025).
Whilst all RNs are trained as generalists, rural and remote RN practice delivers care to populations with a significantly higher burden of disease, lower life expectancy, and experience barriers to accessing health services not experienced in urban areas (AIWH, 2025), with significantly less resources than their metropolitan colleagues (Smith et al. 2020; McCullough et al. 2020; Whiteing et al. 2022), and pre-registration nursing training does not prepare RNs for rural and remote practice (Rogers et al. 2025).
RNs are a critical workforce in rural and remote practice settings and due to the demographic of the consumers they serve and the isolation, require broader knowledge, skills and capability than their metropolitan peers, and are often referred to as 'specialist generalists', "˜rural generalists', "˜expert generalists' and 'remote area nurses (RANs)' (Rogers et al. 2025; McCullough et al. 2022; Muirhead & Birks 2019; Smith et al. 2019). The broader knowledge, skills, capability and scope of practice is driven by the clinical demand in the rural and remote practice context, and the reduced access to medical, paramedics, public health, health promotion, and allied health specialists resulting in medical, paramedicine, and allied health substitution, local public health and health promotion activities in the absence of specialist allocated providers, in addition to non-clinical tasks such as reception and administration duties, cleaning, property, equipment and vehicle maintenance (McCullough et al. 2022; Muirhead & Birks, 2019; Whiteing, 2021; McCullough et al. 2020).
Whilst many rural and remote settings report comprehensive orientation and onboarding programs, clinical practice guidance tools such as the PCCM, CCM and State-wide clinical guidelines, there is no standardised consistent training or transition program to adequately prepare RNs working in rural and remote practice contexts (Rogers et al. 2025). Therefore, it is critical that rural and remote RNs are supported to develop the necessary knowledge, skills, and capabilities required to deliver comprehensive, safe, reliable, high-quality healthcare in rural, remote and isolated contexts, whilst meeting the diverse needs of rural, remote and isolated communities.
Identified gaps that drove this project were:
- Lack of RRGRN training pathway, considering the success of the Allied Health and Medical RG pathways.
- No agreed titles, definitions, or consensus of a 'Rural and Remote Generalist RN' and 'Advanced Rural and Remote Generalist RN' and the necessary training to support development of such and align with Australian and New Zealand's Council of Chief Nurses and Midwifery Officers (ANZCCNMO) specialist-generalist practice continuum (CNMOA, 2020).
- Current language of 'rural nurse', 'remote area nurse', 'RAN' may not meet organisational needs in the future.
Methods
Collaborative project with subject matter experts from rural and remote practice contexts, specifically the four rural and remote HHSs education lead, ORRH, higher education partners from regional academic institution that predominately feed nursing staff into rural and remote areas, sponsored by OCNO, directed by Director of Nursing Professional Capability, managed by the Nursing Director, Education, South West HHS and led by a RIPRN/Midwife, working as a Nurse Educator, Principal Project Officer, employed by South West HHS.
Evidence was scoped from the literature, from which was shared and discussed with subject matter experts (SME) included in the SME reference group. Consultation with this cohort also identified current gaps to support RNs to transition to, and practice in rural and remote practice contexts. The fortnightly consultation, gap identification and discussion of potential solutions with the SME reference group, informed summation of role and skill requirements, pathway development, associated tools, and conceptual model development for feedback. Due to the professional rapport and the gap in evidence identified, a sub-project commenced, with support from OCNO, to conduct a collaborative scoping review from most members of the SME reference group, including industry and academic partners for publication to add to the rural and remote health workforce literature.
Consultation was also conducted with the Nursing and Midwifery Directors of Education Forum, the Executive Directors of Nursing and Midwifery Forum and the Rural and Remote Health Services Chief Executive Forum to share the artefacts and outcomes of the project.
Discussion
Lessons learned were to involve the project officer in all areas of communication with the stakeholders for improved continuity of project messaging, and for the project officer to have greater clarity of the front-end communications with stakeholders and to understand their value of project. From surveying the SME reference group, a strong majority believe that the RRGRN pathway offers individuals and managers greater clarity for career and succession planning.
The SME reference group offered diverse, practice-based perspectives of the many rural and remote contexts which exist, contributing to the robustness of the feedback received on artefacts produced throughout the project. Higher education partners from regional areas were open to working collaboratively with industry on this specialist workforce development project, with strong engagement displayed for the duration of the project. The engagement and collaboration contributed to identifying areas for development and research for both industry, higher education partners and the nursing profession nationally. Robust engagement was displayed by the four rural and remote HHSs, with the agreed end goal to have local access to a digitally housed, accessible, and clear career pathway for contextually relevant training and development of their current and future staff.
Participants agreed that an admirable amount of work has been produced in the short timeframe available, creating a strong foundation and clear direction for implementation of the RRGRN pathway and the future work to enable such.
Having an administration officer (AO) to support documentation of meeting agendas, minutes and document development and control would have greatly benefited the project. Administration support was supplied via South West HHS (SWHHS) Learning and Development team, with RRGRN Toolkit and supporting documents formatting and design outsourced to an external party. Additional to project costs being funded through SWHHS Learning and Development. SWHHS Project Manager contributed project time within current workload in comparison to other projects where both project manager and officer may have been funded. Future projects that may continue this work are encouraged to consider the fundamental need of specialised AO support for design, formatting and digitisation of resources developed, as these skills are often specialised in nature and not pragmatically efficient for a nursing officer skilled in rural and remote practice to develop such skills across the life of a project.
The RRGRN Toolkit and pathway could easily be implemented across the state, with governance for coordination and implementation collaboratively shared between OCNO and ORRH. Ideally the RRGRN Toolkit will be in a digitised format with content tailored into two versions to meet specific needs of nursing managers, leaders and educators and RRGRN participants who choose to navigate their rural and remote nursing professional development venture.
Long term objective could be to have funded RRGRN transition positions in all MMM4 ' 7 HHS sites, similar to medical and allied health rural generalist positions, supporting participants to complete a Rural and Remote Generalist Registered Nurse titled vocational training pathway, which is collaborative, flexible, and interwoven with an Australian Nursing and Midwifery Accreditation Council (ANMAC) accredited postgraduate program, inclusive of RN prescribing, with protected, funded time for training, and professional titling.
Refrences
Australian Institute of Health and Welfare (AIWH). (2025, Nov 20). Rural and remote health. Retrieved February 26, 2026, from https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health
Department of Health. (2025, Jun 30). Strategic Plan 2025 ' 2029. Retrieved on February 26, 2026, from https://www.health.gov.au/resources/publications/advanced-nursing-practice-guidelines-for-the-australian-context?language=en
Chief Nursing & Midwifery Offers Australia. (2020, Oct 20). Advanced nursing practice ' guidelines for the Australian context. Department of Health, Disability and Ageing. Retrieved February 26, 2026, https://www.health.gov.au/resources/publications/advanced-nursing-practice-guidelines-for-the-australian-context?language=en
McCullough, K. Whitehead, L. Bayes, S. Williams, A. & Cope, V. (2020). The delivery of Primary Health Care in remote communities: A Grounded Theory study of the perspectives of nurses. International Journal of Nursing Studies, 102, 103474. https://doi.org/10.1016/j.ijnurstu.2019.103474
McCullough, K. Bayes, S. Whitehead, L. Williams, A. & Cope, V. (2022). Nursing in a different work: Remote area nursing as a specialist-generalist practice area. Australian Journal of Rural Health, 30, 5, 570-581. https://doi.org/10.1111/ajr.12899
Muirhead, S. & Birks, M. (2019). Roles of rural and remote registered nurses in Australia: an integrative review. Australian Journal of Advanced Nursing, 37, 1, 21-33. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=ccm&AN=141839372&site=eds-live
Rogers, D. Calleja, P. Byrne, A-L. & Sahay, A. (2025). Exploring the Role and Skill Requirements of Registered Nurses Working in Rural and Remote Areas: A Scoping Review. Journal of Clinical Nursing, 34, 8, 3051-3071. https://doi.org/10.1111/jocn.17689
Smith, S. Sim, J. & Halcomb, E. (2018). Nurses' experiences of working in rural hospital: An integrative review. Journal of Nursing Management, 27, 3, 482-490. https://doi.org/10.1111/jonm.12716
Smith, S. Lapkin, S. Sim, J. & Halcomb, E. (2020). Nursing care left undone, practice environment and perceived quality care in small rural hospitals. Journal of Nursing Management, 27, 3, 482-490. https://doi.org/10.1111/jonm.12716
Wakerman, J. Humphreys, J. Russell, D. Guthridge, S. Bourke, L. Dunbar, T. Zhao, Y. Ramjan, M. Murakami-Gold, L. & Jones, M.P. (2019). Remote health workforce turnover and retention: what are the policy and practice priorities? Human Resources for Health, 17, 1, 99. https://doi.org/10.1186/s12960-019-0432-y
Whiteing, N. Barr, J. & Rossi, D.M. (2021). The practice of rural and remote nurses in Australia: A case study. Journal of Clinical Nursing, 31, 1502-1518. https://doi.org/10.1111/jocn.16002
Key contact
Frances Calleja
Nurse Educator
South West Hospital and Health Service