title: Voices from the bush: remote area nurses prioritise hazards that contribute to violence in their workplace.
abstract: BACKGROUND
  Remote Area Nurses (RANs) in Australia frequently encounter hazards that contribute to violence in the work place. Resources to deal with this problem are limited.
  
  
  METHODS
  Adopting a risk management approach and using the Delphi method, a panel of expert RANs (n=10) from geographically diverse communities across Australia, identified and prioritised hazards that increase the risk of violence to nurses.
  
  
  RESULTS
  This descriptive study found that RANs encounter a wide variety of hazards from a variety of sources. Environmental hazards are complicated by living in remote areas and practicing in different locations. Relationships between the nurse and the community can be complex and lack of experience and organisational support may contribute to an increased risk of violence. Hazards prioritised as 'major' or 'extreme' risks included: clinic maintenance and security features, attending to patients at staff residences, RAN inexperience and lack of knowledge about the community, as well as intoxicated clients with mental health issues. A work culture that accepts verbal abuse as 'part of the job' was identified as a significant organisational risk to RANs. A lack of action from management when hazards are identified by clinic staff and insufficient recognition of the risk of violence by employers were also significant hazards.
  
  
  CONCLUSIONS
  Further consideration of the hazards described in this study following the risk management process, may provide opportunities to reduce the risk of violence towards RANs. Proposed control measures should be developed in consultation with RANs and the remote communities they work in.
authors.affiliation: Edith Cowan University, Perth, Western Australia, Australia. k.mccullough@ecu.edu.au
authors.forename: K M
authors.initials: KM
authors.lastname: McCullough
authors.forename: A M
authors.initials: AM
authors.lastname: Williams
authors.forename: S
authors.initials: S
authors.lastname: Lenthall
mesh_terms: D001315:Australia; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data*; D054521:Cultural Competency; D003697:Delphi Technique; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006303:Health Services, Indigenous / Q000458:organization & administration; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008605:Mental Health Services / Q000592:standards; D009723:Nurse-Patient Relations; D009740:Nursing Staff / Q000523:psychology* / Q000706:statistics & numerical data / Q000600:supply & distribution; D015279:Organizational Culture; D010563:Personnel Turnover; D012308:Risk Management / Q000379:methods / Q000592:standards*; D019035:Rural Health Services / Q000458:organization & administration; D012637:Security Measures; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014754:Violence / Q000517:prevention & control / Q000523:psychology; D000078329:Workforce; D017132:Workplace / Q000523:psychology