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The recruitment and retention of health professionals in rural Australia is well documented. The COVID-19 pandemic has further exposed the precariousness of human healthcare resources within small rural communities. The external disaster of the COVID-19 outbreak described in this case analysis exacerbated the frail balance of sustaining adequate staffing levels and skill mix, which exposed behaviours of presenteeism within rural healthcare teams. An analysis of the complex of factors that led to the first nosocomial outbreak of COVID-19 within a healthcare environment in Australia demonstrates how rural healthcare environments are ill-equipped to meet the demands of unexpected external disasters. Using the Haddon Matrix to examine the factors that led to this outbreak provides us with the opportunity to learn from the case analysis. Health professional presenteeism contributed to the North West Tasmania COVID-19 outbreak and affected the hospital and health service provision within the region. Recommendations to mitigate risk for future disaster planning in rural healthcare environments include improved infection control strategies and a whole-community approach.

With 2020 being designated the Year of the Nurse and Midwife, it is opportune to acknowledge and recognise the role that nurses undertake in primary care environments. Nurses and midwives play a pivotal role in the delivery of high-quality health care, particularly in geographically challenged areas of Australia, where they may be the only provider of care within their communities. Rural and remote health services require strategic planning to develop and implement solutions responsive to the challenges of rural and remote communities. Maintenance of health services in rural and remote areas is a challenge, crucial to the equity of health outcomes for these communities. Many small communities rely on visiting medical officers to provide the on-call care to facility services, including emergency departments, urgent care centres, acute wards and aged care facilities. It is increasingly difficult to maintain the current rural workforce models, particularly the provision of after-hours ‘on-call’ care necessary in these communities. An alternative model of health care service delivery staffed by nurse practitioners (NP) is one proposed solution. NPs are educated, skilled and proven in their ability to provide an after-hours or on-call service to meet the expectations of rural and remote communities. Achievement of high-quality health care that is cost-efficient, safe and demonstrates improved patient outcomes has been reported in NP-led health care delivery impact evaluations. The value of an NP locum service model is the provision of a transparent, reliable service delivering consistent, equitable and efficient health care to rural and remote communities.

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