Remote area nursing in Australia : an ethnography of practice, identity, and sustainability : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Sociology at Massey University, Palmerston North, New Zealand

Abstract

This thesis examines how Remote Area Nurses (RANs) working in very remote Indigenous communities sustain their roles, and why some remain while others reach a point of departure. Rather than positioning remote nursing as primarily clinical or logistical work, the study centres the relational, emotional, and symbolic dimensions of practice in settings shaped by isolation, workforce instability, historical trauma, and uneven organisational support. Drawing on symbolic interactionism alongside the Job Demands–Resources model, the research examines how Remote Area Nurses construct professional identity, negotiate responsibility, and make sense of demanding work within relational and organisational contexts. Using qualitative ethnographic methods, including semi-structured interviews, participant observation, reflective field diaries, and long-term embedded engagement, the study foregrounds lived experience as both empirical material and analytical lens. Findings suggest that sustainability in remote nursing emerges from the ongoing interaction among structural pressures, relational experiences, and the meanings nurses attach to their work. Demands including isolation, intercultural negotiation, distance management, staffing instability, and social strain shape everyday practice, while sustaining resources such as autonomy, altruism, role diversity, cultural engagement, and meaning-making support continued engagement. The thesis argues that sustainability cannot be explained through workload or individual resilience alone. Instead, it develops through processes of interpretation and identity negotiation, particularly where organisational supports remain inconsistent, and nurses draw on symbolic resources to sustain engagement. By integrating lived experience with theoretical analysis, this research contributes to understandings of workforce sustainability, culturally situated care, and the relational realities of practising at the edge of the healthcare system.