Warburton Jeni, Moore Melissa L, Clune Samantha J, Hodgkin Suzanne P
John Richards Initiative, La Trobe University Albury-Wodonga Campus, Wodonga, Victoria, Australia.
La Trobe Rural Health School, La Trobe University Albury-Wodonga Campus, Wodonga, Victoria, Australia.
Rural Remote Health. 2014;14(3):2721. Epub 2014 Aug 27.
Workforce shortages in Australia's healthcare system, particularly across rural areas, are well documented. Future projections suggest that as the healthcare workforce ages and retires, there is an urgent need for strategies to retain older skilled employees. Very few qualitative studies, with theoretical underpinning, have focused on the retention of older rural nurses and allied healthcare workers. This study aimed to address these gaps in research knowledge.
This qualitative study is phase 2 of a large mixed-methods study to determine the factors that impact on the retention of older rural healthcare workers across northern Victoria, Australia. The initial phase, drawing on the effort-reward imbalance model found high levels of imbalance across a large sample of this population. The present study builds on these findings to explore in more depth the organisational (extrinsic) and individual/social (intrinsic) factors associated with retention. A purposeful stratified sample was drawn from participants at the survey phase (phase 1) and invited to take part in a semistructured telephone interview. A diverse group of 17 rural healthcare workers (nurses and allied health) aged 55 years or more, employed in the north Victorian public sector, were interviewed. The data were transcribed and later analysed thematically and inductively.
Data were categorised into extrinsic and intrinsic factors that influenced their decisions to remain in their roles or leave employment. The main extrinsic factors included feeling valued by the organisation, workload pressures, feeling valued by clients, collegial support, work flexibility, and a lack of options. The main intrinsic factors included intention to retire, family influences, work enjoyment, financial influences, health, sense of self, and social input. Given the noted imbalance between (high) effort and (low) reward among participants overall, strategies were identified for improving this balance, and in turn, the retention of older rural healthcare workers.
Study outcomes provide important insight into factors that impact on the retention of older rural healthcare workers, and, importantly, the imbalance in effort and reward participants experience in their current workplace. Use of a theoretical approach, and a two-stage methodology, enables a deeper understanding of these factors and the strategies needed to address them. Further research is now needed to test the effectiveness of these strategies in the older rural healthcare workforce.
澳大利亚医疗系统存在劳动力短缺问题，尤其是在农村地区，这已被充分记录。未来预测表明，随着医疗劳动力老龄化和退休，迫切需要制定策略来留住年长的熟练员工。很少有基于理论基础的定性研究关注年长农村护士和辅助医疗工作者的留用情况。本研究旨在填补这些研究知识空白。
本定性研究是一项大型混合方法研究的第二阶段，该研究旨在确定影响澳大利亚维多利亚州北部年长农村医疗工作者留用的因素。第一阶段，借鉴努力 - 回报失衡模型，发现该人群的大量样本中存在高度失衡情况。本研究基于这些发现，更深入地探讨与留用相关的组织（外在）和个人/社会（内在）因素。从调查阶段（第一阶段）的参与者中抽取了一个有目的的分层样本，并邀请他们参加半结构化电话访谈。对17名年龄在55岁及以上、受雇于维多利亚州北部公共部门的农村医疗工作者（护士和辅助医疗人员）进行了访谈。数据被转录，随后进行了主题分析和归纳分析。
数据被归类为影响他们决定留任或离职的外在和内在因素。主要外在因素包括感受到组织的重视、工作量压力、受到客户的重视、同事支持、工作灵活性以及缺乏其他选择。主要内在因素包括退休意愿、家庭影响、工作乐趣、经济影响、健康、自我意识和社会投入。鉴于总体参与者中（高）努力与（低）回报之间存在明显失衡，确定了改善这种平衡的策略，进而提高年长农村医疗工作者的留用率。
研究结果为影响年长农村医疗工作者留用率的因素提供了重要见解，重要的是，还揭示了参与者在当前工作场所所经历的努力与回报失衡情况。采用理论方法和两阶段方法，能够更深入地理解这些因素以及解决这些因素所需的策略。现在需要进一步研究来测试这些策略在年长农村医疗劳动力中的有效性。
