Cosgrave Catherine, Maple Myfanwy, Hussain Rafat
Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 49 Graham Street, Shepparton, Vic. 3630, Australia
School of Health, University of New England, Armidale, NSW 2350, Australia
Rural Remote Health. 2018 Sep;18(3):4511. doi: 10.22605/RRH4511. Epub 2018 Sep 3.
Rural health workforce shortages are a global phenomenon. Countries like Australia, with industrialised economies, large land masses and broadly dispersed populations, face unique rural health challenges in providing adequate services and addressing workforce shortages. This article focuses on retention of early-career nursing and allied health professionals working in rural and remote Australia. Some of Australia's most severe and protracted rural workforce shortages, particularly among early-career health professionals, are in public sector community mental health (CMH), a multidisciplinary workforce staffed primarily by nurses and allied health professionals. This study investigated how employment and rural-living factors impacted the turnover intention of early-career, rural-based CMH professionals in their first few years of working.
A constructivist grounded theory methodological approach, primarily guided by the work of Charmaz, was selected for the study. By implication, the choice of a grounded theory approach meant that the research question would be answered through the development of a substantive theory. Twenty-six nursing and allied health professionals working in CMH in rural New South Wales (NSW) for the state health department services participated in in-depth, semi-structured interviews. The study sought to identify the particular life factors - workplace conditions, career-advancement opportunities and social and personal determinants - affecting workers' turnover intention. The substantive grounded theory was developed from an identified core category and basic social process.
The turnover intention theory provides a whole-of-person explanation of turnover intention. It was developed based on an identified core category of professional and personal expectations being met and an identified basic social process of adjusting to change. The theory posits that an individual's decision to stay or leave their job is determined by the meeting of life aspirations, and this relates to the extent of the gap between individuals' professional and personal expectations and the reality of their current employment and rural-living experience. The extent of individuals' professional and personal expectations can be measured by their satisfaction levels. A major finding from the identification of the basic social process was that, in the adjustment stages (initial and continuing), turnover intention was most strongly affected by professional experiences, in particular those relating to the job role, workplace relationships and level of access to continuing professional development. In this stage, personal satisfaction mostly concerned those with limited social connections in the town (ie non-local - newcomers). Having reached the 'having adapted' stage, the major influence on turnover intention shifted to personal satisfaction, and this was strongly impacted by individuals' life stage. By drawing on the turnover intention theory and the basic social process, it is possible to make a risk assessment of individuals' turnover intention. Three levels of risk were identified: highly vulnerable, moderately vulnerable and not very vulnerable.
The study offers a holistic explanation of life factors influencing the turnover intention of early-career health professionals working in public health services in rural NSW. These findings and the turnover intention risk matrix are thought to be suitable for use by Australian public health services and governments, as well as in other highly industrialised countries, to assist in the development of policies and strategies tailored for individual health professionals' work-experience level and life stage. By adopting such a whole-of-person approach, health services and governments will be better positioned to address the life aspirations of rural-based, early-career health professionals and this is likely to assist in the reduction of avoidable turnover.
农村卫生人力短缺是一个全球现象。像澳大利亚这样拥有工业化经济、幅员辽阔且人口分布广泛的国家，在提供充足服务和解决人力短缺问题方面面临着独特的农村卫生挑战。本文聚焦于澳大利亚农村和偏远地区初入职场的护理及专职医疗专业人员的留用情况。澳大利亚一些最严重且长期存在的农村劳动力短缺问题，尤其是在初入职场的卫生专业人员中，出现在公共部门社区心理健康领域（CMH），这是一个主要由护士和专职医疗专业人员组成的多学科劳动力群体。本研究调查了就业和农村生活因素如何影响初入职场、在农村工作的CMH专业人员头几年的离职意向。
本研究选择了一种以建构主义扎根理论方法为主导的研究方法，主要受查马兹的研究影响。这意味着，选择扎根理论方法意味着研究问题将通过发展一种实质性理论来回答。26名在新南威尔士州农村为州卫生部门服务的CMH领域工作的护理和专职医疗专业人员参与了深入的半结构化访谈。该研究旨在确定影响员工离职意向的特定生活因素——工作场所条件、职业发展机会以及社会和个人因素。实质性扎根理论是从一个确定的核心类别和基本社会过程发展而来的。
离职意向理论对离职意向提供了一个全面的解释。它是基于一个确定的核心类别——专业和个人期望得到满足，以及一个确定的基本社会过程——适应变化而发展起来的。该理论认为，个人决定留任或离职取决于生活期望的达成情况，这与个人的专业和个人期望与当前就业及农村生活现实之间的差距程度有关。个人专业和个人期望的程度可以通过他们的满意度水平来衡量。在确定基本社会过程时的一个主要发现是，在调整阶段（初始阶段和持续阶段），离职意向受专业经历影响最大，特别是与工作角色、工作场所关系以及持续专业发展机会相关的经历。在这个阶段，个人满意度主要涉及那些在镇上社会关系有限的人（即非本地人——新来者）。到了“已适应”阶段，对离职意向的主要影响转向个人满意度，而这受到个人生活阶段的强烈影响。通过借鉴离职意向理论和基本社会过程，可以对个人的离职意向进行风险评估。确定了三个风险级别：高度易受影响、中度易受影响和不太易受影响。
该研究对影响新南威尔士州农村公共卫生服务领域初入职场卫生专业人员离职意向的生活因素提供了全面解释。这些发现和离职意向风险矩阵被认为适用于澳大利亚公共卫生服务机构和政府，以及其他高度工业化国家，以协助制定针对个体卫生专业人员工作经验水平和生活阶段的政策和策略。通过采用这种全面的方法，卫生服务机构和政府将更有能力满足农村初入职场卫生专业人员的生活期望，这可能有助于减少可避免的人员流动。
