The second report from the 6th Rural and Remote Health Scientific Symposium focuses on workforce issues and highlights some of the innovative research being undertaken on how to attract and retain a high quality health workforce that meets the needs of rural and remote communities.
Jennifer Doggett writes:
“It’s the workforce, stupid” was a familiar theme of many of the sessions at the 6th Rural and Remote Health Scientific Symposium, with both speakers and delegates stressing the need to put workforce issues at the forefront of efforts to reduce the rural health deficit.
A number of presenters cited a turnover rate of 148 percent for rural nurses in the Northern Territory to highlight the challenges of running health programs with an inadequate and frequently changing workforce.
It was clear from the many presentations on workforce issues that there is no ‘quick fix’ or generic approach to addressing the health care needs of rural communities. What was provided in these presentations, however, was a nuanced understanding of the varied needs of different groups of rural health professionals, some context-dependent approaches to supporting health care providers working in rural and remote areas and sophisticated models of data collection and analysis to support future workforce initiatives.
The need to focus on the whole person when developing retention strategies was emphasised by Dr Cath Cosgrave, who reported on her PhD research on allied health and nursing professionals in rural areas.
The resulting ‘whole of person’ retention strategy she developed is based on her research finding that, regardless of background, young early career professionals are not likely to settle down in any one area and that even young professionals local to rural areas were likely to want to leave at this stage in their lives. She argued that therefore a high turnover in this cohort of the health workforce is inevitable and should be accepted and accommodated rather than challenged.
Cosgrave also stated that her findings suggested the need to redefine what is meant by ‘retention’ of rural health professionals and to set realistic goals that take account of health professionals’ life stages.
Other aspects of her work focussed on the importance of creating positive and supportive rural health care teams which provide health professionals with opportunities to progress their careers while remaining integrated in the community.
The issue of rural clinical placements for medical, nursing and allied health students was discussed by a number of presenters, including Merrilyn Cross, who reported on her research into rural placements in Tasmania.
She described some of the complexities involved in ensuring their success. These included both general issues relating to melding the realities of rural placements with the educational needs of the students and also issues specific to rural Tasmania, such as ensuring student safety when travelling to and from their workplaces in the dark during the short Tasmanian winter days.
A common theme emerging from her consultations with students and providers was the need for longer placements so that students could genuinely integrate into the work of the service and get a feel for the ebbs and flows of rural practice. A comment from the Twitterverse added that as well as ensuring students’ needs are met, it is also important to ask whether rural placements are meeting needs of rural communities.
Rural and remote nurses
As the largest single group of the rural health workforce and, along with Indigenous Health Workers, the entire health workforce in many remote areas, it is clearly important to understand the factors that attract and support nurses in rural and remote areas.
Associate Professor Sue Lenthall reported on consultations she undertook with remote area nurses, which are documented in the Back from the Edge report. She outlined the key findings that nurses working in very remote areas experienced high levels of psychological distress and moderate levels of emotional exhaustion. Despite this, she reported that they also had high levels of engagement and felt strongly committed to their work.
One of the key findings of her research was that many remote nurses found their job demands to be unrealistic and reported that they were operating in an environment with high emotional demands and inadequate resources. The main cause of stress was reported to be the feeling that they could not meet their responsibilities and issues relating to social isolation. Also noted as significant causes of stress were poor relationships with management and safety and violence concerns.
Lenthall noted that one of the challenges in undertaking research on rural health professionals is that their attitudes and honesty about the challenges of their roles can create conflict with managers of the health service in which they work. This occurred in her research when she felt that the clear concerns of the remote nurses she interviewed about their safety were not being acknowledged by management on the basis that the proposed solutions, such as sending drivers to escort nurses on visits, were ‘too expensive’ and unlikely to be funded.
This may be due to a reluctance on the part of managers to admit that there might be problems within a rural health service, as they are worried it may reflect on the public view of rural communities. However, Lenthall was keen to emphasise that when managers fail to acknowledge the attitudes of health care workers they can feel ignored and under-valued.
The need for a more sophisticated approach to workforce modelling than crude ‘nurse per head of population’ ratios was suggested by Professor Amanda Kenny. She explained the need to look at community needs and the type of work being done to determine the number and type of nurses needed to fulfil these needs.
In another session, Data Management Project Officer Mr Gary Walker outlined work he is undertaking to develop a single source of linked data on medical graduates called GradTrack. This resource captures data from a range of different sources, cleans and scales the data so it is compatible and stores in a single centralised resource so that the data is accessible to all.
One of the strengths of GradTrack is that it can link data from high school through to post-university career and track where medical graduates come from and go to study and work over time.
Rural allied health
SARRAH President Rob Curry articulated the specific challenges facing the allied health workforce in rural and remote areas. He explained that the lack of a funding base to support allied workforce in rural areas made it very difficult to increase workforce numbers.
He advocated for better data on efficacy for allied health professions so that the cost benefit for government was clear. He also made the point that there cannot be a culturally safe health system without Indigenous people being part of the health workforce.
Dr Chris Bourke also explained the importance of workforce issues in closing the gap, arguing that better engagement with the Indigenous health workforce is crucial. One example he gave of unanswered questions in this area is that there are 6,000 Indigenous people registered as nurses, and only one-third of these are employed. Finding out why Indigenous nurses are not finding employment is an important way to address cultural safety and ultimately close the health and life expectancy gap between Indigenous and non-Indigenous Australians.