An explanation of turnover intention among early-career nursing and allied health professionals working in rural and remote Australia - findings from a grounded theory study
An explanation of turnover intention among early-career nursing and allied health professionals working in rural and remote Australia - findings from a grounded theory study
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DOI：
10.22605/rrh4511
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发表时间：
2018-01-01
影响因子：
2.1
通讯作者：
Hussain, Rafat
中科院分区：
文献类型：
--
作者：
Cosgrave, Catherine;Maple, Myfanwy;Hussain, Rafat
导言：农村卫生人力短缺是一个全球性的现象。像澳大利亚这样的国家，经济发达，土地面积大，人口分散，在提供足够的服务和解决劳动力短缺问题上面临着独特的农村卫生挑战。这篇文章着重于留住在澳大利亚农村和偏远地区工作的早期职业护理和专职卫生专业人员。澳大利亚一些最严重和持续时间最长的农村劳动力短缺，特别是在职业生涯早期的卫生专业人员中，出现在公共部门社区精神卫生(CMH)，这是一种主要由护士和专职卫生专业人员组成的多学科劳动力队伍。本研究以Charmaz的工作为指导，采用建构主义的扎根理论方法论方法，研究了就业和农村生活因素对职业生涯早期、农村地区的CMH专业人员离职倾向的影响。言下之意，选择扎根的理论方法意味着将通过发展实质性理论来回答研究问题。26名在新南威尔士州农村CMH为州卫生部门服务的护理和专职卫生专业人员参加了深入的、半结构化的访谈。这项研究试图找出影响员工离职意愿的特定生活因素--工作场所条件、职业发展机会以及社会和个人决定因素。实质扎根理论是从一个确定的核心范畴和基本的社会过程发展而来的。结果：离职意向理论提供了对离职意向的全人解释。它是根据所确定的满足专业和个人期望的核心类别以及所确定的适应变化的基本社会进程而制定的。该理论认为，个人的去留决定取决于个人对生活期望的满足，这与个人的职业和个人期望与他们目前的就业和农村生活经历之间的差距有关。个人对职业和个人期望的程度可以通过他们的满意程度来衡量。确定基本社会过程的一个主要发现是，在适应阶段(初始阶段和持续阶段)，离职意向受到专业经验的影响最大，特别是与工作角色、工作场所关系和获得继续专业发展的程度有关的经验。在这一阶段，个人满足感主要涉及那些在城镇中社会关系有限的人(即非本地新来的人)。在达到适应阶段后，对离职意愿的主要影响转移到个人满意度上，而个人的人生阶段对离职意愿的影响更大。借鉴离职意向理论和基本社会过程，可以对个体的离职意向进行风险评估。结论：本研究全面解释了影响新南威尔士州农村公共卫生服务从业人员离职意向的生活因素。这些调查结果和离职意向风险矩阵被认为适合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使用，以帮助制定针对个别卫生专业人员的工作经验水平和人生阶段的政策和战略。通过采用这种全人办法，卫生服务和政府将能够更好地满足以农村为基础、职业生涯早期的卫生专业人员的生活愿望，这可能有助于减少可避免的人员更替。
Introduction: 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.Methods: 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.Results: 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.Conclusions: 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.