Autistic Employees: Workplace Barriers and Solutions for Positive Employment Outcomes

Parenting Adults with ASD: Lessons for Researchers and Clinicians Cassandra R. Newsom, Amy S. Weitlauf, Cora M. Taylor, and Zachary E. Warren Recent reviews of treatments for individuals with autism spectrum disorders (ASD) reveal how little we still know about how to help adolescents with ASD and their families successfully transition into adulthood (Shattuck et al., 2012b; Taylor et al., 2012a). Shattuck and colleagues found that services in the United States for adults with ASD were marked by high unemployment rates, a reliance on families to provide care across the lifespan, high turnover rates in front-line service providers, insufficient transition planning for high school students, and generally insufficient services to meet current needs. In a recent Agency for Healthcare Research and Quality (AHRQ) Comparative Effectiveness Review, the authors similarly found that there is very little evidence available to pinpoint specific intervention approaches for adolescents and young adults with ASD due to a lack of good quality studies. This was especially true for evidence-based approaches to support the transition of youth with ASD to adulthood (Taylor et al., 2012a). For the last decade, with dramatic increases in both ASD awareness and estimates of ASD prevalence, our field has understandably focused intensely on improving early detection and treatment of ASD. Our diagnostic tools and understanding of ASD presentation in very young children has improved tremendously. Different from many of the young adults in these stories, who were often diagnosed in their early teens, we now aim to identify children well before their third birthdays. Research has consistently shown that early and intense ASD-specific intervention can dramatically enhance outcomes for children with ASD. As such, there has been heavy investment in attempting to take full advantage of this early window of neuro-plasticity. However, as these stories illustrate, these children grow up. Their needs change, and our systems are often poorly equipped to help them live fulfilling lives, capitalize on their talents, and obtain independence and equal access, while still providing a safe, supportive environment. Without readily accessible and understandable coordinated systems of care, parents are forced to adopt the multiple roles of case manager, teacher, therapist, community educator, advocate, job coach, housing specialist, financial planner, and often, lifelong caregiver. These stories eloquently illustrate those struggles and successes. Grief and Joy: Opposite Sides of the Same Parenting Coin The idea of grieving a diagnosis is controversial. Many of the writers seemed to feel conflicted about their grief responses and the validity of their feelings. Research shows that many families view the diagnostic process as extremely stressful (Siklos & [End Page 199] Kerns, 2005; Heiman, 2002). Feelings of sadness, anxiety, and depression are common at the point of diagnosis and may reemerge as milestones pass unmet. Families must modify the futures they imagined for their children and begin to envision new goals and dreams. Anonymous Three described this process when she wrote: Most children grow up, go to school, get jobs, move out of their parents’ home, etc. My husband and I have had to seriously consider how much of these are even possible for a young man with autism, even one who has a good number of functional life skills. Tasks of adolescence and adulthood such as starting high school, driving a car, and moving out of the house may be delayed and hard won if met. Raising a child with ASD appears to have particular challenges. Throughout this process, families begin to redefine what “success” means. Rather than ascribing to societal standards, they find joy in personal milestones. McDonald described the triumph of teaching his nephew to shake women’s hands instead of touching their hair, an important safety goal that took three months to accomplish. Each family thereby creates its own path. People outside of the family often do not understand the complicated interplay of love and obligation as well as the frustration and fulfillment that families experience. Just like any family, the parents of children with ASD describe many joys in addition to their struggles. They see their children’s strengths in a world that too often focuses on their weaknesses. Gifted with the everyday experience of their child’s development, they see past the necessity of a...

Background: The nursing work environment is complex with many variables affecting the nurses' perception and work satisfaction. The strongest predictor of nurse's job dissatisfac-tion and intent to leave a job is personal stress related to the practice environment. Negative work environments demoralize nurses and contribute to the development of unsafe working conditions, which are unhealthy and highly associated with nursing job dissatisfaction, low productivity, and high turnover. High nurse turnover in healthcare facilities can negatively affect the ability of hospitals to meet patient needs, provide quality care and increases both direct and indirect labor costs. Aim of Study: To explore the impact of nursing staff perception of work environment on turnover rate in hemodi-alysis unit. Subjects and Methods: A descriptive correlational design was utilized to collect data from A convince sample of nursing staff working in the selected unit (hemodialysis unit) during the time of data collection (from May to September 2017) at a governmental University hospital. Data was collected by using two tools: The Practice Environment Scale-Nursing Work Index (PES-NWI) questionnaire and turnover rate sheet. Results: There were no significant relation between nursing staff perception of work environment and educational level, there were a high positive relation between nurses perception of work environment and years of experience and there were dramatically increase of turnover rate over the years. Conclusion: Poor nurse work environment is the under-lying factor of nursing turnover. Recommendation: Improving nurse work environment should be emphasized through policy to retain nurses in the workforce; Further research is needed to investigate the tools, guidelines and interventions used by managers in the nursing field to create healthy and welcoming working conditions.

The combination of growing demand for long-term care and higher expectations of care staff needs to be set in the context of long-standing concerns about the sustainability of recruitment and retention of front-line staff in the United Kingdom. Organisational and work environment factors are associated with vacancy levels and turnover rates. The aim of the current analysis was to investigate changes in turnover and vacancy rates over time experienced by a sample of social care employers in England. Taking a follow-up approach offers potentially more accurate estimates of changes in turnover and vacancy rates, and enables the identification of any different organisational characteristics which may be linked to reductions in these elements over time. The study constructed a panel of 2964 care providers (employers) using 18 separate data sets from the National Minimum Data Set for Social Care during 2008-2010. The findings indicate slight reductions in vacancy rates but the presence of enduring, high turnover rates among direct care workers over the study period. However, the experience of individual employers varied, with home-care providers experiencing significantly higher turnover rates than other parts of the sector. These findings raise questions around the quality and motivations of new recruits and methods of reducing specific vacancy levels. At a time of increased emphasis on care at home, it is worthwhile examining why care homes appear to have greater stability of staff and fewer vacancies than home-care agencies.

IntroductionThe Places and Spaces of Latinx Cultures Alberto Varon, Issue Editor (bio) As promised during his campaign, President Trump made immigration central to his administration's goals, aiming to restrict the influx of those who immigrate to the United States through either legal or extralegal means. Almost immediately after taking office in January 2017, President Trump issued an executive order instructing the Department of Justice to prioritize the criminal prosecution of immigration offenses. The current attack on immigrants took further shape in September 2017, when President Trump chose to rescind protections under the Deferred Action for Childhood Arrivals (DACA) afforded to the estimated 800,000 people brought to the US as minors. Despite widespread and bipartisan support for the Dreamers, as DACA recipients are often called, President Trump directed the agencies under his purview to phase out the program that enabled DACA recipients to avoid deportation and to work legally in the country. Ending DACA put hundreds of thousands of child immigrants at risk, deliberately undermining these young Americans' chance of success and preventing their inclusion as members of society. The changes to DACA were a clear attack on the social incorporation of a vulnerable segment of the population, paving the way for the immigration crisis the following summer. These attacks deliberately racialize and exclude Latinx people, demanding a collective and concerted response. The immigration crisis requires us to imagine how Latinx communities can engage, resist, and reshape the spaces that structure our lives. ________ From the fall of 2017 into the summer of 2018, under the direction of the Trump administration, the offices under the Department of Homeland Security altered their policies on how to process undocumented immigrants to the United States. On May 7, 2018, Attorney General Jeff Sessions publicly declared a "zero-tolerance policy" for those entering the country without authorization. [End Page 8] Whereas previously authorities working in US border control and enforcement had several options and could exercise discretion, the Trump administration has taken a hardline stance, demanding full criminal prosecution of those entering the country without appropriate documentation and prioritizing deportation as quickly as possible, often at the cost of due process. As part of the drive to criminally prosecute unauthorized immigrants, the administration instituted a "family separation" policy that facilitated the rapid deportation of migrants, refugees, and asylum seekers deemed unworthy or undesirable by authorities. Minors, some as young as toddlers, were torn from their families and travel companions, forced into state custody or detained until foster care arrangements could be made. This practice peaked in the summer of 2018, when over two thousand children remained in detention separate from their families and travel companions. Such practices come with untold costs to the mental and material well-being of those being held, and have direct implications for the immigrants' pending cases. Following an international outcry and national protests, the family separation practice was ended by executive order on June 20, 2018, and a federal judge gave the US government thirty days to reunite families. Nonetheless, in order to remain in compliance with the law, officials have shifted immigration strategy so that families are now detained together. While this shift restores some of the basic human rights and dignity to the detained families, immigration enforcement officials continue to treat migrants as criminals. While there is no official US government policy requiring the separation of families, this is precisely what makes this policy especially pernicious. The decision whether or not to separate families relies on prosecutorial discretion. Should an unauthorized immigrant be held for immigration proceedings, they remain in detention centers united with their kin. However, under the revised directive, adult immigrants are to be tried as criminals, and thus sent to prisons separate from the minor children. Although immigration rates have remained relatively stable year after year, by late summer 2018 an estimated 12,000 migrant children were held in government-contracted detention centers and shelters, with over a thousand others expected to join those ranks.1 Mr. Sessions, who in his announcement of the family separation policy expressed skepticism over the legitimacy of a majority of asylum cases, has long maintained a cynical position regarding American race relations. His record on these...

Millennial is indeed synonymous with high employee turnover rates. This research is to performed employee retention for Indonesians millennials through the work environment, career development, and flexible working to give an overview and additional source of information for the organization to be able to manage their employees who are in the millennial generation to keep them stay longer in the workplace and reduce turnover rate among Indonesians millennials employee. Data analysis method in this research is using SPSS program for the Descriptive Statistic and also using PLS program (Partial Least Square) Version 3.0 for calculating the Outer Model and Inner Model. The populations are a millennial employee in Indonesia and the number of populations is unknown, so the sample in this research are 140 respondents. The results of this research can generally be concluded that Work Environment and Flexible Working have a positive and significant effect on Employee Retention. As well as Career Development can be mediation between Work Environment and Flexible Working toward Employee Retention. Keywords: Work Environment, Career Development, Flexible Working, Employee Retention, Indonesians Millennial

A healthy working life is fundamental for individuals and society. To date, increasingly research connects the earlier, pre-working life to later working life experiences and beyond, recognizing that a worker’s health and exposure starts before the working life begins. The research, however, often lacks a fundamental understanding of (i) the underlying mechanisms and pathways accounting for differences in different life stages and (ii) the role of the social environment in shaping working life experiences. By integrating a life course perspective in our research and crossing disciplinary borders in rigorous, collaborative research, we may get a better understanding of the complex and dynamic interplay between work, environment and health. A life course perspective for work environment and health research A life course perspective in work environment and health research emphasizes the importance of prior life experiences, including the environments in which individuals were raised and exposed, their familial and educational backgrounds, and their physical and mental health status before entering the workforce (1, 2). Life course research in different disciplines has been instrumental in developing more robust causal models (3, 4), particularly for understanding developmental health trajectories and socioeconomic health inequalities (eg, 5–7). Adopting an interdisciplinary life course perspective in work environment and health research helps researchers answering questions as to whether and how the timing, duration, intensity, and context of past and present exposures (ie, pre-working, working, and non-working exposures) are associated with later life work and health outcomes. For instance, the ‘exposome paradigm’ is a concept used to describe the sum of occupational and environmental exposures an individual encounters throughout life, and how these exposures impact biology and health (8). In exposome research, a broad range of genetic, biological, chemical, physical, social and lifestyle factors is examined throughout the life course to provide a comprehensive picture of potential risk factors impacting working life health (9). In exposome research and beyond, it is important to examine how the exposure-outcome relationships are shaped by specific social, cultural and historical contexts (2). The conceptual framework of the ‘Social Exposome’ may help to integrate the social environment in conjunction with the physical environment into the exposome concept (10). Moreover, focusing on both historical and contemporary contexts is essential not only for advancing research but also for informing policy and practice, for example by identifying entry points for interventions. Exposures during the life course During the individual’s life course, several vulnerable time windows for the impact of a multitude of exposures that potentially harm, protect or promote health, eg, occupational, environmental and social, can be distinguished. The (combinations of) exposures may operate in different life stages and contexts and – directly or indirectly via intergenerational transmission – contribute to health (figure 1). The individual may be particulary sensitive to harmful exposures or adverse experiences during developmental life stages, ie, pre/perinatal, childhood, adolescence, pregnancy and menopause/andropause. Other life stages may reflect vulnerable time windows due to a clustering of exposures, eg, work and family demands during parenthood, or an accumulation of exposures during the (working) life course at retirement and post-retirement age. As illustrated in figure 1, occupational exposure(s) can be divided in exposure through the parents’ exposure (early in life) and an individuals’ own exposure (later in life). Already in the pre/perinatal life stage, occupational exposure starts through the intergenerational transmission of the parents’ occupational exposures. Current and bioaccumulated occupational exposure of chemicals and particles in the father at the time of conception can affect sperm quality. Together with the mother’s exposure to occupational exposures of chemicals and particles prior to conception – or chemicals, particles, physical factors, ergonomic load, organizational and (psycho-)social conditions at work during pregnancy – this may affect fetal development and later disease development during the child’s life course (11–15). During childhood, the growing child is exposed to parental occupational exposure(s), directly through chemicals and particles in the work clothes and skin or indirectly through organizational and psychosocial factors in the work environment that may increase the risk for mental and physical health problems in parents, which in turn may affect their parental rearing quality (16, 17). During adolescence and early adulthood, individuals usually encounter their first direct occupational exposures through their first (student) job or jobs. Already from this life stage, occupational exposures may accumulate during the (working) life course and may affect not only the active working life but also the post working life. Also important to note is that brain plasticity is not limited to childhood, adolescence or young adulthood as it persists throughout life. Some studies indicate that high physical and chemical exposure during this life stage, can increase the risk of disease later in life (18). A poor psychosocial school or work environment in younger years may also increase the risk of adverse labour market outcomes and mental health problems later in life (19, 20). In adulthood, men and women often start with (the planning of) family formation. Some occupational exposures affect fecundability, others can increase the risk of pregnancy-related disease, such as preeclampsia, hypertension or diabetes, or affect the offspring (21, 22). Chemicals, heat and stress-related exposures affect the ability to conceive. During pregnancy, the bodily and mental systems are vulnerable with changes in the endocrine and inflammation response that can dysregulate the HPA-axis, resulting in a prolonged stress response. The placenta can filter out many hazards, but not all toxicants, such as methylmercury and arsenic (23, 24). Physical exposure, such as noise and vibration, but also shift and night work can affect the womb and cause fetal growth restriction, preterm birth, and hearing impairment (eg, 12, 13, 25–27). During parenthood, occupational exposures may affect the parents’ (mental) health and work-family balance (28, 29). Many chemical and physical exposures have now manifested in disease, eg, allergy, asthma and musculoskeletal diseases (28). During menopause in women, with a drastic decrease in oestrogen, and the slow testosterone decline in men (sometimes referred to as andropause), dysregulations of the hormone system may disrupt and affect the individual’s susceptibility for occupational exposures in a way similar to environmental exposures (30). Towards retirement, the total cumulative occupational exposure burden over the working life course and the current exposure will affect the ability to stay at work and in the labor market. Post retirement, most direct occupational exposures have ceased, but others may have (bio-) accumulated over time and may cause health problems that manifest after retirement (31, 32). Along with occupational exposures, a multitude of other exposures are present during the entire life course that may operate across different contexts to contribute to health (see figure 1). For instance, chemical, physical and social stressors during the life course leave traces (‘memories’) on the molecular and tissue levels that may affect later life health (33). Epigenetic marks act as heritable memories in the cell as they respond to different endogenous and exogenous signals and can be propagated from one generation of cells to the next generation of cells (33). Next to the epigenetic marks, the social environment and social determinants of health during the life course, eg, socio-economic and lifestyle factors, social relationships, social cohesion and support, are known to impact health and add to the multitude of exposures to be examined, among others in conjunction with the environmental exposome (eg, 34). In residential, family and school contexts, exposures such as air pollution, drinking water pollution, noise, artificial light at night, limited access to green space and crowding may play a role, as can adverse childhood experiences (eg, 35, 36). Moreover, on the overarching societal context, legislations, labor market conditions, norms, values and cultural aspects may affect worker health (2, 37). Main knowledge gaps and challenges Both conceptual and empirical challenges have to be tackled when conducting work environment and health research with an interdisciplinary life course perspective. On the conceptual level, different paradigms and nomenclature still exist in the various disciplines examining the impact of (occupational) exposures on later life health outcomes, which contributes to fragmented research and publication thereof in specialized journals. On the empirical level, questions arise such as: Is it feasible to examine mechanisms and pathways across different exposure levels considering a life course perspective? Is the follow-up duration of existing birth and other cohorts sufficient to address the dynamic interplay between the work environment and health? Are the multifaceted, constantly changing contexts captured? Effect sizes are often small on an individual level and statistical power decreases when several rare assumptions have to be fulfilled to examine clusters or combinations of exposures and contexts in relation to health outcomes. Big data, interdisciplinary research protocols and innovative, advanced statistical models to capture the life course perspective are needed to proceed beyond the exposome studies that are currently being finalized within the EU Horizon 2020 exposome call (https://www.humanexposome.eu). Moreover, a better understanding is needed of how occupational, environmental and social exposures affect individuals (i) in vulnerable time windows, eg, do exposures contribute to health advantages and/or disadvantages, and (ii) while transitioning between and within different life stages (38). Studies in different disciplines have focused on the childhood and retirement life stages, see eg, the research on the school-to-work transition or the work-to-retirement transition (39–41), but little is known about the menopause or andropause life stage. Last, rigorous examinations of different lifecourse models (eg, sensitive periods) and exposure models (eg, current, first, last, peak, single, chronic or accumulated), and their impact on health are needed within and across the different vulnerable time windows and life stages as exposure-outcome relationships may differ and thus call for targeted (preventive) policies and practices (42–44). Interdisciplinary research opportunities The challenges towards a better understanding of the complex and dynamic interplay between the work environment and health provide ample opportunities for rigorous, collaborative quantitative and in-depth qualitative life course research across different research strands. Researchers from different disciplines, such as occupational and environmental medicine, epidemiology, toxicology, health science, sociology, psychology, demography, public (mental) health, and genetics to name a few, should not shy away from the complexity, but embrace the opportunity to use their knowledge and skills to collectively address relevant research questions. Interdisciplinary research opportunities are already present today and will emerge even more in the years to come as more cohorts designed as birth cohorts or multi-generational cohorts mature (eg, LifelinesNext, 45). Researchers have or get access to (national) registers, databases with individual-level internal and external exposure information and neighbourhood-level exposure information or linkages of all these exposure and health data, allowing them to examine the impact of exposures in advanced causal models on later life health. To illustrate the value of and research opportunities with existing data, Ubalde-Lopez and colleagues (46) recently argued that parental work-related data collected in birth cohorts is a valuable yet underutilized resource that could be exploited more fruitfully in the collaboration between birth cohort research, occupational epidemiology and sociology. Having said that, the authors also refer to the possible constraints of eg, cross-national comparative research in terms of technical (ie, harmonization) and ethical challenges (46). In conclusion, to move research on the work environment and health forward, we call for a more integrated, interdisciplinary approach that considers the timing and accumulation of occupational, environmental and social exposures over the life course.

Objectives There is limited perspective in the literature from nonprofessionally trained job coaches concerning employment barriers for youth with disabilities. Methods A written questionnaire and semi-structured interview were used during a community-based work experience program to measure job coach perceptions of future employment barriers of youth mentees. Results Respondent perceptions of some youth employment barriers became significantly more negative from pre- to post-program participation including ‘negative attitudes of coworkers’ and ‘employer legal concerns’. Respondent-suggested strategies for overcoming barriers to employment focused mostly on changing the characteristics and attitudes of the youth, not respondent self-reflection or skill improvement. Respondents may have had a difficult time processing the difference between what they expected in the job coach role and the reality of the role. Conclusions Respondents attributed employment barriers to their youths’ personal deficits rather than their own limited training or work environments. There is a need to determine if short-term training programs (including targeted, online programs or one-day workshops) for nonprofessionally trained individuals can be feasible and cost-effective.

High turnover and staff shortages among home care and hospice workers may compromise the quality and availability of in-home care. This study explores turnover rates of direct care workers for home care and hospice agencies. OLS (ordinary least square) regression models are run using organizational data from 93 home care agencies and 29 hospice agencies in North Carolina. Home care agencies have higher total turnover rates than hospice agencies, but profit status may be an important covariate. Higher unemployment rates are associated with lower voluntary turnover. Agencies that do not offer health benefits experience higher involuntary turnover. Differences in turnover between hospice and home health agencies suggest that organizational characteristics of hospice care contribute to lower turnover rates. However, the variation in turnover rates is not fully explained by the proposed multivariate models. Future research should explore individual and structural-level variables that affect voluntary and involuntary turnover in these settings.

The aim of the present study was to determine whether there are differences in hospital characteristics, nursing unit characteristics, the nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Research in urban hospitals has found an association between the nurse work environment and job satisfaction and turnover rates, but this association has not been examined in rural hospitals. Rural and urban nursing units were compared in a national random sample of 97 United States hospitals (194 nursing units) with between 99 and 450 beds. Significant differences were found between hospital and nursing unit characteristics and the nurse work environment in rural and urban nursing units. Both nursing unit characteristics and the work environment were found to have a significant influence on nurse job satisfaction and turnover rates. Job satisfaction and turnover rates in rural and urban nursing units are associated with both nursing unit characteristics and the work environment. Both rural and urban hospitals can improve nurse job satisfaction and turnover rates by changing unit characteristics, such as creating better support services and a work environment that supports autonomous nursing practice. Rural hospitals can also improve the work environment by providing nurses with more educational opportunities.

Introduction: Workplace incivility and bullying are concerning issues in healthcare with detrimental consequences for healthcare workers (HCW) and healthcare organizations. Organizational leaders’ recognition of incivility/bullying within healthcare organizations, and their sources, is imperative to prevent and/or address issues by creating “zero tolerance” work environments. The purpose of this cross-sectional, descriptive study was to explore HCWs’ experiences with incivility and bullying at a South Florida community hospital. Methods: A convenience sample of HCWs at a South Florida community hospital were recruited to voluntarily complete the Nursing Incivility Scale. Results: A sample of 325 HCWs responded to the survey. The results showed general incivility as the highest source across all HCWs, with certified nursing assistants having the highest level of incivility across all sources (general, nurse, supervisor, physician, and patients). Correlative analysis showed statistically significant relationships between several sources of incivility (general, supervisor, physician, and patient; r = .250 to .390) for those reporting past experiences with incivility/bullying, and healthcare role and physician incivility (r = -.224). Independent t tests and one-way ANOVA showed statistically significant differences. Of note, compared to other HCW roles, registered nurses reported physicians as their highest source of incivility. Discussion: Workplace incivility/bullying is a serious issue in healthcare across all disciplines and roles, requiring healthcare organization leaders’ awareness and subsequent interventions to prevent and address its occurrence. The results of this study provide necessary insight for hospital organization leaders as they endeavor to create and nurture “zero tolerance” work environments. Keywords: workplace incivility, workplace bullying, workplace violence, zero tolerance

Assistive technology (AT) has been successfully used by researchers and practitioners to increase task completion and independence in work and home environments for individuals with intellectual and developmental disabilities. While prior research has shown increased outcomes of incorporating AT into daily tasks, research has also indicated that actual use of AT in these settings is much lower. The current qualitative study used semi-structured interviews with a sample of 25 adults (22 individuals with intellectual and developmental disabilities and three job coaches) to examine the perceived use and implementation of AT into home and work environments, along with potential challenges and barriers. Interviews were analyzed using a thematic analysis approach. Three themes were identified: (1) technologies used to support daily living skills, (2) technologies used to support employment and (3) challenges and barriers to using technologies. Findings indicate that while individuals with intellectual and developmental disabilities are using a variety of AT in their homes both successfully and independently, they have extremely limited use in their workplaces. Implications for practice and future research are discussed.

Stochastic modeling of drug resistance in cancer

BackgroundAboriginal Community Controlled Health Services (ACCHSs) in Australia aim to optimise access to comprehensive and culturally safe primary health care (PHC) for Aboriginal populations. Central to quality service provision is the retention of staff. However, there is lack of published research reporting patterns of staff turnover and retention specific to ACCHSs. This study quantified staff turnover and retention in regional and remote ACCHSs in the Northern Territory (NT) and Western Australia (WA), and examined correlations between turnover and retention metrics, and ACCHSs’ geographical and demographic characteristics.MethodsThe study used 2017–2019 payroll data for health workers in 22 regional and remote PHC clinics managed by 11 ACCHSs. Primary outcome measures included annual turnover and 12-month stability rates, calculated at both clinic and organisation levels.ResultsThere was a median of five client-facing (Aboriginal health practitioners, allied health professionals, doctors, nurses/midwives, and ‘other health workers’ combined) and two non-client-facing (administrative and physical) staff per remote clinic, at any timepoint. Mean annual turnover rates for staff were very high, with 151% turnover rates at the clinic level and 81% turnover rates at the organisation level. Mean annual turnover rates for client-facing staff were 164% and 75%, compared to 120% and 98% for non-client-facing staff, at clinic and organisational levels, respectively. Mean 12-month stability rates were low, with clinic-level stability rates of only 49% and organisation-level stability rates of 58%. Mean annual clinic-level turnover rates were 162% for non-Aboriginal staff and 81% for Aboriginal staff. Both workforce metrics were moderately to highly correlated with the relative remoteness of clinics, size of regular clients serviced, and average annual headcount of employees in each clinic (p values < 0.01).ConclusionsParticipating ACCHSs in remote NT and WA have very high turnover and low retention of healthcare staff. Overall, clinic-level turnover rates increase as distance from regional centres increases and are lower for Aboriginal staff, suggesting that greater employment of Aboriginal staff could help stabilise staffing. Improved retention could reduce burden on ACCHSs’ resources and may also support quality of service delivery due to improved cultural safety and continuity of care.

Valuing and empowering nurses

The hotel industry struggles with high employee turnover and labor shortages. Employing individuals with intellectual and developmental disabilities (EIDD) offers a solution, providing benefits such as improved loyalty, reduced turnover, and greater workplace diversity. Successful integration of EIDD requires addressing challenges like communication barriers, stigma, and the need for tailored support. Key to success are job coaches, who provide on-the-job training, support, and communication between EIDD and supervisors. They also educate coworkers to foster a more inclusive environment. Hotels should implement structured onboarding, provide reasonable accommodations, and offer socialization opportunities to ensure long-term success. Regular job coaching, performance feedback, and clear job roles promote retention. Managers can leverage job coaches to provide personalized training and create a culture of inclusion. By aligning EIDD employment with corporate social responsibility (CSR) goals and partnering with external agencies, hotels can reduce turnover, improve workforce stability, and enhance their public image.