Health Workforce In Australia Research Articles

The Murray-Darling Medical Schools Network Research Collaboration: protocol for a longitudinal, multi-university program of work to explore the effect of rurally based medical school programs in the Murray-Darling region.

There is now strong evidence to support the positive impact of place-based medical education on the recruitment and retention of the rural health workforce in Australia. Much of this work, however, has been undertaken in the context of 'extended rural clinical placement' - students undertaking part of their medical degree in a rural location. Until recently, there were only a few places in Australia in which students could undertake the entirety of their medical degree in a rural area. With the introduction of the Murray-Darling Medical Schools Network (MDMSN) initiative, this dynamic is changing. The MDMSN is part of the Stronger Rural Health Strategy and builds on the Australian Government's existing Rural Health Multidisciplinary Training Program to establish a network of rurally based medical programs in the Murray-Darling region. The MDMSN offers a unique opportunity to explore the effect of complete rural immersion during medical school on subsequent rural practice. This article describes the establishment of a research collaboration intended to ensure the harmonisation of research data collection from the outset of the MDMSN program. The MDMSN research collaboration is a longitudinal, multi-university program of work to explore the effect of rurally based medical school programs in the Murray-Darling region. Initially it has been agreed that administrative student data will be collected from existing university datasets to help characterise this novel student cohort. Each university will then distribute an entry survey to all first-year MDMSN students. The survey will collect demographic information as well as information regarding rural background, preferences and future practice intention. Questions have been aligned with and adapted from the Medical Schools Outcomes Database survey, the Australian Bureau of Statistics, and from the literature. This information will be combined with graduate information from the Australian Health Practitioner Regulation Agency. The MDMSN research collaboration will work toward the co-design of research projects, to facilitate and progress multi-site research addressing nationally relevant research questions. Early research efforts are focused on our ability to better understand the new cohort of students embarking on rurally based medical education, their practice intentions and realisation. Subsequent work of the collaboration may lead to deeper understanding of the rural student experience, any effect of 'place', changes in student professional identity over time, and their relationship to subsequent rural practice. The MDMSN research collaboration is a proactive initiative that brings together data and experience from five new rurally based medical programs, and answers calls for multi-institution and longitudinal studies. It is uniquely placed to capture the impact of the MDMSN program, including the effect of complete rural immersion on the future practice location of these graduates. Ultimately, the combined research efforts of the MDMSN research collaboration will add knowledge to address the known rural workforce maldistribution, particularly how to attract and retain medical workforce.

What accounts for turnover intention in the Australian public mental health workforce?

High staff turnover is common within the Australian public mental health workforce, contributing to workforce shortages and ultimately impacting the ability to provide stable efficient, effective, and ongoing optimal care to the community. In this study, we aimed to (a) establish the most pertinent factors associated with increased turnover intention in the public mental health workforce in Australia, and (b) establish whether such factors differ between metropolitan and rural services. We used a cross-sectional, correlational design using an online survey method. In total, 235 mental health service staff of various disciplines and levels, from four public hospitals in Victoria, Australia participated in the study. We used three feed-forward multiple regression analyses to assess the study aims. We found that job satisfaction, occupational burnout, and understaffing may be the most pertinent factors to consider regarding turnover intention. Job satisfaction and occupational burnout were factors endorsed across the entire sample, as well as specifically within both the metropolitan and rural services, while understaffing was a pertinent factor regarding turnover intention across the entire sample and for rural services, but not metropolitan services. Our findings regarding the pertinence of job satisfaction, occupational burnout, and understaffing in turnover intention provide key information that may be used to inform interventional targets aimed at reducing attrition from the public mental health workforce in Australia.

Are women nursing academics represented in university leadership positions?

The nursing workforce constitutes the largest professional health workforce in Australia. Nursing is traditionally a female dominated profession. This study reviewed Australian universities that provide entry to practice nursing education. The study identified the distribution of females and males in leadership in nursing education, the positioning of the discipline in the university, and where nurses occupy leadership roles above the nursing discipline (faculty/college). Of the 37 universities that offered entry to practice nursing, more females were evident. However, more men were evident in academia than the proportion of men in nursing outside of the academic setting. Leadership nomenclature varied within each nursing discipline group reviewed. This study demonstrated that the number of nursing academics has decreased since the late 1990’s. The nursing workforce is still a significant contributor to the academic workforce and yet numbers of nurse academics working in roles senior to their discipline were few. This paper discusses how the nursing workforce as predominantly female, has implications to both females and males, and may impact opportunities for leadership and promotion to senior roles.

Approaches Used to Describe, Measure, and Analyze Place of Practice in Dentistry, Medical, Nursing, and Allied Health Rural Graduate Workforce Research in Australia: A Systematic Scoping Review.

Redressing the maldistribution of the health workforce in regional, rural, and remote geographical areas is a global issue and crucial to improving the accessibility of primary health care and specialist services. Geographical classification systems are important as they provide an objective and quantifiable measure of access and can have direct policy relevance, yet they are not always consistently applied in rural health research. It is unclear how research focusing on the graduate health workforce in Australia has described, measured, and analyzed place of practice. To examine approaches used, this review systematically scopes Australian rural studies focusing on dentistry, medicine, nursing, and allied health graduates that have included place of practice as an outcome measure. The Joanna Brigg’s Institute Scoping Review Methodology was used to guide the review. Database searches retrieved 1130 unique citations, which were screened, resulting in 62 studies for inclusion. Included studies were observational, with most focusing on the practice locations of medical graduates and predicators of rural practice. Variations in the use of geographical classification approaches to define rurality were identified and included the use of systems that no longer have policy relevance, as well as adaptations of existing systems that make future comparisons between studies challenging. It is recommended that research examining the geographical distribution of the rural health workforce use uniform definitions of rurality that are aligned with current government policy.

Supported online cognitive behavioural therapy for bulimia nervosa: a study protocol of a randomised controlled trial

BackgroundDespite the availability of effective treatments for bulimia nervosa (BN), a number of barriers to accessibility exist. Examples include access to trained clinicians, the expense of treatment, geographical limitations, and personal limitations such as stigma regarding help seeking. Self-help interventions, delivered via a digital platform, have the potential to overcome treatment gaps by providing patients with standardised, evidence-based treatments that are easily accessible, cost-effective, and require minimal clinician support. Equally, it is important to examine the shortcomings of digital interventions when compared to traditional to face-to-face delivery (e.g., high dropout rates) in order to maximise the therapeutic effectiveness of online, self-help interventions.MethodsA three-arm, multisite randomised controlled trial will be conducted in Australia examining the effectiveness and cost-effectiveness of a newly developed online self-help intervention, Binge Eating eTherapy (BEeT), in a sample of patients with full or sub-threshold BN. The BEeT program consists of 10, multimedia sessions delivering the core components of cognitive behaviour therapy. Eligible participants will be randomised to one of three groups: independent completion of BEeT as a purely self-help program, completion of BEeT alongside clinician support (in the form of weekly telemedicine sessions), or waitlist control. Assessments will take place at baseline, weekly, post-intervention, and three-month follow up. The primary outcome is frequency of objective binge episodes. Secondary outcomes include frequency of other core eating disorder behavioural symptoms and beliefs, psychological distress, and quality of life. Statistical analyses will examine treatment effectiveness, feasibility, acceptability and cost effectiveness.DiscussionThere is limited capacity within the mental health workforce in Australia to meet the demand of people seeking treatment for eating disorders. This imbalance has only worsened following outbreak of the COVID-19 pandemic. Further research is required into innovative digital modes of treatment delivery with the capacity to service mental health needs in an accessible and affordable manner. Self-help programs may also appeal to individuals who are more reluctant to engage in traditional face-to-face treatment formats. This study will provide rigorous evidence on how to diversify treatment options for individuals with BN, ensuring more people with the illness can access evidence-based treatment.The study has been registered with the Australia New Zealand Clinical Trials Registry (ANZCTR Registration Number: ACTRN12619000123145p). Registered 22 January 2019, https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619000123145.

Rationale and protocol for the Nursing and Allied Health Graduate Outcomes Tracking (NAHGOT) study: a large-scale longitudinal investigation of graduate practice destinations.

Inequitable distribution of health workforce limits access to healthcare services and contributes to adverse health outcomes. WHO recommends tracking health professionals from their points of entry into university and over their careers for the purpose of workforce development and planning. Previous research has focused on medical students and graduates' choice of practice location. Few studies have targeted nursing and allied health graduates' practice intentions and destinations. The Nursing and Allied Health Graduate Outcomes Tracking (NAHGOT) study is investigating factors affecting Australian nursing and allied health students and graduates' choice of graduate practice location over the course of their studies and up to 10 years after graduation by linking multiple data sources, including routinely collected university administrative and professional placement data, surveys of students and graduates, and professional registration data. By using a prospective cohort study design, each year a new cohort of about 2000 students at each participating university (Deakin University, Monash University and the University of Newcastle) is tracked throughout their courses and for 10 years after graduation. Disciplines include medical radiation practice, nursing and midwifery, occupational therapy, optometry, paramedicine, pharmacy, physiotherapy, podiatry and psychology. University enrolment data are collected at admission and professional placement data are collected annually. Students' practice destination intentions are collected via questions added into the national Student Experience Survey (SES). Data pertaining to graduates' practice destination, intentions and factors influencing choice of practice location are collected in the first and third years after graduation via questions added to the Australian Graduate Outcomes Survey (GOS). Additionally, participants may volunteer to receive a NAHGOT survey in the second and fourth-to-tenth years after graduation. Principal place of practice data are accessed via the Australian Health Practitioner Regulation Agency (Ahpra) annually. Linked data are aggregated and analysed to test hypotheses comparing associations between multiple variables and graduate practice location. This study seeks to add to the limited empirical evidence about factors that lead to rural practice in the nursing and allied health professions. This prospective large-scale, comprehensive study tracks participants from eight different health professions across three universities through their pre-registration education and into their postgraduate careers, an approach not previously reported in Australia. To achieve this, the NAHGOT study links data drawn from university enrolment and professional placement data, the SES, the GOS, online NAHGOT graduate surveys, and Ahpra data. The prospective cohort study design enables the use of both comparative analysis and hypothesis testing. The flexible and inclusive study design is intended to enable other universities, as well as those allied health professions not regulated by Ahpra, to join the study over time. The study demonstrates how the systematic, institutional tracking and research approach advocated by the WHO can be applied to the nursing and allied health workforce in Australia. It is expected that this large-scale, longitudinal, multifactorial, multicentre study will help inform future nursing and allied health university admission, graduate pathways and health workforce planning. Furthermore, the project could be expanded to explore health workforce attrition and thereby influence health workforce planning overall.

Workforce safety in the remote health sector of Australia: a scoping review

ObjectivesTo scope the evidence surrounding workplace health and safety risks for the remote health workforce in Australia and to collate the recommendations to address those risks.DesignA five-stage scoping review framework...

'There's a Wall There-And That Wall Is Higher from Our Side': Drawing on Qualitative Interviews to Improve Indigenous Australians' Experiences of Dental Health Services.

Indigenous Australians experience high levels of untreated dental disease compared to non-Indigenous Australians. We sought to gain insight into barriers that prevent Indigenous Australians from seeking timely and preventive dental care. A qualitative study design was implemented, using face-to-face interviews conducted December 2019 to February 2020. Participants were 20 Indigenous Australians (10 women and 10 men) representing six South Australian Indigenous groups; Ngarrindjeri, Narungga, Kaurna, Ngadjuri, Wiramu, and Adnyamathanha. Age range was middle-aged to elderly. The setting was participants’ homes or workplaces. The main outcome measures were barriers and enablers to accessing timely and appropriate dental care. The findings were broadly grouped into eight domains: (1) fear of dentists; (2) confusion regarding availability of dental services; (3) difficulties making dental appointments; (4) waiting times; (5) attitudes and empathy of dental health service staff; (6) cultural friendliness of dental health service space; (7) availability of public transport and parking costs; and (8) ease of access to dental clinic. The findings indicate that many of the barriers to Indigenous people accessing timely and appropriate dental care may be easily remedied. Cultural competency training enables barriers to timely access and provision of dental care to Indigenous Australians to be addressed. The findings provide important context to better enable health providers and policy makers to put in place appropriate measures to improve Indigenous people’s oral health, and the Indigenous oral health workforce in Australia.

Developing the rural health workforce to improve Australian Aboriginal and Torres Strait Islander health outcomes: a systematic review.

Objective The aim of the present study was to identify evidence-based strategies in the literature for developing and maintaining a skilled and qualified rural and remote health workforce in Australia to better meet the health care needs of Australian Aboriginal and/or Torres Strait Islander (hereafter Aboriginal) people. Methods A systematic search strategy was implemented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist. Exclusion and inclusion criteria were applied, and 26 papers were included in the study. These 26 papers were critically evaluated and analysed for common findings about the rural health workforce providing services for Aboriginal people. Results There were four key findings of the study: (1) the experience of Aboriginal people in the health workforce affects their engagement with education, training and employment; (2) particular factors affect the effectiveness and longevity of the non-Aboriginal workforce working in Aboriginal health; (3) attitudes and behaviours of the workforce have a direct effect on service delivery design and models in Aboriginal health; and (4) student placements affect the likelihood of applying for rural and remote health jobs in Aboriginal communities after graduation. Each finding has associated evidence-based strategies including those to promote the engagement and retention of Aboriginal staff; training and support for non-Aboriginal health workers; effective service design; and support strategies for effective student placement. Conclusions Strategies are evidenced in the peer-reviewed literature to improve the rural and remote workforce for health delivery for Australian Aboriginal people and should be considered by policy makers, funders and program managers. What is known about the topic? There is a significant amount of peer-reviewed literature about the recruitment and retention of the rural and remote health workforce. What does this paper add? There is a gap in the literature about strategies to improve recruitment and retention of the rural and remote health workforce for health delivery for Australian Aboriginal people. This paper provides evidence-based strategies in four key areas. What are the implications for practitioners? The findings of the present study are relevant for policy makers, funders and program managers in rural and remote Aboriginal health.

Is Australasia producing too many emergency physicians? No.

Is Australasia producing too many emergency physicians? No.

Challenges to student transition in allied health undergraduate education in the Australian rural and remote context: a synthesis of barriers and enablers

The optimum supply of an allied health workforce in rural and remote communities is a persistent challenge. Despite previous indicative research and government investment, the primary focus for rural and remote recruitment has been on the medical profession. The consequent shortage of allied health professionals leaves these communities less able to receive appropriate health care. This comprehensive review incorporates a literature analysis while articulating policy and further research implications. The objective was to identify drivers to recruitment and retention of an allied health workforce in rural and remote communities. This issue was observed in two parts: identification of barriers and enablers for students accessing allied health undergraduate tertiary education, and barriers and enablers to clinical placement experience in rural and remote communities. A search of empirical literature was conducted together with review of theoretical publications, including public health strategies and policy documents. Database searches of CINAHL, Medline, ERIC, PsychInfo and Scopus were performed. Selection criteria included Australian research in English, full text online, keywords in title or abstract, year of publication 1990 to 2012 and research inclusive of rural and remote context by application of the Australian Standard Geographical Classication (ASGC) Remoteness Structure. Theoretical publications, or grey literature, were identified by broad Google searches utilising a variety of search terms relevant to the review objective. Allied health professions were defined as including audiology, dietetics, occupational therapy, optometry, orthoptics, orthotics and prosthetics, pharmacy, physiotherapy, podiatry, psychology, radiography, social work, speech pathology and Aboriginal and Torres Strait Islander Health Workers. A total of 28 empirical publications met the selection criteria with a further 22 grey literature texts identified with relevance to the research objective. Patterns of barriers and enablers for rural and remote student transition in the allied health professions were identified in the literature. Recruitment pathways to allied health tertiary studies in rural and remote communities are vague and often interrupted, and the return of graduates is haphazard. Students from rural and remote communities face an assembly of barriers. They often experience secondary education disadvantage with inadequate subject choices, pathways and opportunities. Programs designed to facilitate transition to tertiary study are often limited in their capacity to address cumulative concerns. Students also face financial imposts and are confronted by daunting social isolation, and separation from families and support systems. In regard to clinical placement, the disincentives weigh heavily. The financial burdens of a rural placement offer little inducement. Social isolation associated with a placement far from home is more acutely felt by students when there is inadequate administrative support and consequent disillusionment. Students also lack a frame of reference to pursue a rural placement option, and are often discouraged by the cumulative commitments involved. Clear and accessible pathways to allied health training for students from rural and remote communities are pivotal to a stronger representation of this cohort among graduates. Similarly, greater representation of rural and remote clinical placements for allied health undergraduate students is an important facilitator. Despite regional coordination and strategies designed to promote a broader range of placement opportunities, the problems remain. This review has consequences for policy and program development for growth of the rural allied health workforce in Australia, as well as identifying knowledge deficits to guide future research endeavours.

Specialisation versus special interest - the Australian podiatry experience.

BackgroundEnsuring efficient and effective delivery of health care to an ageing population has been a major driver for a review of the health workforce in Australia. As part of this process a National Registration and Accreditation Scheme (NRAS) has evolved with one goal being to improve workforce flexibility within a nationally consistent model of governance. In addition to increased flexibility, there have been discussions about maintaining standards and the role of specialisation. This study aims to explore the association between practitioners’ self-perceptions about their special interest in musculoskeletal, diabetes related and podopaediatric foot care and the actual podiatry services they deliver in Australia.MethodsA cross sectional on-line survey was administered on behalf of the Australasian Podiatry Council and its’ state based member associations. Self-reported data were collected over a 3-week interval and captured information about the practitioners by gender, years of clinical experience, area of work by state, work setting, and location. For those participants that identified with an area of special interest or specialty, further questions were asked regarding support for the area of special interest through education, and activities performed in treating patients in the week prior to survey completion. Queensland University of Technology Human Research Ethics approval was sought and confirmed exemption from review.Results218 podiatrists participated in the survey. Participants were predominately female and worked in private practices.The largest area of personal interest by the podiatrists was related to the field of musculoskeletal podiatry (n = 65), followed closely by diabetes foot care (n = 61), and a third area identified was in the management of podopaediatric conditions (n = 26).ConclusionsHealth workforce reform in Australia is in part being managed by the federal government with a goal to meet the health care needs of Australians into the future. The recognition of a specialty registration of podiatric surgery and endorsement for scheduled medicines was established with this workforce reform in mind. Addition of new subspecialties may be indicated based on professional development, to maintain high standards and meet community expectations.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0127-0) contains supplementary material, which is available to authorized users.

Podiatry scope of practice: the role of gender in identification as a specialist

Background Ensuring efficient and effective delivery of health care to an aging population has been a major driver for a review of the health workforce in Australia. As part of this review a new National Registration and Accreditation Scheme (NRAS) has evolved with one goal being to improve workforce flexibility. With increased flexibility there have been discussions about the role specialist scopes of practice plays. This study explored the role of gender and other work related characteristics in relation to contemporary scope of podiatry practice and specialisation in Australia.

How evidence-based workforce planning in Australia is informing policy development in the retention and distribution of the health workforce

BackgroundAustralia’s health workforce is facing significant challenges now and into the future. Health Workforce Australia (HWA) was established by the Council of Australian Governments as the national agency to progress health workforce reform to address the challenges of providing a skilled, innovative and flexible health workforce in Australia. HWA developed Australia’s first major, long-term national workforce projections for doctors, nurses and midwives over a planning horizon to 2025 (called Health Workforce 2025; HW 2025), which provided a national platform for developing policies to help ensure Australia’s health workforce meets the community’s needs.MethodsA review of existing workforce planning methodologies, in concert with the project brief and an examination of data availability, identified that the best fit-for-purpose workforce planning methodology was the stock and flow model for estimating workforce supply and the utilisation method for estimating workforce demand. Scenario modelling was conducted to explore the implications of possible alternative futures, and to demonstrate the sensitivity of the model to various input parameters. Extensive consultation was conducted to test the methodology, data and assumptions used, and also influenced the scenarios selected for modelling. Additionally, a number of other key principles were adopted in developing HW 2025 to ensure the workforce projections were robust and able to be applied nationally.ResultsThe findings from HW 2025 highlighted that a ‘business as usual’ approach to Australia’s health workforce is not sustainable over the next 10 years, with a need for co-ordinated, long-term reforms by government, professions and the higher education and training sector for a sustainable and affordable health workforce. The main policy levers identified to achieve change were innovation and reform, immigration, training capacity and efficiency and workforce distribution.ConclusionWhile HW 2025 has provided a national platform for health workforce policy development, it is not a one-off project. It is an ongoing process where HWA will continue to develop and improve health workforce projections incorporating data and methodology improvements to support incremental health workforce changes.

Are Maternity Experiences of Rural Women Getting Better with Time? Results from a Survey in Tasmania

This study investigates the maternity experiences of rural women in Tasmania; and whether the childbirth experiences between women who have had childbirth experiences within the last five years and those more than five years ago are different due to closure of local maternity services. A questionnaire explored women’s experiences of rural maternity services from antenatal to postnatal care in six rural communities in Tasmania, Australia. 210 women completed the questionnaire with a response rate of 35%. Nearly 50% (n=100) of surveyed women did not have a choice where they could get antenatal care, while more than 50% (n=108) of participants lacked the choice about who would provide care during their pregnancy. Women who gave birth recently were more likely to have to travel further to the nearest maternity units. These women were less likely to experience continuity of care and to be satisfied with the antenatal care and care during labour. In contrast, the women who gave birth more than five years ago had shorter travel time to the nearest maternity units and were more likely to have experienced continuity of care and greater satisfaction with care given during their pregnancy, labour and delivery. Maternity experiences of Tasmanian rural women have not improved with time due to the closure of small rural maternity units. Reopening small rural maternity units would not be feasible with the current shortage of health workforce in Australia. However, in order to improve maternity experiences for rural women, it is recommended that basic services including antenatal and postnatal services should be provided in their local communities. The existing maternity health providers in rural communities such as GP obstetricians and multi-skilled rural nurses should be encouraged and provided with incentives to deliver greater antenatal and postnatal care for women. In addition, maternity health providers from major hospitals could come to a local hospital regularly to provide antenatal check-ups and antenatal classes. This will reduce the need of traveling to access services and increase opportunities for continuity of care which in turn may increase the satisfaction with care of rural women.

Towards best practice in national health workforce planning.

Health Workforce Australia (HWA) was established by the Council of Australian Governments through its 2008 National Partnership Agreement on Hospital and Health Workforce Reform, as the national agency to progress health workforce reform and address the challenges of providing a skilled, innovative and flexible health workforce in Australia. The Australian Health Ministers' Conference commissioned HWA to undertake a workforce planning exercise for doctors, nurses and midwives over a planning horizon to 2025. Health Workforce 2025 (HW 2025) was conducted in two phases: developing projections for the size and type of the health workforce (doctors, nurses and midwives) needed to meet future service requirements from 2012 to 2025; and modelling the training pipeline necessary to meet the size and type of this health workforce. HWA has used a number of key principles in developing HW 2025 to ensure the projections are robust and able to be applied nationally. HW 2025 is not a one-off project. Projections will be updated as new data become available, and methodology and assumptions underpinning the projections will be periodically reviewed. To also ensure the continued improvement of national health workforce planning, HWA is pursuing other areas for improvement, including better national data collections and improved estimation methodology for demand. Results of HW 2025 were presented to the Australian Health Ministers (through the Standing Council on Health) in April 2012.

What do graduate registered nurses want from jobs in rural/remote Australian communities?

To explore and describe the needs of new graduate registered nurses in a rural and remote (R&R) setting within Australia. Rural practice has distinctive challenges for nurses. Nurses make up the largest and most widely distributed health workforce in Australia, outnumbering doctors 8:1 in R&R areas. Literature was used to evaluate the graduate registered nurses' needs in R&R communities. Three main themes emerged: expectations, support and workloads. Themes reflected enablers and disablers of retention of nurses as they transition from student role to new graduate practice. New graduates are aware of their limitations as new practitioners. There is an expectation that their employers will provide a supportive learning environment for them to gain the skills necessary to become proficient and valuable employees. This commentary paper identifies the need for a structured, supported new graduate programme that recognizes and meets the needs, both clinical and social, of new graduate registered nurses in the R&R context.

Beyond 50. challenges at work for older nurses and allied health workers in rural Australia: a thematic analysis of focus group discussions

BackgroundThe health workforce in Australia is ageing, particularly in rural areas, where this change will have the most immediate implications for health care delivery and workforce needs. In rural areas, the sustainability of health services will be dependent upon nurses and allied health workers being willing to work beyond middle age, yet the particular challenges for older health workers in rural Australia are not well known. The purpose of this research was to identify aspects of work that have become more difficult for rural health workers as they have become older; and the age-related changes and exacerbating factors that contribute to these difficulties. Findings will support efforts to make workplaces more 'user-friendly' for older health workers.MethodsNurses and allied health workers aged 50 years and over were invited to attend one of six local workshops held in the Hunter New England region of NSW, Australia. This qualitative action research project used a focus group methodology and thematic content analysis to identify and interpret issues arising from workshop discussions.ResultsEighty older health workers from a range of disciplines attended the workshops. Tasks and aspects of work that have become more difficult for older health workers in hospital settings, include reading labels and administering medications; hearing patients and colleagues; manual handling; particular movements and postures; shift work; delivery of babies; patient exercises and suturing. In community settings, difficulties relate to vehicle use and home visiting. Significant issues across settings include ongoing education, work with computers and general fatigue. Wider personal challenges include coping with change, balancing work-life commitments, dealing with attachments and meeting goals and expectations. Work and age-related factors that exacerbate difficulties include vision and hearing deficits, increasing tiredness, more complex professional roles and a sense of not being valued in the context of greater perceived workload.ConclusionsOlder health workers are managing a range of issues, on top of the general challenges of rural practice. Personal health, wellbeing and other realms of life appear to take on increasing importance for older health workers when faced with increasing difficulties at work. Solutions need to address difficulties at personal, workplace and system wide levels.

The rural allied health workforce study (RAHWS): background, rationale and questionnaire development

The allied health professions form approximately 18% of the health workforce in Australia and are well placed to contribute to future multidisciplinary models of health care. There are many reports describing the health workforce in Australia for the medical and nursing professions but there is very little information available about the nature of the allied health workforce. Recent studies have highlighted the need for more current and detailed information about the rural allied health workforce to inform future workforce planning. National health policy reform requires that new healthcare models take into account future workforce requirements, the distribution and work contexts of existing practitioners, training needs, workforce roles and scope of practice. The absence of accurate data profiling the existing rural allied health workforce makes this impossible. The Rural Allied Health Workforce Study (RAHWS) aims to use a cross-sectional survey instrument with high validity to provide a large scale but detailed profile of the allied health workforce in regional, rural and remote Australia. The RAHWS survey instrument used in this study is the result of a comprehensive consultation with clinicians, academics and managers. The RAHWS survey instrument has been designed to provide uniform data across a wide range of healthcare settings. Good concurrent and face validity have been demonstrated and its design allows for data analysis using a wide range of variables. Cross-correlation of responses can answer a number of research questions in relation to rural recruitment and retention, professional education and service delivery models. This valid and feasible instrument will be used to explore the rural allied health workforce by implementing the RAHWS survey in rural regions on a state-by-state basis in Australia during 2009 and 2010.

EXPLORING THE ROLE OF THE MENTAL HEALTH NURSE IN COMMUNITY MENTAL HEALTH CARE FOR THE AGED

There is currently considerable discussion about the impact of the aging population on the demand for health care services, however there is considerably less attention paid to the impact of mental health issues on the needs of the aged population. Nurses comprise the largest professional group within the mental health workforce in Australia. The availability of a high quality mental health nursing workforce will therefore be crucial to meeting the health needs of aging clients in the future, accompanied by an increased pressure to increase the proportion of care delivered in the community. There is however, a paucity of literature on the role and contribution of community mental health nurses specialising in the aged care field. The aim of this paper is to present the findings of a project designed to examine the role of mental health nursing within aged persons' community mental health teams in Victoria, Australia, with particular emphasis on the biopsychosocial interventions used. Fifteen participants from three community mental health services in Victoria participated in a focus group interview to share their insights and experiences. Data analysis revealed two main themes, the role of the nurse, and the specific functions of the nurse. This data is presented as a beginning contribution to the paucity of literature currently available in this important area.