Researchers have discovered what it will take to keep health professionals working in remote Northern Territory where half the nurses leave within four months.
During a multi-year study of staff turnover in 53 NT Government remote clinics, researchers found only 20 per cent of nurses and allied health professionals stayed in their positions for 12 months.
All clinics struggled to fill vacancies, increasing the need for far more expensive agency nurses and decreasing the effectiveness of services.
The paper, Remote health workforce turnover and retention: what are the policy and practice priorities? has revealed "an extremely high turnover of staff" during the period of 2013-2015, where rates reached an alarming 148 per cent every year.
Professor John Wakerman, the study's chief investigator, said the higher turnover was associated with significantly higher hospitalisation rates and higher health costs, and steps need to be taken to keep health professionals working in remote communities.
There is no silver bullet. It's a complex issue requiring a bundle of strategies.
"There is no silver bullet. It's a complex issue requiring a bundle of strategies," professor Wakerman said.
"Based on our analysis of NT data and drawing on international evidence we describe three broad approaches for successfully retaining remote area health staff.
"Firstly, universities need to target enrolment into health training and deliver appropriate, contextualised education.
"Second, health services need to address underlying system issues, such as adequate funding, to ensure a safe and supportive work environment.
"Finally, services need to offer customised individual and family support packages."
The researchers are advocating four key policies to prevent "excessive avoidable turnover".
- Strong intersectoral collaboration between the health and education sectors to ensure a fit-for-purpose workforce
- A funding policy which mandates the development and implementation of an equitable, needs-based formula for funding remote health services
- Policies that facilitate transition to community control of services, prioritise Indigenous training and employment and mandate a culturally safe work context
- An employment policy which provides flexibility of employment conditions in order to be able to offer individually customised retention packages.
"There's sufficient evidence, both local and international, that tells us how to strengthen our primary health care services in the most remote communities," professor Wakerman said.
"Whilst achieving some of these measures, such as a national needs-based funding of primary care, may be difficult, we can confidently say that improving these first-contact services will take the pressure off hospital admissions, decrease costs overall and improve health outcomes."
The report also documents the need for government intervention to slow the high rates of turnover in remote parts of the NT.
"If we wish to ameliorate the very high turnover of staff in remote areas, in order to provide an equitable service to populations with arguably the highest health needs, we need political and executive commitment to get the policy settings right," the report states.
"Health care access issues are largely associated with the persistent problem of health workforce under-supply and maldistribution.
"Over recent years, policies have increasingly promoted the use of short-term and agency staffing in remote communities.This has resulted in several undesirable effects, including concern about cost and quality of care, particularly related to continuity of care in a complex, cross-cultural environment."
The researchers estimated if staff turnover in remote NTG clinics were halved, the potential savings to the Territory health system would be about A$32 million per year.
Proffessor Wakerman said some of the policies set out in the paper are already in place including prioritising Indigenous employment.
"The Department of Health has taken these findings on board," he said.
"They have been working on a training and employment pathway for nurses and are developing strategies to decrease the number of short-term agency nurses they use."
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