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.

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.