Grabbing the Rural and Remote Health Workforce Challenge by the Throat

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					          Grabbing the Rural and
         Remote Health Workforce
          Challenge by the Throat

                Kindergarten to Advanced Practice
                        in Health Careers
Deb Jones
Director, Primary Health Care.                      NSW Rural and
Broken Hill University Department of Rural Health   Remote Health
                                                    Conference 2008.
University of Sydney
Traditional owners and custodians on
whose land we are gathered.

Paakantji People on whose land we
reside and work
             Medicine                               Nursing
All experts agree that recruitment
                                       The international shortage of
into rural and remote practice is a
                                       nurses is intensified in rural and
key problem, exacerbated by a
                                       remote communities where
national medical workforce
                                       nurses may face personal,
shortage.     Gregory et al 2006
                                       professional and structural
                                       challenges… Hofwegen et al 2005

                             Allied Health
    Across rural and remote areas as a whole there are insufficient
    numbers of allied health professionals, and many of them are
    inadequately prepared and/or supported for rural and remote
    practice, stressed and over worked.      NRHA 2004
Career Development Theory
Gottfredson, L (Circumscription and
Compromise Theory)
Lent, Brown & Hackett’s Social Cognitive
Career Theory – 1987 (Self-efficacy,
outcome expectations, personal goals)
Decision Making Theory (Ongoing choices
across a lifespan, influenced by awareness of
1. Orientation to size and power
(3-5 yrs) – Change from wanting to grow up to
  be inanimate objects to recognising powerful
  vs weak people and roles.
2. Orientation to sex roles
(6-8 yrs) – Eliminate roles that are incompatible
  with their gender self concept.
  Boy jobs vs girl jobs
3. Orientation to Social Valuation
(9-13 yrs) – Aware of differences in social
  status, what occupations are higher up the
  social ladder – may not make wise choices
  but tend to be permanent unless challenged

4. Orientation to Unique Internal Self
(14 yrs and older) – More occupational
  alternatives identified – reject incompatible
Accessibility to careers limited by labour
market, training etc
Suitable choice may not be available –
Opt for work in their social space rather than
compromise prestige or sex type
May opt for lower level positions before
conflicting with their gender self-concept.
Experts say the creation of a healthy
science pipeline doesn’t begin in college
or high school, but as early as
kindergarten….Elementary school is
when we get the best, first opportunity to
grab students’ attention and keep them

Babe G 2005 CEO Bayer Materialscience
Professional nursing organisations need to
be in the classrooms at an early age
encouraging school-aged children to pursue
a career in nursing. By reaching these
children in early ages, the profession has
the opportunity to curb the shortage of
nurses in the next 15 to 20 years when
the sudden exit of nurses will occur.
                         (Westendorf J 2007)
    BHUDRH Health Career
  Develop potential R&R health providers,
  creation of a diverse workforce
  Expose students from a young age to health
  career educational experiences
  Establish a cohesive pipeline from schools to
  higher education and professional practice
           Foundation for recruitment
          Key Elements
Coherence, Continuity, Consistency, &
Developmental across the Continuum
Locally coordinated, delivered and supported
with a long term commitment by community
Most likely strategy to result in a stable,
community appropriate pool of health
USA high school students who were
identified, tracked and supported through
health career formative years were most
likely to return to serve their communities of
origin as health professionals.
               (Wyoming County Health Careers 2006)
School based programs (K – Yr 12)
Undergraduate experiences & support
New Graduate experiences & support
Post Graduate experiences & support
Scholarship and resource support
Target minority and underserved populations
       School & Workplace culture
          The University of Sydney
          Faculty of Medicine                                  Broken Hill University Department of Rural Health

                                                  Broken Hill & Willyama High Schools

                                                                                   Directorate of Nursing & Midwifery
East Texas Area Health           Royal Flying Doctor Service
  Education Center

                Broken Hill Aboriginal Community Working Party

                                            OATSIH                                        NSW DET
 MAARI MA HEALTH Aboriginal Corporation
                                        BHUDRH Pipeline
                                          Nurse Academy &        Nurse
                                                                                   TVET Pathways
                                          work experience       Academy
               Health promotion &
F              career introduction
I                   Kindy - YR 6           YR 7 - 10                  YR 11 - 12
N                                                      PHC & supported
D                                                      Placement
    Mentoring, IPL and                                                      Role Models
L                                  Mentors & Role Models
    Support Program
Y    (IRCST Funded)
                         NEW RADUA                                           UNDERGRADUATE
F                         GRA
A                                                            RFDS Flight Nurse
C                          Mentoring           Indigenous
                                                             & Management
                           & Support           Health
L                                                                                Role Models & Mentors
T                        NEW STAFF                      ADVANCED POST GRADUATE
                            Mentors & Role
S                                                                           Mentors & Role Models

           Alumni                            Partnerships
        Development                                                         Indigenous
      Yr 7 – Advanced                        Continuity &                      Focus
           Practice                           Cohesion
                                                         My mum said
I have to be
                                                         you shouldn’t
a doctor when
                                                         blow your nose
I grow up I’m
                                                         in a hanky and
a boy!
                                                         then eat it

                     Kindergarten – Yr 6
                •Health Promotion (Hand washing, Asthma etc)
                •Career Introduction (Role models)
                •09 calendar of delivery under development
                          Nursing Academies
                          •Supported and structured
                          •Plus Yr 10 Work Experience

            Year 7 to Year 10

   Role Models and Mentors
Stepping Back Looking Forward Indigenous Program
                         Attainment Acute
       Nursing           Nursing/Allied Health
       Academy           (GWAHS, TAFE, CSU)

         Year 11 to Year 12

           Role Models and Mentors
Stepping Back Looking Forward Indigenous Program
PHC/Indigenous      Mentoring
Elective     TEN Support and


         Role Models and Mentors
            Mentoring, IPL, and
          Social Support Program

                 New Graduate/Staff

                             Commencing Feb 09

Role Models and Mentors
     Remote Health Service Management 09
                       RFDS/ Remote
Master Indigenous
                    Community Flight Nurse
                       Experience 09

               Advanced Practice

                                    Role Models and Mentors
                   RHSET GRANT (?)

 Positive Work
Environments for            Striving for
    All Staff               Excellence

               Facility Friendly Concept

  Underpinning Recruitment and Retention
                                     Nurse Academy Program (NAP)

                                             Academy participation by gender and year

Number of participants

                              Yr 9   Yr 10   Yr 11   Yr 12        Yr 7   Yr 8   Yr 9   Yr 10   Yr 11    Yr 12

                                     2007                                       2008             Male

     120 Participants: 12.5% Male
                                      Indigenous Participation (NAP)

                                Academy participation by Indigenous status and year


 Number of participants







                               Yr 9   Yr 10   Yr 11   Yr 12             Yr 7   Yr 8    Yr 9   Yr 10    Yr 11   Yr 12

                                       2007                                           2008            Indigenous
                                                                                                      Non - Indigenous

30.8% Participants Indigenous
                             Kids Comments
                                                            I thought it was a
I participated in the 2007                                  great day and hope
Nursing Academy and                                         I’m lucky enough to
that’s what helped me                                       return next year.”
decide on a career in

                                                                   I liked the day
                                                                   and it made me
                                                                   more interested
 Thanks to all of the                                              in nursing.”
 we had today, it was
 a great experience
 and a good way to see           A great start to
 if it’s what I want for         encourage & motivate
 the future”                     students into studying
                                 nursing and stick with
                                 their Yr.12 studies.
                                 Very worthwhile activity
                                 (Teacher comment)
                    PHC Intensive Placement

                      PHC Placements 07-08

Student 5                                                        SCU
Numbers 4                                                        ACU
            April   May   Sept   Nov   2008   Mar   Sept   Nov

Total: 64 (06-08)
                                    PHC Intensive
Thankyou so much – you have no                                 I was fairly aware of
 idea what I have gained from                               issues [Indigenous health]
 this experience. I have grown
 professionally, socially. I have
                                                             before I came out but by
expanded my mind and my world                                seeing the people, talking
 and I have grown as a person.                               to the people and being a
         Thanks a lot!                                      part of their lives, what I
                                                            have learnt about becomes
                                                              real, they become real!

 I think that this                                              Coming out here was like
   placement has                     I came with an acute
                                                                  travelling to another
 come at the right                                              country. It was great to
                                      mentality and then
 time to progress                                                     have guides
                                         I discovered
    my rural and                          ‘the shift’
   remote health
 PHC Location / Role 12-18 Months
        Post Experience

Total participants in research follow up (n=23)
Alice Springs 1
Darwin 2
Broken Hill 1
Dareton 1
Adolescent Mental Health 1
        New Graduate
Mentoring and IPL Support program
Commence in Feb 2009
4 planning meetings, mentor training
Jan 09
Inclusive (integrates with school
Extended Medical Student Program
    Advanced Practice
Consultation with Center Remote Health
Alice Springs re 09 delivery of Remote
Health Service Management on site
Consultation with RFDS re Flight Nurse
experience 09.
      Where to from here?
Expanding the NAP to Allied Health & Medicine in 09
Been approached to support early school leavers/kids at
risk, young mums
Increased focus on Primary Schools K - 6
Pilot Parent Academy planned for Dec 08.
1 Yr 12 student seeking admission to undergraduate
nursing as a result of participating as a Yr 11 student in the
2007 Academy Program (Scholarship applications and
parent information support)
Opportunistic health screening students and teachers (1
Supervising teacher diagnosed with Type 2 Diabetes as a
result of participation)
 Undergraduate Nursing
Exposed 64 urban nursing students to a
supported Rural and Remote PHC placement
over the last 3 years
(PHC vs Acute Illness Models);
Impact on undergraduate nurses career
decisions and professional practice;
Staff buy in and facility support through
community owned PBL case scenarios
(Menindee, Dareton, CHAC,
RFDS,Wilcannia, Brewarrina, Bourke);
               Item                 Funding Body         Budget       Timeframe

1 FTE Indigenous Secondary        USyd Indigenous       $100K         06- 07
School Community Development      Education Committee
“                  “              OATSIH                $50K          08-09
Indigenous 2ndry School
Mentoring Program
                                  IRCST                 $50K          07-08
Undergrad Nursing Evaluation
Clinical Supervision (Undergrad   Feeder Uni’s          approx        Ongoing
                                                        $6K for 4-6
PHC)                                                    wks
Mentoring/IPL/Support Program     IRCST                 $70K          08-09
(New Grad Nurses, Med students,
Allied Health Undergrad)
Nurse Academy Shirts              DN&MW (GWAHS)         $2 500        Ongoing

Nurse Academy                     Career Education      $30K          08-09
                                  Lighthouse School
                                  Project (?)

Friendly Facility concept         RHSET (?)             $145K         08-09
      Policy Implications
Structured reinvestment in process of health
career development
Supporting collaboration – removing barriers
Committed school health programs (well
being & career role modeling)
Benchmark friendly facilities
Funding and sustainability
Transferability of model to unique
environments & other professions
Our Pipeline
Thank you

Mundi Mundi Lookout
Brandt’s Photo (PHC Participant)

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Description: Grabbing the Rural and Remote Health Workforce Challenge by the Throat