title: Extrinsic and intrinsic factors impacting on the retention of older rural healthcare workers in the north Victorian public sector: a qualitative study.
abstract: BACKGROUND
  Workforce shortages in Australia's healthcare system, particularly across rural areas, are well documented. Future projections suggest that as the healthcare workforce ages and retires, there is an urgent need for strategies to retain older skilled employees. Very few qualitative studies, with theoretical underpinning, have focused on the retention of older rural nurses and allied healthcare workers. This study aimed to address these gaps in research knowledge.
  
  
  METHODS
  This qualitative study is phase 2 of a large mixed-methods study to determine the factors that impact on the retention of older rural healthcare workers across northern Victoria, Australia. The initial phase, drawing on the effort-reward imbalance model found high levels of imbalance across a large sample of this population. The present study builds on these findings to explore in more depth the organisational (extrinsic) and individual/social (intrinsic) factors associated with retention. A purposeful stratified sample was drawn from participants at the survey phase (phase 1) and invited to take part in a semistructured telephone interview. A diverse group of 17 rural healthcare workers (nurses and allied health) aged 55 years or more, employed in the north Victorian public sector, were interviewed. The data were transcribed and later analysed thematically and inductively.
  
  
  RESULTS
  Data were categorised into extrinsic and intrinsic factors that influenced their decisions to remain in their roles or leave employment. The main extrinsic factors included feeling valued by the organisation, workload pressures, feeling valued by clients, collegial support, work flexibility, and a lack of options. The main intrinsic factors included intention to retire, family influences, work enjoyment, financial influences, health, sense of self, and social input. Given the noted imbalance between (high) effort and (low) reward among participants overall, strategies were identified for improving this balance, and in turn, the retention of older rural healthcare workers.
  
  
  CONCLUSIONS
  Study outcomes provide important insight into factors that impact on the retention of older rural healthcare workers, and, importantly, the imbalance in effort and reward participants experience in their current workplace. Use of a theoretical approach, and a two-stage methodology, enables a deeper understanding of these factors and the strategies needed to address them. Further research is now needed to test the effectiveness of these strategies in the older rural healthcare workforce.
authors.affiliation: John Richards Initiative, La Trobe University Albury-Wodonga Campus, Wodonga, Victoria, Australia. j.warburton@latrobe.edu.au.
authors.forename: Jeni
authors.initials: J
authors.lastname: Warburton
authors.affiliation: John Richards Initiative, La Trobe University Albury-Wodonga Campus, Wodonga, Victoria, Australia. m.moore@latrobe.edu.au.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Moore
authors.affiliation: John Richards Initiative, La Trobe University Albury-Wodonga Campus, Wodonga, Victoria, Australia. s.clune@latrobe.edu.au.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Clune
authors.affiliation: La Trobe Rural Health School, La Trobe University Albury-Wodonga Campus, Wodonga, Victoria, Australia. s.hodgkin@latrobe.edu.au.
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Hodgkin
mesh_terms: D000368:Aged; D004651:Employment / Q000523:psychology; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010563:Personnel Turnover; D017150:Public Sector; D036301:Qualitative Research; D012179:Retirement / Q000523:psychology; D019035:Rural Health Services; D012649:Self Concept; D012944:Social Support; D014739:Victoria; D000078329:Workforce; D016526:Workload
keywords: Aged Care; Allied Health; Australia/Pacific; Geriatrics; Health Promotion; Mental Health; Nursing; Practice Tips; Primary Health Care; Qualitative Research