What do nurses practising in rural, remote and isolated locations consider important for attraction and retention? A scoping review

Introduction: Nurses play a vital role in the provision of healthcare in rural, remote, and isolated locations. Consequently, the current global nursing workforce shortage has significant and far-ranging implications for these communities where there are enduring issues with workforce maldistribution and shortage, instability, high staff turnover, and health disparities. This article provides an analysis of existing literature on what rural, remote, and isolated practising nurses view as important for the attraction and retention of this workforce in the Australian context.
Methods: A structured scoping review informed by Arksey and O’Malley’s framework for conducting scoping studies was undertaken. Six electronic databases were searched in August 2022. Cosgrave’s person-centred retention improvement framework (which includes attraction) for addressing health workforce challenges in rural contexts was used to guide the synthesis and interpretation of information from the included studies. Key themes were identified inductively, conceptualised within Cosgrave’s framework, and mapped to the overarching lifecycle stages of attraction, retention, and resignation, also referred to as turnover or decision to leave.
Results: Twelve articles met the inclusion criteria for this review. Six themes related to attraction, retention, and resignation were identified: 1. Demanding role and scope of practice; 2. Values divergence and professional opportunities; 3. Continuing professional development and mentoring; 4. Social, lifestyle, and personal or family; 5. Management and organisation; and 6. Pay and incentives. The issues articulated within each of these themes overlapped, highlighting the complexities involved.
Conclusion: Limited empirical research that combines a person-centred and whole-of-lifecycle approach to understanding the rural and remote nursing workforce was found. However, our analysis of existing evidence suggests that such approaches are required to appropriately plan for and target solutions that centre nurses’ specific needs and experiences for the future nursing workforce. Relatedly, limited translational research on the nursing workforce that explicitly includes and engages with nurses was found. Such research is fundamentally needed to improve retention outcomes.
Keywords: attraction, motivations, nursing workforce, recruitment, resignation, retention, rural nursing, remote nursing, isolated nursing, turnover.