The reality gap: A grounded theory whole-of-life explanation of turnover intention of early career rural-based community mental health professionals.
This study focused on retention of early career (0-5 years after graduating) health professionals working in rural and remote Australia. Some of Australia’s most severe and protracted workforce shortages are in public sector mental health and, within this sector, community mental health (CMH) services experience critical staffing shortages and high staff turnover. CMH services are heavily relied upon by rural-based Australians living with serious mental illness, however, research to date has been fairly limited (Health Workforce Australia (HWA) 2013, Cosgrave, Hussain et al. 2015). 
A whole-of-life interview approach was taken to build an understanding of how and when workplace, professional development and quality-of-life factors affected early career health professionals’ decision to stay or leave their CMH positions and this was used to develop a grounded theory explaining turnover retention. Twenty-six nursing and allied health professionals working for NSW Health in rural and remote community mental health (CMH) services participated in in-depth, semi-structured interviews.
The turnover intention theory developed concerned the manageability of the gap between an individual’s professional and personal expectations compared to the reality of their current employment and rural-living experience. The size of the gap was found to be affected by an individual’s experience of four key factors. These were:
Time in the current job and extent of relevant prior work experience and professional identity formation
- Service remoteness and team size
- Extent of feelings of belonging to the local community and town; and
- Assessment made of the town’s ability to meet future life aspirations
Drawing on these factors and an individuals’ stage of adjustment to the job an assessment of turnover risk could be made.
The identification of a whole-of-life group of factors influencing retention, as well critical time points in the adjustment process in a new job and development of a turnover intention risk matrix provides for a fresh approach and more nuanced understanding of turnover intention. These findings are useful for other public health services facing similar rural CMH workforce challenges as Australia’s, and can be used to assist in developing appropriate and timely supports relevant to the particular current life circumstances of rural-based early career CMH health professionals.
Further reading: Cosgrave, C., Maple, M., & Hussain, R. (2016). Factors affecting job satisfaction of Aboriginal mental health workers working in community mental health in rural and remote New South Wales. Australian Health Review (Published online 5th December). DOI: 10.1071/AH16128
This article was kindly provided by Dr Cath Cosgrave, Research Fellow – Nursing and Allied Health Rural Workforce at The University of Melbourne
Dr Cosgrave submitted an abstract for the 2016 Australian Rural and Remote Mental Health Symposium.
Find out what’s on for the 2017 Australian Rural and Remote Mental Health Symposium here.
Cosgrave, C., R. Hussain and M. Maple (2015). "Factors impacting on retention amongst community mental health clinicians working in rural Australia: A literature review." Advances in Mental Health 13(1): 58-71.
Health Workforce Australia (HWA) (2013). Mental health workforce planning data inventory. Adelaide, SA, HWA.
