INTRODUCTION: Very little is known about the long term workforce outcomes, or factors relating to these outcomes, for nursing and allied health rural placement programs. The positive evidence that does exist is based on short term (1-3 year) evaluations, which suggest that undergraduate rural placements are associated with substantial immediate rural practice of 25-30% graduates practising rurally. These positive data suggest the value of examining long term practice outcomes, since such data are necessary to providing an evidence base for future workforce strategies. The objective was to measure long term (15-17 year) rural practice outcomes for nursing and allied health graduates who had completed an undergraduate rural placement of 2-18 weeks through a university department of rural health (UDRH).
METHODS: This was a longitudinal cohort study, with measures taken at the end of the placement, at one year and at 15-17 years post-graduation. Participants were all nursing and allied health students who had taken part in a UDRH rural placement, who consented to be followed up, and whose practice location was able to be identified. The main outcome measure was factors associated with location of practice as being either urban (RA 1) or rural (RA 2-5).
RESULTS: Of 776 graduates initially surveyed, 474 (61%) were able to be contacted in the year after their graduation, and 244 (31%) were identified through the Australian Health Practitioner Regulation Agency, 15-17 years later. In univariate analysis at the first graduate year, previously lived rural, weeks in placement, discipline and considering future rural practice all had significant relationships with initial rural practice. In multivariate analysis, only rural background retained significance (odds ratio (OR) 3.19, confidence interval (CI) 1.71-5.60). In univariate analysis 15-17 years later, previously lived rural and first job being rural were significantly related to current rural practice. In multivariate analysis, only first job being rural retained significance (OR 11.57, CI 2.77-48.97).
CONCLUSION: The most significant long term practice factor identified in this study was initial rural practice. This suggests that funding to facilitate a rural pathway to not just train but also support careers in rural nursing and allied health rural training, similar to that already established for pharmacy and medicine, is likely to have beneficial long term workforce outcomes. This result adds to the evidence base of strategies that could be implemented for the successful development of a long term rural health workforce.