The threshold of rural placement frequency and duration: A repeated cross-sectional study examining rural career aspirations among student nurses.

AIM: This study aimed to explore what changes rural placement had on the perceptions of nursing students and the impact of placement frequency and duration on student considerations for rural practice. BACKGROUND: A strong rural healthcare workforce is a global concern and has led countries to look for creative ways to address this challenge. One approach is to train more health professionals, however, nursing students who grew up or lived in metropolitan or urbanised areas are suggested to be less inclined to pursue a rural career. As such it is posited that recurrent exposure to rural settings may exert a positive impact on future intention for rural practice. However, there is a need to explore the specific thresholds related to both the frequency and duration of rural placement exposure, as well as the cumulative impact multiple rural placements may have on the intention to engage in rural practice. DESIGN: A repeated cross-sectional design. METHODS: All nursing students from an Australian regional university were invited to complete an online questionnaire between 2019 and 2023. Demographic and placement specific questions were included. A modified version of the Nursing Community Apgar tool also measured the importance of key variables in rural career decision-making. Data were analysed using independent sample t-tests and one-way ANOVAs. Significance was determined at two-tailed p≤.05. RESULTS: Among the 835 respondents (response rate 15.4%), the average number and duration of rural placements was 2.45 placements and 3.01 weeks respectively. Rural placements did not have an impact on students who resided rurally or regionally. However, among metropolitan students who had experienced more than three rural placements, or more than sixteen cumulative weeks of placement, were significantly more likely to consider rural employment. Greater number of rural placements and longer cumulative duration had the greatest impact. CONCLUSION: Issues related to the nursing rural workforce are dynamic and complex. Understanding the unique drivers that improve the rural experiences among students, particularly metropolitan students, can have an impact on decision-making to pursue employment in rural environments. Importantly, whilst professional and clinical motivation and experiences are influential factors, the socialisation, environment and community features are essential elements that influence students' decisions to pursue a career in rural practice. Undertaking a nuanced approach that facilitates rural practice understanding among students may help shape future employment decision-making.

This Bloke Who Helps Me With My Tractor, He's Been the Best Psychologist: The Experience of Seeking Mental Health Support in Rural Australia.

Mental illness is difficult to discuss among men due to notions of remaining tough, being a man, and societal expectations. In rural communities this is particularly evident which is further exacerbated by poor health care access. The aim of this study is to understand the lived experiences of men and their significant others when seeking mental health support in rural areas. A qualitative study was conducted using purposeful sampling. Data were collected using semi-structured interviews in rural or regional areas of Australia. Open-ended questions were asked but more questions were developed from the responses given. Data analysis was conducted using thematic analysis. Four key themes emerged. These encompassed triggers and help-seeking caused by stressors such as work, family, and poor physical health, with support seeking from professional or informal supports. The second theme included challenges securing professional support appointments, while the third was centered on access to medication and travel time. Finally, the final theme encompassed relationships being impacted by poor mental health or created insights into the need to seek help. The experiences explored throughout this study highlight that as men are impacted, so too are married or romantic partners and children; however, they are the catalyst for help-seeking. The study further highlights even when men are psychologically prepared to seek help, it may be difficult to do so. Improving access goes beyond mere medical professionals in rural areas and must focus on supporting families and loved ones to support men.

Understanding rural pharmacists' perspectives: lived experiences and insights associated with rural recruitment and retention.

INTRODUCTION: Pharmacists serve an important role in rural communities, and in some cases they may be the only health professional available. Their recruitment and retention is a major concern for rural communities and health services; however, a deeper understanding regarding the advantages and challenges of sustaining a rural pharmacy workforce is somewhat limited. The aim of this study was to develop a deeper understanding of pharmacists' perspectives about factors influencing pharmacist recruitment and retention to rural and remote communities. METHODS: The exploratory study, carried out in rural Tasmania and rural Western Victoria, used a qualitative descriptive design. Structured interviews, lasting between 30-60 minutes, were conducted by a single researcher using the Pharmacist Community Apgar Questionnaire via face-to-face, telephone or videoconferencing technology. Data were analysed thematically using verbatim transcription, extraction of significant statements and identification of similarities in formulated meanings, grouping the similar meanings and significant statements that pertained to the phenomena of interest. Specifically, qualitative data were used to provide a deeper understanding of factors identified as key assets, capabilities, or those most challenging for pharmacist recruitment and retention. RESULTS: The advantages and disadvantages rural communities face in recruiting and retaining pharmacists are presented. These insights are linked to the advantages of financial income, incentives and moving allowance. Further advantages include the degree of practice autonomy, breadth of tasks, the perception of the community, loyalty to the pharmacy and its pharmacists, along with community recognition. Challenges associated with the recruitment and retention of pharmacists centred on the need for spousal or partner employment opportunities, having greater proximity to schools, access to social or cultural opportunities, along with good transport connections. Further challenges included housing, the cost of schooling for children, having adequate locum or peer coverage and opportunities to host interns. DISCUSSION: The study provides a deeper exploration of the meaning and experiences of factors that previous research has shown are considered advantageous or challenging to the recruitment and retention of pharmacists in rural areas. Through the voices of pharmacists living and working in a rural area, the findings further enlighten our understanding regarding how the multifaceted and complex nature of health workforce planning may be addressed. As such, greater pharmacist recruitment and retention is enabled through adequate financial compensation and incentives, along with additional tax incentives for business and health services. Further, innovation is required to enhance economic sustainability. Locum coverage and intern opportunities also require innovative approaches to address concerns among potential candidates. Lastly, efforts to enable and support social connections such as schooling and spousal employment, while building community connection and a sense of rural community belonging, remain essential to recruit and retain pharmacists. CONCLUSION: Rural pharmacist recruitment and retention is complex, requiring a multi-pronged approach to implement practical solutions. Given this complexity and the unique features of each rural community, solutions require whole-of-community ownership to create innovative solutions. Recognition of specific advantages and challenges can address key driving factors for pharmacist recruitment and retention in rural communities.

"I Just Know if I Keep Going, I'll End Up Hating Nursing." Lived Experiences of Emergency Nurses Three Years Into the Global COVID-19 Pandemic.

INTRODUCTION: As the coronavirus disease 2019 pandemic continues globally, the personal and professional pressure on health care workers continues to accumulate. Literature suggests that as the pandemic evolves, nurses are experiencing increased levels of anxiety, depression, and post-traumatic stress, ultimately leading them to voice intentions to leave the profession, if they have not done so already. METHODS: Informed by an interpretive hermeneutic phenomenological approach, this longitudinal study was designed to capture how the lived experiences of 9 emergency nurses evolved over the coronavirus disease 2019 pandemic, highlighting their feelings, attitudes, and perceptions toward working in the emergency department at this time in history. Interviews were undertaken in June 2022 and were analyzed using a thematic analysis approach. RESULTS: Data analysis resulted in a total of 2 major themes and 8 minor themes. The 2 major themes included "exposed wounds" and "Band-Aid solutions." Levels of burnout increased during the pandemic, with most of the emergency nurse participants dropping their hours, moving roles within the profession, or leaving the profession entirely. Findings elucidate where and how concerns may arise in clinical practice and holistic well-being among emergency nurses, particularly surrounding professional boundaries and protecting work-life balance and professional identity. DISCUSSION: As the world moves to managing coronavirus disease 2019 as a recognized common respiratory illness, providing time and space for emergency nurses to voice their concerns, design their well-being interventions, set professional boundaries, and reconnect with their professional passion may see lower attrition rates and higher levels of professional satisfaction in emergency nurses globally.

The mechanisms of student grit at the height of a major crisis: Identifying key predictors when times get really tough.

AIM: The study aims to provide insights into the key predictors of grit both before, during and throughout a common crisis event, where other more individualised challenges may not provide these insights. DESIGN: A repeated cross-sectional design. METHODS: Data were collected via an anonymous questionnaire among n = 818 (20.8% response rate) nursing students who were undertaking a three-year baccalaureate degree. Data collection occurred in the mid-year break of 2019, 2020 and 2021. The online questionnaire, which examined student demographics, personality, locus of control-4, general self-efficacy, psychological capital and grit, took 15-25 min to complete. Data were prepared and analysed using Statistical Package for the Social Sciences to undertake Structural Equation Modelling. Reporting methods adhered to the STROBE guidelines. RESULTS: The pathway models of grit prior to, at the time of, and after the global pandemic varied slightly as to their predictor variables, however, neuroticism was consistently present. Locus of control and psychological capital also varied over this period with hope having a positive impact, prior to and after the initial crisis, however, negatively impacted grit afterwards. Understanding the key drivers of grit, particularly those essential at or around the time of a crisis guides our understanding of how to better support nursing or healthcare students. These insights enable a greater focus of energies towards malleable attributes that can increase grit levels and better fortify nursing students for challenges they may encounter in practice. These insights also serve to further prepare healthcare, emergency, or other professionals who may encounter regular crises. Within months of a global pandemic occurring, the key predictors of grit were shown to fundamentally alter. Each pathway model varied slightly suggesting the timing of a crisis impacts students' capacity to manage new or novel situations, with hope as a key driver of grit throughout a crisis.

Self-efficacy, grit, and rural career aspirations among early career nurses: a repeated cross-sectional study.

BACKGROUND: Global nursing workforce shortage represents an impediment to the delivery of safe, evidence-based healthcare. Despite collective efforts, a consistent stream of nurses leaving the profession remains, particularly within the first five years of practice, which is exacerbated in rural communities. The aim of the study was to compare self-efficacy, grit, and rural career aspirations among nursing graduates between their second and fourth year of their nursing profession. METHODS: As part of a longitudinal investigation, a repeated cross-sectional design was utilised. Participants included, 117 (response rate 52.2%) who completed an online questionnaire 18-24 months after graduating, and 32 participants (response rate of 21.0%) who agree to repeat the questionnaire 36-48 months after graduating. The questionnaire included demographic, employment, and measures examining general and occupational self-efficacy, grit, and rural career aspirations. RESULTS: No differences between general and occupational self-efficacy or grit were identified between second- and fourth-year nurses. In addition, the importance placed on undertaking rural career also remains unchanged. However, a higher proportion of fourth year nurses were more likely to be in management or were considering leaving the profession. CONCLUSIONS: This examination of early career nurses, now in their second and fourth-year post-graduation highlights self-efficacy, grit, and rural career aspirations remains stable between two- and four-years following graduation, while nursing in their fourth year were more likely to consider leaving the profession. Nursing retention is a 'Wicked Problem' that is unavoidably a complex amalgam of macro, meso and micro factors that we are yet to fully appreciate.

The experience of methamphetamine use disorder and the negative consequences of relapse - a qualitative study.

BACKGROUND: The rate of relapse for people in recovery for substance use disorder is as high as 85% within the first 12 months of recovery, however, research on the lived experience of relapse is limited. OBJECTIVE: The present qualitative study investigated the experience of relapse with people who have Methamphetamine use disorder and the reasons why they returned to recovery. METHODS: The exploratory study recruited five (n = 5) adults who identified as having Methamphetamine use disorder. All participants had sought treatment for more than 12 months, they were attending an addiction support service, and had experienced a relapse within the past 15 months. Interviews were conducted in which participants were asked an open-ended question about their most recent relapse and the negative consequences associated with their drug use. Data were analyzed using thematic analysis. RESULTS: A return to daily drug use led to negative consequences such as relationship breakdowns, poor mental health and acting in ways that went against the participant's morals and values. This study provides an insight into the types of experiences people who relapse after seeking treatment for Methamphetamine use disorder may have and how these experiences can influence their decision to return to recovery. CONCLUSIONS: People who regularly attend a recovery program are still susceptible to relapse. Those who have maintained abstinence for a period of time prior to relapse may be able to assess the negative consequences of their drug use more easily. This prior experience of recovery might influence their decision to stop using again.

A return to daily drug use led to negative consequences of substance misuse.The negative consequences encountered by people who relapse may include relationship breakdowns, poor mental health and acting in ways that go against the person's morals and values.The negative consequences of substance misuse can influence people's decisions to return to recovery.People who regularly attend an addiction support service remain vulnerable to relapse.

"I Don't Really Wanna Go Back. I Know What I've Got in Front of Me." Lived Experiences of Emergency Nurses 2 Years Into the Global COVID-19 Pandemic.

INTRODUCTION: As the coronavirus disease 2019 pandemic continued into 2021 and beyond, unrelenting work pressures continued to mount on the emergency nursing workforce. In the second year of this longitudinal study on emergency nurse lived experiences, staff outlined the continued strain of the profession, highlighting their increasing levels of burnout and identifying early stages of trauma response. METHODS: This research aimed to continue to explore lived experiences of Australian emergency nurses working on the frontline 2 years into the coronavirus disease 2019 pandemic. A qualitative research design was used, guided by an interpretive hermeneutic phenomenological approach. A total of 9 Victorian emergency nurses from both regional and metropolitan hospitals were interviewed between October and November 2021. Analysis was undertaken using a thematic analysis method. RESULTS: A total of 3 major themes and 12 subthemes were extracted from the data. The 3 overarching themes included "On the floor each day," "Can I keep going?" and "What's around the corner?" Increasing levels of emotional exhaustion and burnout were evident, with emergency nurses stating their intentions to leave the profession. DISCUSSION: Deep engagement with participant emergency nurses across 2 years of the coronavirus disease 2019 pandemic has revealed a need for greater emphasis on staff well-being for future maintenance of a resilient and healthy workforce. Without this, lack of support for subsequent nursing cohorts may affect the quality and reliability of care being provided in acute care centers.

Paediatric Emergency Asthma Presentations: Temporal Trends and Representations in Rural Australia.

Asthma is a key illness driving children to present to emergency departments, and although paediatric emergency asthma presentations have been examined, the temporal trends remain somewhat elusive. The aim is to highlight, describe, and model the temporal trends of emergency paediatric asthma presentations, using comprehensive hospital emergency presentation data. A retrospective cross-sectional study examined de-identified paediatric (0 to 14 years) emergency asthma presentation data over a three-year period. Data were obtained from nine healthcare facilities in Victoria, Australia. Episode-level data were collected through RAHDaR, a comprehensive emergency data register which includes missing data (35.0%) among rural health facilities not currently captured elsewhere. Monthly presentation rates demonstrate a significant difference in presentations between fall/autumn and spring, and males had higher presentation rates in February and June-August. Emergency presentations were more likely to occur Sunday-Tuesday, peaking in the time periods of 8-9 a.m., 11 a.m.-12 p.m., and 8-9 p.m. Significant differences were noted between all age groups. Examining previously unavailable rural data has highlighted patterns among emergency asthma presentations for children 0-14 years of age. Knowledge of these by season, month, and day of the week, in combination with time of day, offers scope for more focused workforce education and planning, and nuanced referral pathways, particularly in resource-limited settings.

Developing rights-based standards for children having tests, treatments, examinations and interventions: using a collaborative, multi-phased, multi-method and multi-stakeholder approach to build consensus.

Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020-2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.    Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child. What is Known: • Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. • Professionals report uncertainty and tensions in applying evidence-based practice to children's procedural care. What is New: • This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives. • The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.

"If I Can't Do It, Who Will?" Lived Experiences of Australian Emergency Nurses During the First Year of the COVID-19 Pandemic.

INTRODUCTION: The World Health Organization estimates that approximately 180,000 health care workers have died in the fight against COVID-19. Emergency nurses have experienced relentless pressure in maintaining the health and well-being of their patients, often to their detriment. METHODS: This research aimed to gain an understanding of lived experiences of Australian emergency nurses working on the frontline during the first year of the COVID-19 pandemic. A qualitative research design was used, guided by an interpretive hermeneutic phenomenological approach. A total of 10 Victorian emergency nurses from both regional and metropolitan hospitals were interviewed between September and November 2020. Analysis was undertaken using a thematic analysis method. RESULTS: A total of 4 major themes were produced from the data. The 4 overarching themes included mixed messages, changes to practice, living through a pandemic, and 2021: here we come. DISCUSSION: Emergency nurses have been exposed to extreme physical, mental, and emotional conditions as a result of the COVID-19 pandemic. A greater emphasis on the mental and emotional well-being of frontline workers is paramount to the success of maintaining a strong and resilient health care workforce.

Enhancing Students' Cultural Competency in Tertiary Health Education Using Internationalization at Home: A Literature Review.

BACKGROUND: Internationalization at home (IaH) is a novel concept that aims to integrate intercultural learning into an academic curriculum to promote global collaborative learning and support cross-cultural engagement without leaving home. However, little is known about the experience and perceptions of tertiary health education students who have engaged in IaH. This literature review examines how intercultural learning via IaH can enhance students' sense and capacity of cultural competency. METHOD: A systematic database search of all published studies between 2001 and 2021 was conducted. RESULTS: A total of 113 studies were screened for eligibility, and nine studies were included in the analysis. Three subthemes emerged from the overarching theme of enhancing cultural competence. CONCLUSION: IaH provides an effective and safe learning environment for students to engage in cross-cultural interactions and broaden their multi-cultural views and understanding. [J Nurs Educ. 2023;62(4):199-206.].

Changes in grit and psychological capital at the time of major crisis: nursing students' perseverance, resources, and resilience.

OBJECTIVES: To examine changes in grit and psychological capital among nursing students prior to, during the height of the pandemic, and more than 12 months after the initial pandemic announcement. METHODS: A cross-sectional study design addressed the aim of the study. Nursing students undertaking a three-year baccalaureate degree between 2019 and 2021 were included. RESULTS: Mean grit levels among the n=818 unique student participants were significantly lower in 2020 than in 2019 and 2021; however, no significant difference was detected for psychological capital over the same period. CONCLUSIONS: Although normative day-to-day challenges may aid grit development, a major event has a negative impact yet has a buffering effect of negative life events at the time of a crisis. The study further placates that psychological capital remains malleable and open to change at the time of a crisis and may be an essential mechanism to mediate grit and has the capacity to influence student performance over time. It remains essential to develop grit through the mediating elements of psychological capital to enable nursing student to undertake academic studies, particularly in the event of major challenges, such approaches may further enable students' endurance to withstand major crises as they enter the workforce.

Totally devoted to you: A qualitative study examining the experiences of sacrifice among pharmacists in rural and regional areas.

BACKGROUND: The health of rural and regional communities is routinely identified as poor and access to healthcare services is often limited. Rural and regional pharmacists are well placed to deliver a variety of high-quality services to their community, however there is a limited examination of the complexities of their role in rural contexts. This study seeks to examine the types of personal sacrifices and what impact these may have among pharmacists working in rural and regional communities of Australia. METHOD: A qualitative approach was adopted to examine the experiences of pharmacists working in public health service and private community pharmacies across 13 rural communities in Australia. Purposive sampling was used to recruit pharmacists as part of a larger study examining the efficacy of a workforce recruitment tool (PharmCAQ). As part of the development of the tool, a one-on-one interview were conducted. RESULTS: A total of 20 participants were recruited. Two major themes emerged: Above all the community and More than just a script monkey that embodies the experiences of pharmacists. Centred around self-sacrifice, the first theme captures the tension that is experienced by these professionals as they tread an unsustainable path for the benefit of the community. The second theme provides some insights into the complex nature of the rural and regional context that is juxtaposed with that of their urban counterparts. CONCLUSION: Pharmacist in rural and regional areas offer a highly skilled and accessible resource to better address the growing needs of those living in rural and regional areas. Despite the opportunities that exist to expand the role of pharmacists in these areas and to capitalise on their expertise, there is a growing need to find ever better ways to support those who support others.

The Use of an Interactive Social Simulation Tool for Adults Who Stutter: A Pilot Study.

This study reports a user evaluation of a DVD-based social simulator, developed for people who stutter to potentially gain confidence in using a learned fluency technique. The aim was to examine and evaluate the pilot of the DVD-based social simulator, Scenari-Aid, to inform the development of an online version of the program. Thirty-seven adults who were stuttering were recruited to the study from non-professional groups in Australia. The DVD comprised scenarios with actors in real-life settings that were designed to elicit verbal responses. Participants worked through the scenarios at their own rate and then completed an online survey. The survey comprised 29 statements requiring responses on a 5-point Likert scale and provided information about users' perceptions of participating in the social simulations. There was high positive agreement among the participants on all statements, the most important being that they perceived the scenarios represented in everyday speaking situations and that they felt immersed in them. Participants also agreed that both their fluency and confidence increased in everyday speaking situations as a result of working through the DVD scenarios. The developers were satisfied that, despite the subjective nature of the findings, the study provided sufficient support for constructing the online version, which is now available to the public free of charge. Further research is needed to provide empirical evidence of the contribution it can make to the efficacy of speech programs for adults who stutter.

Professionalising care into compliance: The challenge for personalised care models.

One of the most basic understandings of nursing is that a nurse is a caregiver for a patient who helps to prevent illness, treat health conditions, and manage the physical needs of patients. Nursing is often presented as a caring profession, which provides patient care driven by ideals of empathy, compassion and kindness. These ideals of care have further been foregrounded through the development and implementation of stress on patient centred care (PCC) and/or person-centred practice (PCP). Although the idealisation of nursing as a caring profession is common, and one certainly seen as integral by nurses and written into the heart of regulatory documentation, we contend that the actual delivery of care is being undercut by the very regulatory climate that strives to professionalise care. As we outline, with specific reference to the context of Australian Nursing, this transformation delivers a commodified, even McDonaldized, model of patient management rather than care. It seems that even with its explicit stress on PCC and PCP, Australian Nursing cannot live up to its own care ideals. Having outlined this problem, the paper then demonstrates the ways in which PCC is thwarted at the coal face of nursing practice and that there must be an institutionalised change to be able to provide genuine patient-centred care.

Hermeneutic Constructivism: One ontology for authentic understanding.

Nursing and nurses rely upon qualitative research to understand the intricacies of the human condition. Acknowledging the subjective nature of reality and commonly founded in a constructivist epistemology, qualitative approaches offer opportunities for uncovering insights from the perspective of the individual participants, the insider's view, and the construction of representations that maintain an intimacy with the subject's realities. Debate continues, however, about what is needed for a qualitative construction to be considered an authentic understanding of a subject's realities. Authenticity in the context of qualitative research has been described as entailing consideration of a number of well-trodden dimensions: fairness, ontological, educative, catalytic and tactical. Taking these dimensional requirements as key, this paper argues that authenticity may not always be as well-developed through some of the standard practices in qualitative research as perhaps expected. In particular, qualitative understandings of authenticity stress that participants should not be merely reported on but instead should be dynamically involved in and changed by the constructions and interpretations of data developed throughout the research process. As this paper illustrates, such engagements appear problematic for qualitative research approaches that are beholden to designative commitments in the context of language and meaning-making and which tend to prioritise commonality and generality at the expense of individual authenticity. An alternative qualitative approach, Hermeneutic Constructivism, is proposed as better able to achieve the requirements of the dimensions of authenticity. As outlined, this approach is well-placed to present an understanding of human experience through a genuinely expressivist approach and transcends the stress upon the common or the general that can be pervasive and problematic.

Sustaining rural pharmacy workforce understanding key attributes for enhanced retention and recruitment.

OBJECTIVE: To pilot the Pharmacist Community Apgar Questionnaire (PharmCAQ) and evaluate its usability and capacity to develop a greater understanding of the unique factors that impact the rural recruitment and retention of pharmacists. DESIGN: Cross-sectional design involving face-to-face, telephone or video conferencing interviews. SETTING: Twelve rural communities across Tasmania and Western Victoria, Australia. PARTICIPANTS: Participants (n = 24) included pharmacists, a Director of Clinical Services, pharmacy practice managers and senior pharmacy assistants. MAIN OUTCOME MEASURES: Interviews enabled the completion of the PharmCAQ, which assigns quantitative values to 50 key factors to ascertain a community's strengths and challenges associated with recruitment and retention and their relative importance to the pharmacist workforce. RESULTS: The cumulative PharmCAQ scores indicated the tool was sensitive enough to differentiate high- and low-performing communities. Overall, the highest-rated factors considered most vital to pharmacist recruitment and retention were the reputation of the pharmacy, the ability of the pharmacist to be independent and autonomous, the loyalty of the community to the pharmacy, the level and stability of monetary compensation and the breadth of tasks available to a pharmacist. CONCLUSIONS: This study identified the strengths and challenges of participating communities and provided an insight into the shared factors to consider in recruiting and retaining pharmacists. Further, each community has unique strengths that can further be promoted in recruitment, flagging where limited resources are best used to address site specific challenges. This is more likely to ensure the matching of the right candidate with the right community.

The Pharmacy Community Apgar Questionnaire: a modified Delphi technique to develop a rural pharmacist recruitment and retention tool.

INTRODUCTION: An adequate healthcare workforce remains essential for the health of rural communities. Strategies to address rural health workforce challenges have often centred on the medical and nursing workforce; however, addressing the rural pharmacist workforce also remains critical as they are often the first point of contact for health advice. Initiatives have increased pharmacist supply; however, key issues such as poor attraction, recruitment, and retention to rural areas remain. The aim of this study was to support the recruitment and retention of pharmacists in rural areas of Australia through the development of the Pharmacy Community Apgar Questionnaire (PharmCAQ). METHODS: A modified Delphi technique was employed to develop the PharmCAQ. A panel of experts were purposively selected. Eight representatives were from organisations with rural experience relevant to the study including the Society of Hospital Pharmacists of Australia, the Pharmaceutical Society of Australia, the Pharmacy Guild of Australia, the Pharmacy Board of Australia, and a representative of a government health agency, who also leads a hospital pharmacy. Three additional participants included local and international academics with health policy and rural health workforce expertise. All participants participated in three separate focus groups of 45-60 minutes duration, where the review and refinement of factors that drive recruitment and retention of pharmacist were discussed. Face and content validity was achieved through the representatives, while internal consistency was achieved when the tool was piloted among 10 rural pharmacists in rural Victoria. RESULTS: Fifty key factors that impact the recruitment and retention of pharmacists were identified, developed and succinctly described. All factors were grouped into five classifications: (1) geographic, (2) economic and resources, (3) practice and scope of practice, (4) practice environment and (5) community practice support. After final consensus, the factors and their definitions formed the final questionnaire. Lastly, the reliability of PharmCAQ was determined, with a Cronbach's alpha coefficient of 0.852. CONCLUSION: While the development and use of the Apgar questionnaire for the recruitment and retention of health professionals is not a novel idea, seeking to specifically focus on pharmacists is unique. However, 10 factors were similar to factors associated with rural recruitment and retention of both physicians and nurses; they encompassed geographic, community support, and economic and resource factors. Regardless of similarities or differences between health professions in terms of recruitment and retention, as a mechanism for addressing the worsening health professional shortage currently experienced in rural areas, the PharmCAQ was developed to support the recruitment and retention of the pharmacist workforce in rural areas.

Empowerment as an alternative to traditional patient advocacy roles.

There has long been acceptance within healthcare that one of the roles that nurses fulfil is to do with patient advocacy. This has historically been positioned as part of the philosophical and inherent requirements of the nursing profession at large and is supported through shared conceptualisations of the nursing profession. Such conceptualisations are communicated to nursing professionals by way of first their education, and second their professional codes, guidelines and standards for practice. The focus on advocacy is further embedded within patient-centred care frameworks and concepts of the nurse-patient therapeutic relationship. Nurses have also been considered ideally placed to undertake the work of patient advocacy due to the 24/7 nature and intimacy of the care provided. What this means is that nurses are under the impression that that they must be an advocate for their patients through their nursing practice. However, for a fundamental concept of nursing, advocacy is poorly defined, and practices commonly associated with advocacy are undercut by the professionalisation of nursing and other constraints. In addition, nursing standards and frameworks of care are being actively reframed around ideas of empowerment which do not necessarily fit well with those of advocacy. This article thus suggests that it is time to recognise that the work of advocacy is no longer representative of what nurses (can) do in practice, and to explicitly reorient conceptualisations of nurse practice around empowerment. This article will further analyse what this may look like in practice.