Are there more healthcare workers in our community? A phenomenological exploration of factors influencing local hospital and primary care worker re-engagement in rural Australia

Early Abstract:

Introduction: The local healthcare workforce is critical to rural communities, which face more complex health conditions than urban counterparts. Workforce shortages exacerbate strain on rural healthcare systems and create service access barriers. To date, retention and recruitment strategies have struggled to resolve staffing issues. This study investigated an overlooked local resource: hospital and primary health care workers previously employed or working at less than full-time capacity in rural Queensland. We explored barriers and enablers to increasing their working hours or returning to the workforce.
Methods: A descriptive phenomenological approach was co-designed by a collaborative including Western Downs Regional Council, Toowoomba and Surat Basin Enterprise, the Queensland Government, Rural Medical Education Australia, and Griffith University.
The study was conducted in the Western Downs region of Queensland, encompassing 37,937 km² with approximately 35,000 residents served by two rural hospitals and several smaller health facilities. Participants were Western Downs residents aged 18+ years, currently employed at less than full-time capacity or previously employed as healthcare workers in the region. Recruitment occurred via online workforce survey and word-of-mouth within rural communities. Semi-structured phone interviews of approximately 30 minutes explored workforce participation barriers and enablers. Interview data were analysed using descriptive phenomenology and inductive thematic analysis by two researchers independently using NVivo, with consensus achieved through discussion.
Results: Thirteen healthcare professionals participated (11 nurses, 2 doctors).Four main themes were identified: Proactive Burnout Prevention, Inadequate Staffing, Rural Context, and Enabling Workforce Participation. Overall, workers lacked willingness or capacity to work additional hours. Reasons included proactive burnout prevention and emotional exhaustion, with participants working at their full personal capacity despite part-time hours. Inadequate staffing created negative feedback loops, where increased workloads accelerated turnover, which further increased individual workloads and contributed to burnout. Additional barriers included dissatisfaction with management, workplace culture, and workload. Childcare availability was the greatest limiting factor for increasing hours. Housing, recreational infrastructure, and lack of community engagement were additional barriers to retaining staff hired from outside the local community. Enabling workforce participation encompassed three sub-themes: workplace experience (supportive cultures, flexible rostering, adequate staffing levels), training (professional development, retraining opportunities, educational support), and rural liveability (childcare availability, housing supply, community amenities, family-friendly infrastructure).
Conclusions: Findings suggest many rural part-time, casual, and unemployed healthcare workers could not easily increase workforce contribution due to operating at full personal capacity while managing burnout risks. While findings primarily reflect nursing and medical perspectives, structural barriers (childcare, housing, community supports) likely affect all rural healthcare disciplines. Novel insights include healthcare workers' proactive burnout prevention strategies, and the critical role of community-level supports in workforce retention. Rural employers and communities should ensure fundamental social supports are available, foster psychologically safe workplace cultures, provide flexible working arrangements, and invest in community amenities to attract and retain healthcare workers. Sustainable rural healthcare workforce solutions require coordinated efforts addressing both workplace conditions and community infrastructure, moving beyond traditional recruitment-focused approaches.
Keywords: Casual, burnout, health personnel, rural health, job satisfaction, part-time, recruitment, retention, retired, return to work, qualitative research, workforce