Original Research

Factors associated with rural work for nursing and allied health graduates 15–17 years after an undergraduate rural placement through the University Department of Rural Health program


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Denese Playford1
BA (Hons), MCS, PhD (West Aust), Associate Professor, RCSWA, School of Medicine *

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Monica C Moran2
DocSocSc, MPhil(OT) GCertClinED, DipCOT, Associate Professor

Sandra Thompson3 FAFPHM, Professor and Director


1 Rural Clinical School, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia

2, 3 Western Australian Centre for Rural Health (WACRH), The University of Western Australia, PO Box 109, Geraldton, WA 6531, Australia

ACCEPTED: 18 November 2019

early abstract:

Background: Very little is known about the long-term workforce outcomes, or factors relating to these outcomes, for nursing and allied health rural placement programmes. 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 practicing 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.

Objective: 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).

Design: Longitudinal cohort study, with measures taken at the end of the placement, at one year and at 15–17 years post-graduation.

Participants: 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.

Main outcome measure: Factors associated with location of practice as being either urban (RA1) or rural (RA2-5).

Results: Of 776 graduates initially surveyed, 474 (61%) were able to be contacted in the year after their graduation, and 244 (31%) were identified in 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 (OR 3.19, CI 1.7–1­ 5.6).  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 of nursing and allied health graduates who had undertaken a rural placement as a student 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.