Amorphous practice: Nursing in a remote Indigenous community of Australia

Working well: a systematic scoping review of the Indigenous primary healthcare workforce development literature

“…& professional org. PoliciesCommunities & culturesPHC policies & environmentsCharacteristics of health practitionersRecruitment & retentionRoles, teamwork & capacitySupervision, mentoring & supportWorkforce capacityWorkforce sustainabilityResources to enable growthHealthcare improvements(Ahuriri-Driscoll et al, 2015) [47]XXXXX(Boulton et al, 2009) [48]XXXXX(Browne et al, 2013) [36]XXXXX(Chernoff & Cueva, 2017) [37]XXX(Conway et al, 2017) [38]XXXXXXXX(Cramer, 2006) [39]XXXXX(Gampa et al, 2017) [40]XXXXX(Katz, O’Neal, Strickland, & Doutrich, 2010) [49]XXXXXX(Keltner, Kelley, & Smith, 2004) [50]XXXXXX(King et al, 2017) [41]XXXX(Laufik, 2014) [51]X...…”

“…Studies also identified the role of government legislation and/or policy in regulating the recruitment, terms and length of employment, financial accountability requirements, quality of working life, capacity and scope for career development and support for groups of healthcare professionals [47, 51, 52, 56, 59]. Two studies identified the need for improved clarity in government legislation and/or policies concerning the translation of nationally consistent competency standards and qualifications into job specifications and training pathways for IHW [56]; and practice responsibility for nurses and IHW [39, 56]. One study [50] identified the importance of partnerships between national/state/local government departments and PHC to keep Indigenous health issues on the radar.…”

“…Conditions that enhanced workforce development and/or implementation were: long-term commitment from managers to Indigenous health improvement [42, 43, 53], strong clinical leadership [43], and sound relationships between managers with workers [43]. A lack of management support had detrimental effects including: a lack of enthusiasm for work [45]; ineffective team work [44]; poorly designed electronic patient records or failure to share them [38, 44]; not knowing role expectations [44, 54]; having to prioritise acute care demands over preventive or chronic disease management [42–44, 59]; loss of continuity of care and patient trust [38]; disquiet over the standard of care provided [39, 54]; and staff frustration, stress and turnover [38, 41, 42, 44, 45, 48, 49, 51, 54, 57].…”

“…Seven studies highlighted the impact of staff shortages (particularly in remote PHC) on the employment conditions of the remaining workforce. Staff shortages resulted in a heavy reliance on short-term agency-employed nurses and high staff turnover [7, 38, 39, 42, 44, 46, 58]. Partly as a result of workforce shortages, studies described the complexity of roles of remaining workforce groups [42, 43, 48, 49, 51, 58, 60], time pressures in meeting community members’ healthcare needs [38, 44, 47], the need for greater management support [38, 42, 44, 57], the absence of uniformity in training, roles, or conditions of employment [51, 58, 60], and being given leadership roles which staff were not prepared for [49].…”

“…Nurses experienced being ‘dropped’ in the remote area where practice rules are disregarded and ‘no-one sees your practice’; ‘crossing’ or ‘overstepping boundaries’ occurred regularly; and practice ‘outside the scope of nursing’ was expected. Cramer [39] urged nurses to reflect on how they could meet their professional obligations given these workforce conditions, since the consequence was to infringe on the rights of Aboriginal people to adequate standards for safe health care [39].…”