Factors affecting job satisfaction of Aboriginal mental health workers working in community mental health in rural and remote New South Wales

Abstract

Objective The aim of the present study was to identify factors affecting the job satisfaction and subsequent retention of Aboriginal mental health workers (AMHWs). Methods Five AMHWs working in New South Wales (NSW) for NSW Health in rural and remote community mental health (CMH) services participated in in-depth, semi-structured interviews to understand how employment and rural living factors affected workers' decisions to stay or leave their CMH positions. Results Using a constructivist grounded theory analysis, three aspects negatively impacting the job satisfaction of AMHWs were identified: (1) difficulties being accepted into the team and organisation; (2) culturally specific work challenges; and (3) professional differences and inequality. Conclusions Policy and procedural changes to the AMHW training program may address the lower remuneration and limited career opportunities identified with regard to the Bachelor Health Sciences (Mental Health) qualification. Delivering training to increase levels of understanding about the AMHW training program, and cultural awareness generally, to CMH staff and NSW Health management may assist in addressing the negative team, organisational and cultural issues identified. What is known about the topic? The Bachelor Health Sciences (Mental Health) qualification and traineeship pathway undertaken by AMHWs differs significantly from that of other health professionals working in NSW Health's CMH services. The health workforce literature identifies that each health professional group has its own culture and specific values and that forming and maintaining a profession-specific identity is an extremely important aspect of job satisfaction for health workers. What does the paper add? AMHWs working in rural and remote NSW CMH services commonly experience low levels of job satisfaction, especially while undertaking the embedded training program. Of particular concern is the health sciences qualification not translating into NSW Health's 'professionalised' workplace, as well as having negative effects with regard to remuneration and career opportunities within NSW Health. In addition, role challenges involving cultural differences and managing additional professional and personal boundaries negatively affects the job satisfaction of AMHWs. What are the implications for practice? The current structure of the AMHW training program creates workplace conditions that contribute to job dissatisfaction among rural and remote-based AMHWs. Many issues could be rectified by NSW Health making changes to the degree qualification obtained under the training program, as well as raising the level of understanding about the program and Indigenous cultural awareness generally among CMH staff and NSW Health management.

“We are everything to everyone”: a systematic review of factors influencing the accountability relationships of Aboriginal and Torres Strait Islander health workers (AHWs) in the Australian health system

“…AHWs’ connection with community, while described as essential to developing client and community trust and as a source of personal satisfaction and pride, also resulted in AHWs feeling like they are ‘everything to everyone’ [ 12 , 38 ]. AHWs in multiple studies described feeling like they were never off-duty even after work hours [ 6 , 37 , 38 ].…”

“…AHWs in multiple studies described feeling like they were never off-duty even after work hours [ 6 , 37 , 38 ]. A blurring of private and professional life was also described [ 35 ], with AHWs feeling a responsibility to help people in the community: ‘you’ve got to give them something, or help in some way’ [ 12 ]. The high community expectation experienced by some AHWs was also described [ 38 , 39 ] and included fear of blame if and when something went wrong [ 35 ].…”

“…AHWs (encompassing AHPs) may be employed by state or territory health departments to work in government hospitals or primary care services; by Aboriginal community controlled health services; or by other entities delivering health and allied services. Remuneration is dependent on the employing organisation, but AHWs and AHPs are typically among the lowest paid in both government and non-government organisations [ 12 , 13 ].…”

“…Lack of state or national scopes of practice for example, have resulted in pressure on individual AHWs to fulfil ambitious localised terms of reference without sufficient support, supervision or resourcing [ 18 , 19 ]. Challenges relating to the ways in which AHWs balance (sometimes competing) obligations to their communities and their clinical service managers also exist [ 4 , 12 ]. Such issues appear to be contributing to difficulties in both recruitment and retention, with substantial numbers of unfilled AHW posts nationally pointing to ongoing and potentially intensifying issues of job satisfaction [ 8 ] that bring the very sustainability of the role into question.…”

Promoting perceived insider status of indigenous employees

“…It is important to pay adequate salaries as the feeling of being insufficiently compensated for a stressful or heavy workload has been shown to contribute to high turnover rate of indigenous employees (Cosgrave et al, 2017;Ellemers et al, 2004). Finally, PIS is favored by 621 Perceived insider status of indigenous employees participatory decision making (Hill et al, 2001;Kuntz et al, 2014;Roche et al, 2018;Shore et al, 2011) and by capacity to influence organization development (Ding and Shen, 2017;Hui et al, 2015;Loxton et al, 2012;Mor Barak et al, 1998;Pelled et al, 1999;Pless and Maak, 2004;Randel et al, 2018;Whiteside et al, 2006).…”