Factors supporting retention of aboriginal health and wellbeing staff in Aboriginal health services: a comprehensive review of the literature

Abstract

Introduction Aboriginal Health and Wellbeing staff are crucial for successful primary health care for Aboriginal communities. However, they are often affected by high rates of stress, burnout, and staff turn-over, which can impact primary health care delivery to Aboriginal peoples. The aim of this review was to identify organisational factors that help support the retention of Aboriginal Health and Wellbeing staff in Aboriginal Health services. Methods A comprehensive literature review was undertaken. Eleven electronic databases were searched for papers published between 2002 and 2017 and supplemented by hand searching. Papers were included if they were in English, full text, peer-reviewed, and had a focus on retention of Aboriginal Health and Wellbeing staff, or health staff in comparable roles working in Aboriginal health services. Twenty-six papers were included in the final review. Results Five key themes were identified as being important to the retention of Aboriginal Health and Wellbeing staff in Aboriginal Health Services: feeling culturally safe and secure within the workplace; teamwork and collaboration; supervision and strong managerial leadership and support from peers (to debrief, reflect, receive emotional support and strengthen coping mechanisms); professional development (the opportunity for skill development and role progression); and recognition (of work load, quality of work performed, being trusted to work autonomously, and financial remuneration that reflected the high pressure of the role). Conclusion Aboriginal Health and Wellbeing staff are fundamental to successful primary health care for Aboriginal peoples. State and Federal Governments should consider formalising recognition of the significant cultural knowledge that Aboriginal Health and Wellbeing staff bring to their roles. Formal recognition could also pave the way to revise remuneration as well as ensure adequate support mechanisms are put in place to improve retention and reduce stress and burnout affecting Aboriginal Health and Wellbeing staff.

“We’re very much part of the team here”: A culture of respect for Indigenous health workforce transforms Indigenous health care

“…Work environment is a fundamental predictor of retention for the Indigenous health workforce [ 30 , 32 , 41 ]; however, a culturally safe work environment does not just happen through good will and good intentions. Both services have made consistent and ongoing efforts over a number of years to develop a culturally safe work environment, expressed both in the physical environment (such as flags, artwork and Acknowledgement of Country plaques) and the culture of the organisation, which is vital for creating a culturally safe space for Indigenous patients [ 21 , 32 , 47 ]. The importance of the physical environment in creating a culturally safe environment has been previously reported [ 16 , 34 ].…”

“…Developing the culture of an organisation, while less tangible than the physical environment, is both harder and of greater importance for creating a culturally safe workplace [ 30 , 32 ]. Both services worked to develop the culture of the organisation, including through mandatory cultural awareness training.…”

“…The literature makes clear that having clearly documented roles, scope of practice and responsibilities helps empower Indigenous health professionals in their roles. This occurs through managing their workloads, clarifying employee, employer and community expectations, and encouraging productive working relationships, which in turn contribute positively to retention [ 30 , 32 , 57 ].…”

“…Furthermore, some Indigenous health professionals chose not to self-identify in mainstream organisations to avoid discrimination or being given responsibility for everything ‘Indigenous’ [ 29 , 30 ]. Health services require policies and strategies to recruit and retain Indigenous staff, yet the literature reports few effective interventions around supporting an Indigenous health workforce [ 30 – 32 ].…”

Strengthening Indigenous Australian Perspectives in Allied Health Education: A Critical Reflection

“…Many of the health issues Indigenous Australians experience are those that are likely to greatly benefit from individual and inter-disciplinary allied health care (Ewen et al, 2019). A person with Type 2 diabetes mellitus, for example, may benefit from allied health care such as podiatry, orthoptics, counselling, and psychology, because of frequent co-morbidities of lower-limb infections and amputation, diabetic retinopathy, and risks of poor mental health and social isolation (Australian Institute of Health and Welfare [AIHW], 2016;Cunningham, 2010;Deroy & Schütze, 2019).…”