Table 3 Meta-synthesis of recruitment and retention factors
| Â | Recruit factors | Retention factors | Recruitment and retention strategies |
|---|---|---|---|
Bent 1999 | Working with aboriginal populations, team environment, permanent position, diversity of work, bush travel Deterrents: insufficient staff, management and organizational problems, professional isolation, vacant positions results in increased work | Access to professional development, understanding of rural practice skills by management and support from management, cost of living, networking and communication with peers | Cross-cultural training / education, professional networking, management support, information technology, heightened profile of rural practice- focus on the positives of living/ working in rural, acknowledgement of rural practice as a specialty |
Butler & Sheppard 1999 | Rural childhood and final placement in rural (regardless of mandatory) Students felt prepared to take up positions in rural areas Rural training module did increase interest in working in a rural area and awareness of life in rural community | Retention factors not identified Prior background in rural inconclusive Similar levels of support noted for rural and metro graduates | Support and professional development critical for new graduates regardless of geographical location |
Mills & Millsteed 2002 | Appeal of the opportunity, variety of tasks Deterrents: lack of orientation to position and to community, lack of support, isolation, high workload | Personal factors- social sphere, compensation Professional factors-rural practice issues, rural experience Retention is the balance between incentive to stay and incentives to leave | Orientation and assistance with building contacts |
Lee & MacKenzie 2003 | Rural lifestyle, rural background, clinical opportunity Deterrents: perceived lack of support | Rural placement reinforces intentions to stay in rural community; professional support valued | Recruitment from rural background and rural fieldwork experience. Peer support, feedback and evaluation, social contact and support networks |
Denman & Shaddock 2004 | Lifestyle and personal factors, evidence of support for professional development, ‘critical mass’ of staff, professional supervision, career structure | Reasons to leave: partner moves away, resource limitations, insufficient support, opportunity for professional development, vacancies, work not valued by management | Flexibility by management (accommodation for concerns relating to why people leave or stay), creation of cross-sectorial teams, remuneration and employment conditions individualized |
Steenbergen & MacKenzie 2004 | Professional support to build professional identity | Wide variety of resources required Reasons to leave depleted resources and decreased education | New graduates require support and professional development to establish professional identity regardless of geographical location |
Devine 2006 | Rural background (self or spouse), attracted to position not location, multidisciplinary team, personal autonomy, development of skill Undergraduate program focused on problem solving skills and ability to work autonomously | Professional support including educational preparation and development Clinical placement in rural setting did not adequately prepare for rural practice | Preparation by undergraduate course (including subjects such as health promotion and primary health care, autonomy) Development of skills and support for competency throughout career |
Gillham et al 2007 | Rural background, rural placement or rural connection, career opportunities (rotating positions for new graduates), financial incentives, career progression, mentoring, access to professional support, supervision, social networks (especially for students) | Career/ professional development, social network opportunities, management style & organizational policy (collaboration between staff & management, consultation & open communication), flexibility in work schedule, financial remuneration for accommodation & relocation | Mentors, adequate human resources in order to best practice, career opportunities |
Thomas & Clarke 2007 | Knowledge of community, role of health care professional in community | Relationships with other professionals and community; time management, responsibility in the community, personal resourcefulness, adventure Reasons to leave: stress, responsibility | Development of skills and attributes in training programs |
Boshoff & Hartshorne 2008 | Variety of caseload and services delivered | Reasons to leave: limited resources, high client to therapist ratio, lack of professional support, strategies and collaboration | Service delivery model specific to the setting, networking and collaboration to reduce isolation, workplace support, account for recruitment factors and profile of practice |
Le & Kilpatrick 2008 | Autonomy, the family oriented nature of rural communities | Reasons to leave: cultural shock, lack of social and emotional support, communication and lack of collegiality | Professional development, assistance in accommodating cultural needs and decreasing distance through connections with colleagues |
Manahan et al 2009 | Rural background, availability and accessibility of training programs in rural areas determined career choice, decision to work in rural prior to work, need for health care professionals in rural community, positive past experience in rural community | Age and stage of life, proximity to family, career advancement opportunities, peer support, affordability, lifestyle, congruent with life values | Account for age and stage of life, values in addressing personal and professional factors, admissions selection criteria of training programs |