Abstract
Objective. This paper describes stages in the research literature related to recruitment and retention of health professionals to rural health careers.
Data sources. Electronic databases accessed included Medline, CINAHL, Social Sciences and Humanities. Key search terms included 'high school', 'career choices', 'rural', 'attachment', 'recruitment' and 'retention'.
Data synthesis. We identified four stages: (1) making career choices; (2) being attached to place; (3) taking up rural practice; and (4) remaining in rural practice. This is termed the 'rural pipeline'. However, as some stages of the 'rural pipeline' refer specifically to the medical profession, we propose an extension of the notion of the medical 'rural pipeline' to include other professions such as nursing, midwifery and allied health.
Conclusions. Utilising the 'rural pipeline' as a template for medicine, nursing and allied health would strengthen current approaches to the recruitment and retention of professionals in rural areas and provide a consolidated evidence base that would assist in policy development to improve availability and service provision of the rural health workforce. Future research that utilises a multidisciplinary approach could explore how the role and relationship between place and identity shape needs of career choices and would provide important information to advance the practical aspects supporting rural health career pathways.
Additional keywords: health workforce, health professionals.
What is known about the topic? A universal shortage of rural health professionals is a significant issue and is becoming critical in rural areas of Australia. Although there have been many studies, internationally and in Australia, there are several gaps in recruitment and retention of rural health professionals that require further attention.
What does this paper add? This paper examines workforce studies related to recruitment and retention of health professionals to rural health careers. The pipeline, however, refers mainly to the medical profession. The stages in this paper extend the notion of the medical 'rural pipeline' to include other professions such as nursing and allied health. This paper focusses on literature concerning developed countries such as Australia, New Zealand, Europe, the USA and Canada and identifies several proposed areas of future research.
What are the implications for practitioners? The literature clearly identifies important issues for the rural health workforce. Having an understanding of the key issues underpinning the recruitment and retention of health professionals in rural areas allows the development and enhancement of appropriate workforce strategies. Utilising the 'rural pipeline' as a template for medicine, nursing and allied health would strengthen current approaches to the recruitment and retention of professionals in rural areas and provide a consolidated evidence base.
Introduction
A shortfall of health professionals in rural areas is a key global issue.1 In Australia, a reported inequitable shortfall of many heath professionals in rural and remote locations2-4 occurs in a context of disadvantage. This inequity of access to health services results in poorer health outcomes. Recent labour force figures indicate that the supply of health professionals decreases with increasing remoteness. For instance, numbers of medical practitioners (including specialists, surgeons and generalists) and allied health professionals are higher in capital cities and become lower with increasing remoteness.5,6 Conversely, the nursing labour force (including registered nurses and midwives) was higher in inner regional areas than capital cities, but numbers still decrease with increasing remoteness.7 However, the supply of enrolled nurses was higher in inner and outer regions of Australia with similar decreases with increasing remoteness.7 Evidence regarding the different patterns of distribution suggests that a range of initiatives is necessary to address an ongoing challenge of health workforce shortages4 and is an imperative to improving health outcomes.
The universal shortage of rural health professionals has led to a significant amount of research. These studies identify recruitment and retention of rural health professionals as different complementary approaches. The literature about recruitment and retention into the rural health workforce has sought to understand a career pathway. This includes how high school students make decisions about their career pathways, how individuals construct their career choice based on their personal identity and how an individual's attachment to place interacts with their decision to enter a professional practice in a rural location and ultimately be retained in that workforce.
This paper aims to describe stages in the research literature related to recruitment and retention of health professionals to rural health careers and focusses on literature concerning developed countries such as Australia, New Zealand, Europe, the USA and Canada. The literature review included the use of electronic databases such as Medline, CINAHL, Social Sciences, Humanities and Google Scholar, using a combination of key terms that included high school, career choices, rural, attachment, practice, recruitment and retention. Within the literature the term 'rural' varied.8 Where authors stated they had undertaken their study in rural communities these studies were also included in the literature review. Additionally, relevant urban-based studies identi- fied in the literature review have also been included in our discussion. Definitions of health professionals also varied and were not necessarily universal. Search terms used were broad and included medical practitioners, general practitioner, nurse, midwife, enrolled nurse, nursing, allied health, health practitioners.
This literature review forms the basis of a planned future study that aims to explore perceptions of rural high school students and career advisors in relation to career choices in the health sector.
Issues
Based on our literature review, we identified four stages of rural career pathways including making career choices, taking up rural practice, being attached to place and remaining in rural practice. This pathway involves both a professional and personal journey. The stages represent a complex yet flexible framework that is not linear or prescriptive but has a similarity to the 'rural pipeline' described in the medical literature. The rural pipeline has been reported in the literature as a metaphor for describing the passage of medical students from the point of developing their aspiration for a career in medicine through the influence of the education process to retaining General Practitioners (GPs) in rural locations. 9 According to Henry et al.10 there are four stages to the pipeline: structured contact between secondary schools and medical professions, rural student selection into medical programs, a curriculum oriented towards rural health that includes rural exposure during medical training and measures to address retention, that is a system of educational and professional support for practising GPs. Some stages of the 'rural pipeline', however, refer specifically to the medical profession. The stages in this paper extend the notion of the pipeline to include other professions such as nursing and allied health.
Stage 1. Making career choices (structured contact between schools and health professionals)
The first stage of the 'rural pipeline' refers to structured contact between secondary schools and medical professions, which we have named 'making career choices'. The first stage of the pipeline already includes promotion of health careers such as medicine, nursing and allied health.11,12 However, these approaches do not take into consideration some of the socioeconomic barriers that may exist for rural students. For instance, gender stereotyping in rural communities and in particular, the high regard that women place on the humanistic aspects of work and their desire to help others.13,14 The socialisation of males towards masculine careers in small rural communities reflects the underlying culture and limited exposure to a range of health professions.15,16 The domination of gendered and classed roles present within rural communities thus has an influence on gender roles17 and gender relations18,19 that in turn can potentially influence career choices. There has been some attempt to address these issues through Rural Health Clubs, which provide a group of health students with a broad range of multi disciplinary experience; however, inadequate resources are a continuing problem.20 Rural Health Clubs are part of the Australian National Strategy specifically aimed at improving the rural health workforce.
In addition, issues related to socioeconomic status is supported in the literature as having an influence on career aspirations. For instance, Connolly and Healy21 identified that for middle class boys in Belfast, education was a fundamental condition that was necessary for entry into their chosen career. However, for working class boys education was not important as many of the role models (brothers, fathers and uncles) having occupations that did not require formal qualifications. Their aspirations were limited to what they knew. Hence, locality is an important mediator in the career aspirations of some students and there is a need to assess this influence in a rural setting. Ensuring that there is an adequate mix of health professionals from differing gender and socioeconomic status could strengthen the first stage of the rural pipeline. Consequently, an understanding of the interplay of gender, identity and place with an individuals experience is crucial to understanding the influence of these elements on career choices.
Stage 2. Being attached to place (rural student selection)
The second stage of the 'rural pipeline' specifically refers to rural student selection into medical programs.10 We refer to this stage as 'being attached to place'. Several reports in Australia and other countries suggest that attachment to place predicts rural practice supporting the development of procedures to select rural students into medical programs in Australia.22-25 Long-term residence in a rural community contributes to this attachment by increasing social bonds among members of the community.26 Lyle et al.27 point out that within the University of Sydney one-third of health programs encouraged facilitated entry for rural students and one-third of health programs offered rural content. However, there is very little information available in Australia regarding facilitated entry into Universities for rural students in professions such as allied health and nursing.
The provision of scholarships for medicine, nursing, and allied health in Australia provide a scheme for retaining health professionals in rural areas.28-30 Pathman et al.31 points out that loan repayment and direct financial incentives programs achieved better outcomes (longer retention, greater satisfaction) than scholarships in rural USA. A systematic review32 identified that financial incentives for physicians have had a positive outcome on the distribution of health resources; however, the majority of studies were from the US. Information relating to the effectiveness of financial incentives for other health professionals appears to be absent. Ensuring the availability and effectiveness of multiple strategies to address rural attachment is an important approach to strengthen the second stage of the 'rural pipeline'.
Stage 3. Taking up rural practice (rural exposure)
The third stage of the 'rural pipeline' refers to rural exposure. We propose this stage be called 'Taking up rural practice'. Training rural medical students to become qualified independent doctors can take a lead-time of practising up to 12 years and involves the interplay of both university and hospital practice based vocational training. Training for nursing and allied health students has a shorter lead-time of up to 3 years full time for registered nurses and radiographers. Four years of full time training is required for midwives, social workers, physiotherapists, occupational therapists and speech pathologists. Enrolled nurses have an even shorter lead-time of 2 years before qualifying for independent practice.
It is acknowledged that exposure to rural clinical settings and different locations can increase interest in rural practice for medical, nursing and allied health students.33-40 For instance, several programs in Australia and the United States have shown an effective link between training opportunities and increasing interest in rural practice for medicine and allied health.35,41,42 Similarly, feelings of personal and professional belonging enhanced nursing students' learning experience during clinical placements.43-45 However, barriers preventing enrolled nurses in rural areas from gaining access to further higher education require flexibility and a different model of education.46
Other factors that are considered by medical, nursing or allied health professionals included enjoyment of a rural lifestyle, supportive networks, and ease of childcare.47-50 Negative aspects for medical, nursing, midwifery or allied health professionals include professional isolation and limited access to educational opportunities.49,51-53 Overseas trained doctors found a shortage of employment opportunities for their spouses negated the appeal of rural practice.54
Lack of anonymity was a factor that affected both medical and nursing professionals.49,55-57 For instance, being visible in rural locations meant that maintaining professional boundaries became difficult when you may be administering healthcare to your neighbour. An issue for some nursing students was the effects of stress as a result of horizontal violence - an act of hostility and aggression by one colleague toward another colleague during clinical placement.58
Although there are some positive outcomes from rural exposure, there is a need to address cultural issues particularly among the rural nursing profession to improve the nurturing role that they provide to students. Exploring other options for different models of education in rural areas needs to address some of the traditional expectations of rural areas. However, the capacity to implement initiatives is constrained by funding, staff limitations and lack of institutional coordination.27 Hence, when implementing different models consideration of resources is imperative to ensure sustainable and effective approaches.
Stage 4. Remaining in rural practice (educational and professional support)
The forth stage of the 'rural pipeline' refers to educational and professional support, which we have called 'Remaining in rural practice'.
Remaining in rural practice is concerned with time spent in a rural context, contentment of rural life and balancing personal and professional roles. Professional considerations such as on call and after hours arrangements were reported as the most important factor that influenced medical practitioners' decision to remain in rural practice.59,60 Other important factors include contentment with rural life, the ability to tolerate uncertainty and adaptability. 61 Equally, allied health professionals working in the public sector cited lack of professional support and career options as reasons for leaving their position within five years.62,63
Similarly, nurses identify professional support as an important component of retaining nursing staff in rural areas. Mills et al.64 points out that mentoring is an important process, whether viewed as a structured or accidental process, and needs to be recognised as an element of support for new and novice nurses. The transition period for new nurses is stressful65 and the provision of a structured mentoring program66 could ensure a more positive transition period and an improvement in retention rates.
Although there is a well-developed program of continuing education for medical practitioners, it seems continuing education programs for other health professionals are less developed. Current evidence suggests that the coordination of a structured support system could strengthen and sustain retention of health professionals in rural areas.67
Conclusion
It is evident from the literature that medicine, nursing and allied health practitioners follow a similar career pathway. There is obviously a need to consider extending the 'rural pipeline' to include a multitude of health professionals. Extension of this model could strengthen and consolidate current and future resources towards a coordinated approach to rural health workforce shortages. The use of the 'rural pipeline' as a template for future research would enhance and consolidate evidence to ensure a coordinated approach to recruitment and retention of all health professionals is used in rural areas. Evaluating the effectiveness of suitable models of education for some professional groups could strengthen the pathways available for rural students therefore enhancing the skill base within rural communities.
Further research on the relationship between place and identity and their role in shaping the career choices of high school students could add to the body of knowledge on the health workforce shortage. Comparisons across different social aspects (class, gender and culture), location (Australia, Canada and Europe) and health professions could provide further insight into recruitment pathways into health careers. Comparative work could explore how rural diversity shapes motivation and exposure of career choices for rural individuals. The use of a multi-disciplinary approach could ideally provide a substantial and alternative in-depth viewpoint for advancing both policy and practical aspects of career pathways in rural society.
Acknowledging and understanding the experiences of high school students and career advisors is an important aspect to exploring the role of place and identity when making career choices. It requires moving beyond the implications of factors and barriers and moving into the area surrounding subjectivity and the gendered use of rural spaces. Exploration of the relationship between place and identity requires sensitivity of the meanings of place to students and career advisors. The construction of rurality and the relationship between ideas of rurality and the lives of teachers and students contribute to the literature on recruitment and retention of health professionals in rural and remote locations.
Competing interests
No conflicts of interest exist.
[Reference]
References
1 WHO. World health report 2006: Working together for health. 2006. Available at http://www.who.int/whr/2006/en/index.html [verified 5 August 2008].
2 Millsteed J. Issues affecting Australia's rural occupational therapy workforce. Aust J Rural Health 2000; 8(2): 73-6. doi:10.1046/j.1440- 1584.2000.00245.x
3 Johnston G, Wilkinson D. Increasingly inequitable distribution of general practitioners in Australia, 1986-96. AustNZ J Public Health 2001; 25(1): 66-70.
4 Joyce C, Wolfe R. Geographic distribution of the Australian primary health workforce in 1996 and 2001. AustNZ J Public Health 2005; 29(2): 129-35.
5 Australian Institute of Health and Welfare. Australia's health 2008. Canberra: AIHW; 2008.
6 Australian Health Workforce Advisory Committee. The Australian allied health workforce: an overview of workforce planning issues. Sydney: AHWAC; 2006.
7 Australian Institute of Health and Welfare. Health and community services labour force 2006. Canberra: AIHW; 2009.
8 Panelli R. Rural society. In: Cloke P, Marsden T, Mooney P, Eds. Handbook of rural studies. London: Sage Publications Ltd; 2006: pp. 63-90.
9 Tesson G, Curran V, PongR. Advancesin rural medical education in three countries: Canada, the United States and Australia. Rural Remote Health 2005; 5: 397. doi:10.1080/13576280500289728
10 Henry JA, Edwards BJ, Crotty B, Crotty J. Why do medical graduates choose rural careers. Rural Remote Health 2009; 9: 1083.
11 Eley RM, Hindmarsh N, Buikstra E. Informing rural and remote students about careers in health: the effect of health careers workshops on course selection. Aust J Rural Health 2007; 15(1): 59-64. doi:10.1111/j.1440- 1584.2007.00851.x
12 Fraser J, Alexander C, Simpkins B, Temperley J. Health career promotion in the New England area of New South Wales: a program to support high school career advisers. Aust J Rural Health 2003; 11(4): 199. doi:10.1046/j.1440-1584.2003.00511.x
13 Fraser JD, Alexander C, Simpkins B. Australian rural high school students' interest in health careers: implications for our future workforce? MJA 2004; 180(8): 431-2.
14 McKinstry B, Colthart I, Elliott K, Hunter C. The feminization of the medical work force, implications for Scottish primary care: a survey of Scottish general practitioners. BMC Health Serv Res 2006; 6(1): 56. doi:10.1186/1472-6963-6-56
15 Durey A, McNamara B, Larson A. Towards a health career for rural and remote students: cultural and structural barriers influencing choices. Aust J Rural Health 2003; 11(3): 145-50. doi:10.1046/j.1440-1584. 2003.00481.x
16 Harrison ME. Identity and experience: a study of selected female physicians in five provincial states of Mexico. Salud Publica Mex 2000; 42: 208-16.
17 Durey A. 'Heroes and fairy wrens': the changing face of rural general practice. Health Sociology Review 2004; 13(2): 166-77.
18 Little J. Gender relations in rural areas: the importance of women's domestic role. J Rural Stud 1987; 3(4): 335-42. doi:10.1016/0743-0167 (87)90052-0
19 Bryant L, Pini B. Gender, class and rurality: Australian case studies. J Rural Stud 2009; 25(1): 48-57. doi:10.1016/j.jrurstud.2008.05.003
20 Turner JV, Scott LM, Scott JTL. University rural health clubs: nurturing the future Australian rural workforce. Rural Remote Health 2007; 7: 649.
21 Connolly P, Healy J. Symbolic violence, locality and social class: the educational and career aspirations of 10-11-year-old boys in Belfast. Pedagogy Cult Soc 2004; 12(1): 15-33. doi:10.1080/146813604002 00187
22 Somers GT, Strasser R, Jolly B, Strasser GSR. What does it take? The influence of rural upbringing and sense of rural background on medical students' intention to work in a rural environment. Rural Remote Health 2007; 7: 706.
23 Laven G, Wilkinson D. Rural doctors and rural backgrounds: how strong is the evidence? A systematic review. Aust J Rural Health 2003; 11(6): 277-84. doi:10.1111/j.1440-1584.2003.00534.x
24 Charles DM, Ward AM, Lopez DG. Experiences of female general practice registrars: are rural attachments encouraging them to stay? Aust J Rural Health 2005; 13(6): 331-6. doi:10.1111/j.1440-1584.2005. 00731.x
25 Cutchin MP. Physician retention in rural communities: the perspective of experiential place integration. Health Place 1997; 3(1): 25-41. doi:10.1016/S1353-8292(96)00033-0
26 Goudy WJ. Community attachment in a rural region. Rural Sociol 1990; 55(2): 178-98.
27 Lyle D, Klineberg I, Taylor S, Jolly N, Fuller J, Canalese J. Harnessing a university to address rural health workforce shortages in Australia. Aust J Rural Health 2007; 15(4): 227-33. doi:10.1111/j.1440-1584. 2007.00895.x
28 Commonwealth of Australia. Health practitioners: Nurses. 2009. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/ work-pr-nurs [verified 2 June 2009].
29 Commonwealth of Australia. Health professionals: Allied health. 2009. Available at http://www.health.gov.au/internet/main/publishing.nsf/ Content/work-pr-alli [verified 2 June 2009].
30 Commonwealth of Australia. Health practitioners: Medical practitioners 2009. Available at http://www.health.gov.au/internet/main/publishing. nsf/Content/work-pr-gp [verified 2 June 2009].
31 Pathman DE, Konrad TR, King TS, Taylor DH Jr., Koch GG. Outcomes of states' scholarship, loan repayment, and related programs for physicians. Med Care 2004; 42(6): 560-8. doi:10.1097/01.mlr.0000128003. 81622.ef
32 B�rnighausen T, Bloom D. Financial incentives for return of service in underserved areas: a systematic review. BMC Health Serv Res 2009; 9(1): 86. doi:10.1186/1472-6963-9-86
33 Rabinowitz HK, Diamond JJ, Markham FW, Paynter NP. Critical factors for designing programs to increase the supply and retention of rural primary care physicians. JAMA 2001; 286(9): 1041-8. doi:10.1001/ jama.286.9.1041
34 Wilkinson D, Laven G, Pratt N, Beilby J. Impact of undergraduate and postgraduate rural training, and medical school entry criteria on rural practice among Australian general practitioners: national study of 2414 doctors. Med Educ 2003; 37(9): 809-14. doi:10.1046/j.1365-2923.2003. 01596.x
35 Wilkinson D, Birks J, Davies L, Margolis S, Baker P. Preliminary evidence from Queensland that rural clinical schools have a positive impact on rural intern choices. Rural Remote Health 2004; 4: 340.
36 Chan BTB, Degani N, Crichton T, Pong RW, Rourke JT, Goertzen J, McCready B. Factors influencing family physicians to enter rural practice: does rural or urban background make a difference? Can Fam Physician 2005; 51(9): 1247.
37 Playford D, Larson A, Wheatland B. Going country: rural student placement factors associated with future rural employment in nursing and allied health. Aust J Rural Health 2006; 14(1): 14-9. doi:10.1111/ j.1440-1584.2006.00745.x
38 Daniels ZM, VanLeit BJ, Skipper BJ, Sanders ML, Rhyne RL. Factors in recruiting and retaining health professionals for rural practice. J Rural Health 2007; 23(1): 62-71. doi:10.1111/j.1748-0361.2006.00069.x
39 Tolhurst HM, Adams J, Stewart SM. An exploration of when urban background medical students become interested in rural practice. Rural Remote Health 2006; 6(1): 452.
40 Lea J, CruickshankM.Factors that influence the recruitment and retention of graduate nurses in rural health care facilities. Collegian: Journal of the Royal College of Nursing Australia 2005; 12(2): 22-7. doi:10.1016/ S1322-7696(08)60489-8
41 GuionWK,Mishoe SC, Taft AA, Campbell CA. Connecting allied health students to rural communities. J Rural Health 2006; 22(3): 260. doi:10.1111/j.1748-0361.2006.00042.x
42 Dunbabin JS, Levitt L. Rural origin and rural medical exposure: their impact on the rural and remote medical workforce in Australia. Rural Remote Health 2003; 3: 212.
43 Levett-Jones T, Lathlean J. Belongingness: a prerequisite for nursing students' clinical learning. Nurse Educ Pract 2008; 8(2): 103-11. doi:10.1016/j.nepr.2007.04.003
44 Levett-Jones T, Lathlean J, McMillan M, Higgins I. Belongingness: a montage of nursing students' stories of their clinical placement experiences. Contemp Nurse 2007; 24(2): 162-74.
45 SedgwickMG,YongeO. 'We're it', 'we're a team', 'we're family' means a sense of belonging. Rural Remote Health 2008; 8: 1021.
46 Latham H, Hamilton M, Manners J, Anderson J. An innovative model improving success at university for regional Australians suffering educational and social disadvantage. Rural Remote Health 2009; 9: 1128.
47 Ellsbury KE, Baldwin LM, Johnson KE, Runyan SJ, Hart LG. Genderrelated factors in the recruitment of physicians to the rural northwest.JAm Board Fam Pract 2002; 15(5): 391-400.
48 Ozolins IZ, Greenwood G, Beilby J. Keeping women doctors in the country. Rural Remote Health 2004; 4(2): 268.
49 Bushy A, Leipert B. Factors that influence students in choosing rural nursing practice: a pilot study. Rural Remote Health 2005; 5(1): 387.
50 Schoo AM, McNamara KP, Stagnitti KE, Schoo A. Clinical placement and rurality of career commencement: a pilot study. Rural Remote Health 2008; 8: 964.
51 Richards HM, Farmer J, Selvaraj S, Selvaraj H. Sustaining the rural primary healthcare workforce: survey of healthcare professionals in the Scottish highlands. Rural Remote Health 2005; 5(1): 365.
52 Tracy S, Barclay L, Brodie P. Contemporary issues in the workforce and education of Australian midwives. Aust Health Rev 2000; 23(4): 78.
53 Fahey CM, Monaghan JS, Monaghan CFJ. Australian rural midwives: perspectives on continuing professional development. Rural Remote Health 2005; 5: 468.
54 Kearns R, Myers J, Adair V, Coster H, Coster G. What makes 'place' attractive to overseas-trained doctors in rural New Zealand? Health Soc Care Community 2006; 14(6): 532-40. doi:10.1111/j.1365-2524.2006. 00641.x
55 Hays R, Wynd S, Veitch C, Crossland. Getting the balance right? Gps who chose to stay in rural practice. Aust J Rural Health 2003; 11(4): 193-8. doi:10.1046/j.1440-1584.2003.00501.x
56 Denz-Penhey H, Murdoch J. A student view of the difference between general practice and rural and remote medicine. Rural Remote Health 2007; 7: 641.
57 Spenny ML, Ellsbury KE. Perceptions of practice among rural family physicians: is there a gender difference? J Am Board Fam Pract 2000; 13(3): 183-7.
58 Lea J, Cruickshank MT. The experience of new graduate nurses in rural practice in new south wales. Rural Remote Health 2007; 7: 814.
59 Pathman DE, Konrad TR, Dann R, Koch G. Retention of primary care physicians in rural health professional shortage areas.AmJ Public Health 2004; 94(10): 1723-9. doi:10.2105/AJPH.94.10.1723
60 Humphreys JS, Jones MP, Jones JA, Mara PR. Workforce retention in rural and remote Australia: determining the factors that influence length of practice. MJA 2002; 176(10): 472-6.
61 Eley D, Young L, Shrapnel M. Rural temperament and character: a new perspective on retention of rural doctors. Aust J Rural Health 2008; 16(1): 12-22.
62 Smith T, Cooper R, Brown L, Hemmings R, Greaves J. Profile of the rural allied health workforce in northern New South Wales and comparison with previous studies. Aust J Rural Health 2008; 16(3): 156-63. doi:10.1111/j.1440-1584.2008.00966.x
63 O'Toole K, Adrian S, Karen S, Kate C. Rethinking policies for the retention of allied health professionals in rural areas: a social relations approach. Health Policy 2008; 87(3): 326-32. doi:10.1016/j.healthpol. 2008.01.012
64 Mills J, Francis K, Bonner A. Getting to know a stranger - rural nurses' experiences of mentoring: a grounded theory. Int J Nurs Stud 2008; 45(4): 599-607. doi:10.1016/j.ijnurstu.2006.12.003
65 Duchscher JB.Aprocess of becoming: the stages of new nursing graduate professional role transition. J Contin Educ Nurs 2008; 39(10): 441-50. doi:10.3928/00220124-20081001-03
66 Scott ES, Smith SD. Group mentoring: a transition to work strategy. J Nurses Staff Dev 2008; 24(5): 232-8. doi:10.1097/01.NND. 0000320691.24135.72
67 Smith R, Pilling S. Supporting the transitionfrom student to professional- a case study in allied health. Aust Health Rev 2008; 32(1): 134-8. doi:10.1071/AH080134
Manuscript received 2 March 2009, accepted 3 November 2009
[Author Affiliation]
Karin A. Fisher1,3 PhD, Senior Research Officer
John D. Fraser1,2 MD, Head - School of Rural Medicine, Director - Hunter New England Area Rural Training Unit
1Hunter New England Area Rural Training Unit, Hunter New England Health Service, Locked Bag 9783, New England Mail Sorting Centre, Tamworth, NSW 2348, Australia. Email: jfrase22@une.edu.au
2University of New England, School of Rural Medicine, Armidale, NSW 2351, Australia.
3Corresponding author. Email: karin.fisher@hnehealth.nsw.gov.au
