Rural Nursing Workforce Sustainability in Australia: A Scoping Review of Global Retention Strategies

Abstract

Introduction: The global nursing shortage significantly impacts healthcare sustainability, particularly in rural Australia, where geographic isolation, professional remoteness and resource constraints amplify challenges.

Objective: To map and synthesise evidence on factors influencing rural nursing workforce sustainability across individual, organisational and systemic levels.

Design: A scoping review following PRISMA-ScR guidelines was conducted. Five databases and grey literature were searched for English-language publications (1995-2024) on rural nursing workforce sustainability. A micro-meso-macro conceptual framework guided the analysis of 33 publications, focusing on baccalaureate-prepared Registered Nurses.

Findings: Key determinants were identified across three levels. Micro-level factors included personal characteristics, professional identity and safety considerations. Meso-level factors, addressed in 32 studies, encompassed health services programmes, organisational culture, management approaches and professional development opportunities. Macro-level factors included community engagement, educational pathways, scope of practice policies and government initiatives. Significant interconnections existed between factors across all levels.

Discussion: While targeted interventions show promise, programmes need systematic evaluation using standardised frameworks. Research priorities include longitudinal effectiveness studies, economic impact analyses and the development of practical implementation tools.

Conclusion: A sustainable rural nursing workforce requires integrated approaches that simultaneously address individual, organisational and systemic factors. Success depends on evidence-based collaboration between healthcare organisations, educational institutions and government bodies to strengthen rural healthcare delivery through coordinated multilevel strategies.

Keywords: health workforce; multilevel framework; organisational culture; professional development; recruitment barriers; shortages; systems.