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Objective: To identify self-reported influences and drawbacks for early career nurses to work in a rural location. Background: The international shortage of rural nursing workforce is increasing. As a result, evidence that focuses on mechanisms to recruit early career nurses to these areas is important. This research focuses on the influences and drawbacks for early career nurses to undertake a rural graduate nursing program, aimed at providing evidence that can inform the design of rural nurse recruitment programs. Study design and methods: Manifest content analysis of open-ended questions in a cross- sectional survey that was administered in two rural Local Health Districts (LHDs) in New South Wales, Australia. Early career nurses commencing employment in either of the research locations in 2019 and 2020 were eligible to complete the survey. In two open-text questions, respondents were asked to respectively describe what the most influential factor was in their decision to commence employment in their location, and what were the drawbacks of this location, if any. Results: Of the 175 early career nurses invited to complete the survey, 165 (94.29%) returned a completed survey. Four themes were identified as influencing rural early career nurse employment; proximity to social and/or familial ties, being attracted to rural clinical practice, taking advantage of a job offer in a limited market, and wanting a rural lifestyle. Where drawbacks were described, themes referred to distance from social and/or familial ties, rural lifestyle factors, resource challenges, and a perception of less professional opportunity. Discussion: There may be an opportunity to attract and retain rural nurses through targeted social initiatives and creating community ties, particularly among those early career nurses who have no close friends and family nearby. This reflects other literature and the growing understanding of the importance of social connection, familial ties and life course in early career nurse decision making. Conclusion: The results of this research demonstrate that proximity to social and/or familial ties is both the biggest influence and drawback for early career nurses to accept employment in a rural location. Implications for research, policy, and practice: Strategies that capitalise on practical ways to integrate social connection and life course approaches in early career nurse onboarding in rural areas should be explored in future research with a view to creating guidance for rural health organisations and policy makers. What is already known about the topic? • Australia is facing a significant and growing deficit in the number of nurses choosing to practice rurally. • Rural origin and rural placements influence rural practice intention. • Early career nurse programs are an initiative aimed to support the transition of nurses into practice from undergraduate study and can act as a pathway for nurses to enter rural careers. What this paper adds: • Family and social ties are the most influential reasons for choosing a rural location for early career nurses. • Commensurate with this is the greatest drawback for choosing a rural location for early career employment was being away from family and/or friends. • Future research should explore practical strategies that capitalise on the importance of social connections, familial ties, and life course for rural nurse career decisions. [ABSTRACT FROM AUTHOR]

Objectives: The study investigated how senior residential aged care staff perceived the purpose, function, impact and challenges of implementing a new role in their organisation for an unregistered care worker with a Bachelor of Dementia Care: the Dementia Care Support Worker. The role was piloted over two years in an Australian organisation with three aged care facilities to examine its potential to address gaps in service provision for people with dementia. Background: The residential aged care workforce is under pressure to care for residents with increasingly complex health conditions and where most care is provided by care workers. Presently no formal leadership role exists for care workers with specialised dementia knowledge in the aged care setting. Study design and methods: A qualitative descriptive approach was taken to explore senior staff members' perceptions of the role at two time points. Twenty-three semi-structured interviews held in July-August 2017 (n = 12), soon after role commencement, and in February-March 2019 (n = 11) were thematically analysed. Results: Three themes reflected senior staff members' expectations of the role: enhancing staff and management knowledge about dementia and dementia care practices; facilitating changes to improve care for residents living with dementia; and educating and supporting residents' families. Eighteen months later, participants felt the role was helping meet the need for improved care of residents with dementia, and staff understanding of dementia. They suggested communication and support structures to improve role effectiveness. Discussion: Staff were receptive to the establishment of the Dementia Care Support Worker role and felt it resulted in improvement in dementia care. Success was contingent on strong organisational support and resourcing. Conclusion: Improving dementia knowledge of care staff is an essential first step in driving care quality improvements. The Dementia Care Support Worker role for care workers has the potential to address knowledge needs and support improved care practices. Implications for research, policy, and practice: This research models how a new role might be configured for unregistered care workers with specialist dementia knowledge. Further research is needed to explore the establishment of such a role more widely in other organisations, to investigate whether it could provide a new career development pathway for care workers and improve the skills and capacity of the aged care workforce. Substantial policy changes would also be required to support role viability, such as around increased salary. Research which examines the impact of such roles on care outcomes would complement the findings. What is already known about the topic? • While dementia is common in residential aged care, knowledge of dementia is typically low among the care staff. • Consequently, care staff are not equipped to meet the complex needs of residents with dementia and their families. • New roles for unregistered care workers with specialised dementia knowledge have been proposed, but not tested. What this paper adds • This research models how a new role might be configured for care workers with specialist dementia knowledge. • Aged care facility leaders support a role for care workers with formal specialist dementia knowledge and skills, and perceive the role helps improve the quality of resident care and develop stakeholders' dementia knowledge. • Appropriate communication and support structures are required for the effective establishment of the role. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had widespread impacts on the community and has demanded a rapid response from the aged care sector. System changes for infection control have been required including the use of personal protective equipment, lockdowns, visitor restrictions and changes to activities within aged care facilities. Even prior to COVID-19, the high physical and emotional demands of aged care work were recognised. Objective: This study sought to understand aged care workers' experiences of the COVID-19 pandemic. Methods: Using a pragmatic paradigm qualitative data about work experiences during COVID-19 was collected from people employed in different aged care organisations in a range of aged care roles and settings from multiple Australian states. Data was collected using focus groups and interviews conducted online between August-October 2020. Inductive thematic analysis was used to identify key themes in the data. results: Participants included 15 people working across a range of aged care roles including clinical, care and management staff and across both residential and community settings. Five themes were identified which characterised aged care workers thoughts about their jobs during the pandemic. These included intensified procedures and emotional demands, feeling undervalued and detached from the frontline, exposure of existing system deficiencies, recognising teamwork and increased confidence in technology. conclusion: Reflecting on aged care workers' experiences of COVID-19 highlights the need to better support workers and acknowledge their important role in caring for older Australians. This includes at an organisational level by providing supportive environments and access to online resources as well as at the community and policy level by recognising aged care workers as frontline workers. The COVID-19 pandemic has also highlighted existing systemic issues in the aged care sector that need to be addressed for the provision of quality aged care in Australia during the COVID-19 pandemic and into the future. What is already known about the topic? * While the COVID-19 pandemic is affecting the global community, it is disproportionately impacting the aged care sector with higher rates of severe illness and death and wide-ranging system changes to prevent and control the spread of the virus. * Prior to COVID-19, aged care work was associated with high job demands and lack of access to resources to support aged care workers in their role. * Survey data on the Australian RACF workforce found workers felt prepared for the pandemic with a wide range of measures to control the spread of COVID-19 but they faced several challenges associated with their additional roles and restrictions. What this paper adds * This paper provides qualitative and descriptive insights into the challenges experienced by the Australian aged care workforce during COVID-19 including increased workloads and intensified emotional demands of their roles while at the same time feeling undervalued by the wider community. * This study has highlighted the need to better support and acknowledge aged care workers in the community through their portrayal in the media and within their organisations by facilitating supportive team environments and providing access to online resources and training. * This paper discusses existing systemic issues that have been highlighted by COVID-19 and the Royal Commission into Aged Care Quality and Safety and need to be addressed for the wellbeing of workers and the provision of quality aged care. [ABSTRACT FROM AUTHOR]

Objective: To explore factors that can influence implementation of a nurse-led model of care for early medication abortion provision in the primary healthcare setting of regional and rural Victoria, Australia. Background: Global research indicates that an increased involvement of primary healthcare nurses in the delivery of early medication abortion provision has the potential to improve abortion access. In Victoria, access in regional and rural areas is restricted despite abortion being legal. A nurse-led early medication abortion provision model is feasible and can potentially improve the current situation. Study design and methods: An online three-round classic Delphi method was used. This paper reports the qualitative findings. Non-probability sampling techniques were used to recruit a panel of professional experts. Data from the three questionnaires were collected and analysed using thematic analysis. Factors influencing model implementation were categorised into the Capability, Opportunity, Motivation-Behaviour framework. Results: A total of 24 medical and other health professionals participated. They identified a range of factors that can hinder model implementation, including a lack of affordable medication abortion education, no remuneration for nurse-led early medication abortion provision, and concerns related to stigma and support. Discussion and conclusion: Understanding and addressing barriers to model implementation may enable the development of primary healthcare nurses' role in the delivery of early medication abortion provision to improve abortion access. Impact: To improve abortion access in Victoria's under-served regions, the potential of nurse-led early medication abortion provision was explored. Barriers to model implementation relate to a lack of medication abortion education and funding, professional support and stigma concerns. The study identified a range of support elements that would enable primary healthcare nurses to develop new roles and responsibilities in the delivery of medication abortion services. What is already known about the topic? * Evidence indicates that appropriately trained primary healthcare nurses can provide early medication abortion and associated tasks as effectively, safely and satisfactorily as physicians. * Nurse-led early medication abortion provision is a worldwide recognised strategy to overcome the shortage of early medication abortion providers and to improve equity in access to abortion services. * The legal climate of Victoria allows qualified registered nurses to independently administer physician-prescribed early medication abortion drugs to women. What this paper adds: * The Delphi panellists of this study all endorsed nurse-led early medication abortion provision in regional and rural Victoria and beyond. * The study provides a range of model implementation barriers, which are categorised into the components of the Capability, Opportunity, and Motivation Model of Behaviour. Those barriers need to be challenged and addressed to improve abortion access in underserved regions. [ABSTRACT FROM AUTHOR]

Objective: To describe development, implementation, and evaluation of an evidence-based online critical care nursing education program to upskill a registered nurse workforce in response to Coronavirus disease 2019 (COVID-19) pandemic. Background: As Australian federal, and state governments prepared for the possible influx of critically ill patients associated with COVID-19, initiatives were sought to assist frontline healthcare workers meet the complex care requirements of these patients. Study design and methods: A team of experienced acute and critical care nursing, medical practitioners, and education specialists, online and mobile learning specialists, and front-line workers were assembled. This team developed 10 online educational modules for rapid delivery and upskilling of registered nurses in Victoria, Australia. Nurses undertaking these modules were invited to complete a satisfaction survey. Survey questions were answered in Likert style or free text. Quantitative data were summarised descriptively, whilst freeform answers were explored for themes. Results: An online Critical Care Essentials course was launched in May 2020. In its first month 2,875 students had accessed this course. Course evaluation (n = 395 students) found over 92% responded favourably (Strongly Agree or Agree) to all 14 Likert style questions. Qualitative course feedback revealed four core themes: applicability, accessibility, engagement, and endorsement. Discussion: This innovative project demonstrated how a university department of nursing collaborated with government and industry partners to rapidly respond to develop and implement an online educational program. This program was immediately responsive to local, national, and international urgency. Obtained student feedback was overwhelmingly positive. However, future areas for development and evaluation are presented. Conclusion: An inter-professional and inter-organisational model is proposed for the development and implementation of future online programs. This focused online flexible learning, specific to care of critically unwell people with COVID-19, provides an approach to rapid upskilling of registered nurses. This approach appears favourably to its intended target audience. Furthermore, this program could be adapted for a national or international community. What is already known about the topic? * Globally, Coronavirus disease 2019 quickly overran advanced healthcare systems with vast numbers of critically ill patients requiring specialist care. * To address surging critical care numbers, healthcare staff require increased knowledge to care for higher acuity patients. * Online educational packages can be one element of fulfilling healthcare staff training needs. What this paper adds: * Description of development, implementation, and evaluation of a novel evidence-based online critical care nursing education program. * Evidence of how an online education can be made accessible to frontline healthcare workers to support the demand for a scalable resource that is responsive to emergent global health pandemic. * Using a tripartite model for knowledge translation is one potential approach for the future responses to urgent educative program development. [ABSTRACT FROM AUTHOR]