Mrs Jessica Elliott1,2, Ms Lee O'Malley3, Ms Clara Walker2,4, Dr Ansmarie Van Erp5, Dr Priya Martin6, Dr Hwee Sin Chong5,7, Dr Bahram Sangelaji2,4, Dr Tony Fallon2,4
1University of Southern Queensland (UniSQ) – School of Nursing and Midwifery, Ipswich / Toowoomba, Australia, 2Centre for Health Research, University of Southern Queensland, Ipswich / Toowoomba, Australia, 3Griffith University – School of Nursing and Midwifery, Gold Coast, Australia, 4Faculty of Health and Behavioural Sciences, Southern Queensland Rural Health, The University of Queensland, Toowoomba, Australia, 5Darling Downs Health, Queensland Rural Medical Services, Queensland Health, Toowoomba, Australia, 6University of Southern Queensland – School of Health and Medical Sciences, Toowoomba, Australia, 7Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
Biography:
Jessie Elliott is an emerging researcher involved in projects exploring emergency nursing, immunisation practice, and knowledge implementation, with a focus on graduate nurse employability and rural health. With a strong academic background and commitment to community engagement, she helped develop the Charleville End to End Training program to address nurse shortages in Southwest Queensland. Passionate about expanding the rural nursing workforce, Jessie is currently undertaking a PhD examining how social factors and rural community dynamics influence nursing student retention, aiming to strengthen pathways for future nurses in remote settings.
Abstract:
Retention of nurses and midwives in rural and remote Australia remains a critical workforce challenge. Despite numerous proposed strategies, large-scale, localised data on actual retention patterns is limited. This study quantifies retention duration across varying levels of rurality, providing foundational evidence to inform workforce planning and policy. Early attrition—especially within the first six months in MMM6–7 areas—emerged as a tipping point, suggesting delayed interventions may miss the opportunity to influence long-term workforce stability.
Methods
A retrospective cohort study used 3,234 employment records from two public health services in southern Queensland (2010–2021), covering nurses and midwives across Modified Monash Model (MMM) classifications 2 to 7. Retention analysis and Cox proportional hazards regression estimated time-in-location and identified associations between retention duration and demographic, geographic, and employment characteristics.
Results
The analysis revealed a median retention time of just 1.83 years, with significantly lower retention observed in MMM4–5 and MMM6–7 locations. Nurses and midwives employed in permanent part-time roles tended to remain longer in location, whereas those in full-time or temporary positions were more likely to leave. Registered Nurses and Midwives demonstrated higher overall retention rates compared to Enrolled Nurses. However, individuals who commenced employment at higher pay grades (e.g., RN/CN) were paradoxically more likely to leave—likely reflecting a cohort of experienced clinicians who enter rural roles later in their careers and may be more mobile or selective in their employment choices.
Conclusions
This study provides the first large-scale, locally specific analysis of public sector nursing and midwifery retention in Queensland. The findings highlight the need for targeted, place-based strategies to support retention—particularly within the first 6 to 12 months of employment—to reduce turnover, enhance continuity of care, and strengthen the rural and remote health workforce. The “tipping point” concept offers a useful framework for understanding cumulative pressures leading to early workforce exit.