Table 2 Summary table of included articles

Battye 2003 [39]

Mixed methods: Develop a model of allied health service delivery to meet the needs of 11 culturally diverse remote communities.

Improvements: 1) Model for professional support and mentoring; 2) formal training during orientation; 3) financial remuneration; 4) community participation; 5) increased supervision and management; 6) opportunities for career progression.

Teamwork and collaboration; Professional development

Curtis 2012 [23]

Literature review: Identify ‘best practice’ for recruitment of Indigenous students into NZ tertiary health programmes.

Better support and opportunities required to encourage pursuit of a career in the health sector. Retention more likely when Indigenous students feel the study environment is culturally safe.

Professional development;

Cultural safety

Durey 2008 [32]

Qualitative: To examine professional communication and how this influences the retention in OTD in PHC in rural/remote AUS.

This study highlights the institutional and cultural challenges OTD face in PHC in areas with high proportions of Aboriginal patients and suggests areas for improvement.

Cultural safety

Dywili 2012 [31]

Systematic review: Investigated the experience of OTD in rural and remote areas.

OTD were expected to possess relevant professional and cultural skills. They expected recognition of their previous experience and adequate support in new locations. Feeling welcomed and accepted resulted in successful integration and increased staff retention rates.

Cultural safety

Ella 2015 [30]

Mixed methods: To understand how to better support and develop the Aboriginal alcohol and other drug workforce.

Issues identified for improvement: 1) address remuneration discrepancies; 2) Clarify position descriptions and improve access to formal supervision.

Cultural safety; Supervision; Recognition

Ferdinand 2014 [26]

Program evaluation using quantitative survey data: To build internal cultural competency for recruiting and retaining Aboriginal staff.

Significant increase in participant understanding across all program objectives and in support of organisational policies to improve Aboriginal recruitment and retention.

Cultural safety

Gwynne 2017 [20]

Systematic review: Identify strategies for developing and maintaining a skilled rural and remote health workforce in AUS, to better meet Aboriginal peoples’ health care needs

Four key findings: 1) Aboriginal peoples’ experiences in the health workforce affects their engagement with training and employment; 2) several factors affect retention rates non-Aboriginal staff working in Aboriginal health; 3) workforce attitudes and behaviours directly affect service delivery; and 4) student placements positively affect the likelihood of applying for health jobs in Aboriginal communities.

Cultural safety; Professional development; Recognition

Huria 2014 [27]

Qualitative: Explore the experience and impact of racism on Māori registered nurses within the NZ health system.

Māori nurses highlighted that while their clinical skills were validated, their cultural skills were often not. Experiences of racism were common at every level.

Cultural Safety

Katz 2010 [24]

Qualitative: Describe the experiences of Native American nurses working in their tribal communities to address retention.

Native American nurses were more likely to remain in their roles if they felt valued, respected, and trusted to use independent judgement for decision making.

Recognition;

Cultural safety

Khalil 2010 [33]

Qualitative: Explore the challenges facing community and hospital pharmacists’ tenure in rural Victoria.

Issues: Isolation, flexible working hours, ethnic background, and having to be a ‘generalist’. Benefits: good rapport, appreciation from patients and doctors, and rural lifestyle.

Cultural Safety

McConnel 2011 [40]

Implementation study: To propose a new style of health care in remote Aboriginal communities based on a biopsychosocial model which includes traditional healers.

The lack of improvement in remote Aboriginal health may be linked to failure to utilise Aboriginal staff appropriately and culturally inappropriate healthcare, and perpetuated by recruitment and retention issues. The authors present an alternative and Aboriginal-centred approach.

Teamwork and collaboration;

Professional development

Modder-man 2017 [22]

Literature review: Identify themes that focus on knowledge that can prepare transnational social workers for the AUS context.

More strategies are needed to properly orientate transnational social workers for work within Aboriginal communities to develop culturally safe practice and adapt to the local culture of professional practice.

Cultural Safety

Moore 2010 [38]

Qualitative: Contribute to the development of a more sustainable and effective regional mental health workforce.

Difficulties included: rurality, staff shortages, unattractiveness of mental health work, short term funding, short-comings in training, policy changes and models of care.

Teamwork and Collaboration

Newham 2016 [34]

Qualitative: Investigate the barriers and enablers to implementing a CQI program in Aboriginal PHC services in South Australia.

Barriers identified: 1) resource constraints, project support access; 2) management and leadership for CQI, organisational readiness; 3) Staff knowledge, attitudes and tenure. Success stem from: 1) organisational systems, individual behaviour change; 2) regional level collaborations.

Teamwork and collaboration;

Supervision

Nielsen 2014 [25]

Qualitative: To explore Aboriginal nurses’ experiences of the ‘whiteness’ of nursing.

Key strategy identified is to increase the participation rates of Aboriginal registered nurses within the AUS healthcare workforce.

Cultural safety; Professional development

Onnis 2016 [37]

Systematic review: Identify human resource factors common to the remote health workforce and those unique to remote Aboriginal communities.

The challenges and rewards are similar for health professionals working in remote Aboriginal communities and for those working in other rural and remote populations.

Teamwork and collaboration

Paul 2012 [45]

Literature review: Provide an overview of long-term strategies used to build the capacity of the Aboriginal health workforce.

The review reflects on the partnerships, structures and approaches that have been utilised by the University of Western Australian that have enabled achievements, and the challenges with initial implementation and sustainability.

Professional development

Polaschek 2007 [43]

Qualitative: Examine the education provided to prepare nurses and other health staff to give and receive supervision.

Nurses and other health staff learnt strategies to gain peer supervision skills, which centres around the staff member receiving the supervision.

Supervision

Roche 2013 [44]

Quantitative: Examine organisational, workplace and individual factors that can contribute to stress and influence well-being of staff serving Aboriginal communities.

10% of Aboriginal drug and alcohol staff reported high levels of emotional exhaustion, a key predictor of turnover. Aboriginal staff also had significantly lower levels of mental health and well-being, and greater work/family imbalance, contributing to emotional exhaustion.

Professional development; Recognition

Russell 2017 [46]

Quantitative: Correlations of turnover and retention in remote Northern Territory communities.

High mean annual turnover rates for nurses and Allied Health professionals. Low stability rates: only 20% remain working 12 months after commencing; half left within four months.

Recognition

Russell 2013 [41]

Mixed methods: Propose benchmarks for reasonable length of stay within a workplace.

Workforce-retention benchmarks that differ according to geographic location and profession can be empirically derived, facilitating opportunities to improve retention.

Supervision

Scerra 2012 [21]

Literature review: Identify supervision aspects that have been successfully used with Aboriginal staff and can be widely adapted to suit Aboriginal staff in Australia.

Significant supervision factors include: 1) development of cultural competency; 2) creation of relevant reflective spaces; 3) support the building of culturally inclusive supervision environments and to adapt supervision sessions to meet different professional and cultural needs.

Cultural safety; Supervision; Recognition

Sutton 2011 [36]

Qualitative: Identify approaches and solutions to the challenges of mental health workforce recruitment, retention and training.

Solutions included: increased staffing, collaboration/cross-sectoral linkages, flexible funding, a contemporary curriculum, strong leadership, organisational culture, meeting individual and community needs, and adopting models of care.

Teamwork and collaboration

Ward 2006 [42]

Literature review: Identify how stories can help staff make meaning of experience on a personal level during clinical supervision.

Use of stories in clinical supervision is well substantiated as a heuristic device, however, more research is needed to carefully explore this approach.

Supervision

Weymouth 2007 [35]

Mixed methods: Gain a better understanding of the effects of distance management on the retention of rural nurses in the Northern Territory, Western and South Australia.

Poor distance management may contribute to high staff turnover in remote Australia. Retention may increase with better managerial practices, effective communication and leadership, staffing, staff development, and appraisal.

Teamwork and collaboration; Supervision

Woodruff 2010 [47]

Mixed methods: To train community health advisors to conduct smoking cessation programs in Latino communities.

There were changes in the desired direction pre-to-post training for most of the psychosocial constructs measured. Community health advisors were more likely to remain in their role when receiving financial incentives.

Recognition