Building rural workforce capacity, Western NSW Primary Health Network Nurse Practitioner Scholarship Program: A Realist Evaluation

Background and aims.
Retention of general practitioners remains challenging in rural NSW, impacting the provision of After-Hours Primary Health Care. A focus on developing new workforce models of after-hours care that could reduce pressure on the existing workforce resulted in a pilot Nurse Practitioner (NP) scholarship program. The program was developed by the Western NSW Primary Health Network in collaboration with the Rural Doctors Association, Queensland University of Technology, and the Australian Primary Health Care Nurses Association. Four scholarship recipients located in Orange, Bathurst, Dubbo and Broken Hill commenced the 2-year program in January 2021. Charles Sturt researchers were asked to evaluate the program to explore how NP roles are constructed, enacted, and implemented in rural/regional primary health care settings.
Methods
The evaluation was informed by case study research design guided by a realist evaluation approach. Each site was designated as a separate case study given the distinctive contextual factors and recipients with different experiences and skills. The realist evaluation framework considered national, state-wide, and local policies while investigating the disciplinary, professional, and personal factors contributing to outcomes. This enabled linking evidence collected from contexts with different organisational and mechanistic factors and the data from the multi-layered scholarship program to provide recommendations relevant to different settings.
Results
While each recipient commenced the same program, outcomes and experiences for each recipient were markedly different. Three of the four recipients completed the program, obtained endorsement to practice as a NP and have accessed the relevant provider and prescriber numbers. A key determining factor for recipients applying for the demanding program was access to a scholarship with additional funding and protected study time. Employers with prior experience of working with NPs and a plan to incorporate the NP role into their business model provided ongoing support for the recipient and led to successful completion. Limited prior exposure to the NP role and changes in management in the employing organisation reduced commitment to providing the originally agreed support.
Conclusion
The outcomes highlight the benefits of a rural ‘Grow Your Own’ strategy and support continuation of the scholarship program. Adjustments to recruitment, strengthening aspects of the program and support for graduates to transition to NP practice and sustainable NP roles are recommended. To successfully integrate sustainable NP roles in rural primary health networks and develop alternative models of after-hours care that include NPs who complete the scholarship program will require careful planning, organisational support, and service-wide collaboration.