Annette Horton

Thesis Name

Thesis Abstract

Australia’s regional, rural, and remote (RRR) health systems face acute workforce sustainability challenges, particularly among nurses and midwives. These professionals are central to service delivery in RRR settings but often work under conditions of limited support, expanded scope, and persistent staff shortages. At the same time, healthcare reform efforts aimed at improving system performance frequently introduce changes to roles, workflows, and expectations. When those most affected are not meaningfully engaged, such reforms can heighten stress and contribute to attrition, ultimately compromising both workforce resilience and patient outcomes.
This PhD study uses Classic Grounded Theory methodology to investigate the main concerns of nurses and midwives as they engage with healthcare system change and reform in RRR Australia. Through iterative data collection and analysis using surveys and open-ended interviews, the research will generate an inductively derived theory that explains the behavioural strategies nurses and midwives use to manage and respond to health reform and change. The study does not impose pre-existing frameworks but builds theory from the lived experiences of participants.
The findings will offer theoretical and practical insights to inform more supportive implementation strategies. By foregrounding the perspectives of frontline nurses and midwivex, the study aims to strengthen workforce sustainability, enhance engagement in reform processes, and support equitable healthcare outcomes for regional, rural and remote communities.