Aim: To describe the establishment of a cross‐border and multi‐university collaboration in rural Australia to mitigate potential competition, maximise Rural Health Multidisciplinary Training (RHMT) Programme investments and regional health workforce outcomes.Context: Rural Health Multidisciplinary Training programme investments have enabled the establishment of 19 Australian University Departments of Rural Health (UDRH) and 17 Rural Clinical Schools. The importance of these investments is acknowledged. However, in regional settings, due to limited clinical placement and training opportunities, there is potential for heightened competition between universities who are operating within shared geographical footprints. Competition between universities risks focusing RHMT programme activity on individual reporting requirements and activities, in preference to: regional needs; existing community–university relationships; and place‐based approaches to health workforce development.Participants: A rural New South Wales and Victorian RHMT‐funded departments, collectively known as the Sunraysia Collaboration.Approach: Strategic and operational processes, structures and actions underpinning collaboration formation and relationship consolidation will be described. Co‐design methodologies employed to collectively define collaboration vision and aims, governance framework and guiding principles, reporting structures and co‐contributions to teaching, research and service will be discussed. Collaboration sensitivity to the social, cultural, relationship and economic connectedness within the region and existing health workforce flows will also be explored.Conclusion: The Sunraysia collaboration demonstrates one approach towards mitigating potential competition between RHMT Programme funded universities within rural and remote Australia. The collaboration is an exemplar of co‐design in action providing an alternative approach to address RHMT Programme parameters and regional needs whilst supporting rural‐remote health workforce training and education innovations.

The role of nurses in leading the design and delivery of primary health care services to address health inequities is growing in prominence, specifically in rural Australia. However, limited evidence exists to inform nurse‐led primary health care in this context. Based on a focus group with nursing executives and semi‐structured interviews with registered nurses we describe nurse experiences of leading the design of a primary health care service in rural Australia and nurse transition to and practice in this service. Nurse experiences were analysed using reflexive thematic analysis. The study reveals the centrality of relational integration in service design and nurse acquisition of relational practice as it relates to nurse to care recipient and nurse to nurse relationships. Tensions between primary health care nurses and their peers, and resultant de‐valuing of primary health care practice, are described. The acquisition of nurse professional agency draws attention to investments required to position nurses to lead and sustain care innovations external to hospital settings. The authors propose that relational approaches may provide nurses with the opportunity to reframe their leadership and service contributions towards community literate primary health care provision and provide a pathway to professional emancipation from constrained practice expectations.

Background: Cross-sectoral collaborations are considered necessary to address detrimental health, social, educational and economic outcomes that impact marginalised and disadvantaged populations. There is a strong relationship between the health of children and their educational attainment; good health promotes positive learning. This paper reports cross-sectoral executive and senior management level systems changes required to enable the design of a collaborative primary healthcare service model for children and young people in rural Australia. Methods: A descriptive qualitative design was used. Data were collected from executive and senior managers from three organisations (Education, Health and a University Department of Rural Health [n = 6]) through individual semi-structured interviews. Data were analysed using an inductive, thematic approach. The study draws on Lewin’s Model of Change. Results: Three overarching themes were generated from the data: an embedded challenge and experimental solutions; building a shared language and understanding; and the role of relationships and trust. Despite the unique geographical and social context of the study area, strategies emerged from the data on how a solution to an embedded challenge, through design of a primary healthcare model, was established and how the strategies described could be transferred and scaled to other rural and remote communities. Conclusion: Contextual differences make each rural and remote area unique. In this study, strategies that are described in the managing change literature were evident. The authors conclude that drawing on strong management of change principles could mean that a service model designed for one remote community might be transferrable to other communities.

Background/Objective: The quality of care afforded to rural, remote, and First Nations Peoples is dependent on access to a health workforce with the capacity to contextualize healthcare and practice to the needs and expectations of these populations. In Australia, the lack of representation of rural health in undergraduate and post graduate health professional education undermines this preparedness and consideration of rural practice uptake and longevity, compounding the inequities confronted by 7 million Australians residing in these locations. Urgent educational reforms are required to address this omission, the deficit discourses used to characterize rural healthcare, and the persistent health workforce shortages experienced. This paper presents the Anabranch Framework for the Ruralization of Health Professional Education, a high-level strategy to transform rural healthcare provision, professional practice, and health workforce outcomes. Methods: The framework was developed through an iterative process involving a series of systematic steps. The process included the following: individual and group critical dialogues with internal academic educators, external health service leaders, metropolitan academic allies, and leaders of other rural health academic departments; an internal review of empirical studies of relevance to the ruralization of health professional education and practice; the visualization of a place-based framework; the academic conceptualization of the framework; and further critical dialogues to test the framework’s face validity. Results: The Anabranch Framework comprises four inter-related rural domains: theories, pedagogies, practices, and connectivity; four constructs: knowledge acquisition and generation, immersion in rural curriculum, knowledge translation and sharing, and relational practice; and two structural elements: spiraled and scaffolded curriculum and duration and the quality of rural placement and practice. Conclusions: The Anabranch Framework is a high-level strategy to ruralize health professional worldviews, advance rural person-centered practice, enable a deeper understanding of rural places and the development of an equity-orientated, sustainable and rural-literate health workforce.

Objective: To explore the experiences of final‐year pre‐registration nursing students undertaking a longitudinal integrated placement in rural Australia.Setting: Rural primary health care settings in far west NSW and northwest Victoria, Australia.Participants: Thirteen final year pre‐registration nursing students comprised two pilot cohorts undertaking the placement in semester one (n = 7) and two (n = 6) of 2022.Design: A descriptive qualitative study design using semi‐structured individual interviews with transcripts analysed using reflexive thematic analysis.Results: Three themes were generated from the data: Experiencing comprehensive care, Making connections and Engaging with complexity. The subtheme of rural curriculum is described for each theme.Conclusion: Findings highlight the importance of longitudinal integrated placements for student nurse exposure to comprehensive care, mitigating previous experiences of episodic and fragmented care associated with short duration placements across multiple settings. Placement duration enabled students to establish connections with their peers, health care teams, and the communities in which placements were undertaken. Student exposure to complexity‐informed practice extended their capacity to interpret and respond to the broader inequities experienced and complexity as it relates to nursing practice in rural contexts. There is an imperative to reframe Australia's commitments to national nursing workforce policy, curriculum and clinical education to transform nursing education and maximise the full potential of our nursing workforce. These reforms must include consideration for the design, implementation, and scalability of rurally embedded longitudinal integrated placements, informed by rural curriculum, to enable the development of a competent future rural nursing workforce to address critical workforce shortages.