2. Malad, Idaho
Southeastern Idaho town just north of the Utah border
2010 population: 2,095 (county = 4,125)
34.3% homes with children less than 18
Median age 38.2
2009 median household income: $37,290
3. Oneida County Hospital
Spectrum of services from lab to diagnostic
radiology, emergency to operating
room, maternal/child to long term care
11 beds/11 certified (+ 41 LTC)
Approximately 35 FTE with 8.25 RN FTE
4. Rural environment
Unique issues
Must be over 35 miles from another hospital –OR- 15
miles away in mountainous area with only secondary
roads
Maximum 25 beds acute care inpatient/swing beds
Multi-specialty practitioners
Limited resources
5. Recruiting & Retaining RN
Competing with larger facility pay practices
Nurses must be knowledgeable in multiple specialties
Independent practice ,which can lead to burnout
Flexibility of work
6. Objectives
Recruitment of nurses within the community.
Exposure to field of nursing
Collaboration for education /advancement
ISU/BSU
Retention of current nursing workforce
American Nurses Credentialing Center
Pathway to Excellence program
7. Recruitment
Collaboration with Oneida School District for
Career fairs
Initiating school nurse position
Visible Nurses’ Week celebration
Job shadowing
Collaboration for nursing education
OHSU rural education template
ISU internship program
8. Retention
Pathway to Excellence certification
Standards foundational to ideal nursing practice environment
Standards include:
Shared governance
Healthy work environment
Systems in place for patient care and practice concerns
Orientation prepares new nurses
Leadership competent, accountable, & participatory
Professional development & achievement recognition
Balanced lifestyle
EBP are utilized
Quality program
10. Preparation
Master’s degree preparation affords
Foundation of theoretical frameworks
Questioning mentality
Creating vision
Mentoring
11. Conclusion
Oneida County Hospital
Decrease turnover by creating an ideal nursing
environment
Increase visibility of nursing within the community
Recruitment of nurses within the facility AND the
community
12. References
Curtis, E., & O'Connell, R. (2011). Essential leadership skills for
motivating and developing staff. Nursing Management, 18(5), 32-35.
Malad city/Oneida county economic development foundation. (n.d.).
Retrieved from http://maladidaho.org/
Mason, W. A. (2004). Oregon's economic crisis and the national
nursing shortage: a transformational opportunity for rural areas.
Online Journal of rural nursing and health care, 4(1), 64-74. Retrieved
from http://www.thefreelibrary.com/Oregon's economic crisis and the
national nursing shortage: a...-a0174057701
McPeck, P. (2006). Growing their own--the rewards and challenges of
rural nursing. NurseWeek News, Retrieved from
http://www2.nursingspectrum.com/articles/print.html?AID=24966
Moulton, P. (2012) Rural students views on nursing workforce issues:
The results of a focus group study. Retrieved from
http://ruralhealth.und.edu/presentations/pdf/focusgroupposter5-
03.pdf
13. References (cont.)
Skillman, S. M., Palazzo, L., Keepnews, D., & Hart, L. G. (2005).
Characteristics of registered nurses in rural vs. urban areas:
implications for strategies to alleviate nursing shortages in the united
states. Informally published manuscript, Department of Family
Medicine, University of Washington, Seattle, Washington.
Spencer, K. (2012). Rural Assistance Center Idaho. Retrieved from
http://www.raconline.org/states/idaho.php
Swartwout, E. ( n.d.) ANCC’s pathway to excellence program.
Retrieved from
http://www.nursecredentialing.org/Pathway/AboutPathway/Backgrou
nd-and-Overview.aspx
Tomey, A. M. (2009). Nursing leadership and management effects work
environments. Journal of Nursing Management, 17, 15-25.
United States Census Bureau. (2010). Profile of general population and
housing characteristics: 201o [Data file]. Retrieved from
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productvie
w.xhtml?src=bkmk
Editor's Notes
There is an elementary, middle and high school along with 7 universities within a 2 hour distance.
Oneida County Hospital is a CAH designated in 1999 by CMS as it meets the governments requirements for critical access hospitals.
18% of the U.S. population lives in rural areas and rural areas make up 80% of land mass. Unique issues: 44 hospitals in Idaho, 27 of which are located in rural areas and identified as a critical access hospital (CAH).Small facilities require that nursing be ‘generalists or have the skills necessary to care for all patient populations. Rural facilities also have limited resources—financial as well as educational opportunity that are unique from their urban counterparts.
Skillman, Palazzo, Keepnews & Hart analyzed data from the National Sample survey of Registered Nurses between 1980 and 2000 and found that more RNs are living in rural areas, but that two-thirds of them don’t work in those areas but commute to work in urban facilities. On average, urban nurses earn $7-9,000 more than a rural nurse. Another issue is that the rural nurse must practice as a ‘generalist’. They must assess and manage patients across all life-spans and for all health conditions from childbirth to geriatrics. Rural nurses also practice more independently, meaning that they may not have immediate ‘on-site” resources and must utilize critical thinking skills to make potentially split-second life-saving decisions. Skillman suspects that another issue that keeps rural nurses travelling to urban facilities is the flexibility of work. They may work three 12 hour shifts and have the ability to be home for several days.SO—what can be done to address nurse recruitment & retention at Oneida County Hospital?
I will discuss the objectives in depth in the next few slides. The first objective would be to recruit nurses/potential nurses within the Malad community by creating opportunities for exposure to the nursing profession & collaborating with a local university to provide opportunity for education. The second objective would be to pursue certification through ANCC. Magnet certification will likely be out of reach for most rural facilities; however, ANCC offers a fairly new certification that is geared for facilities of all sizes. Magnet certification recognizes excellence in nursing and patient care while Pathway to Excellence certificationrecognizes foundational elements of an ideal nursing environment.
Because the average age of the rural nurse is 6 years older than the urban nurse, I need to think not only about my current nursing population but the future nursing population as the more than 50% of nurses are close to retirement with a projection of 28.8% shortage of RN’s by 2020.I want to make the nursing profession more visible to the community so Oneida School District will be contacted to help coordinate career fairs to elementary through high school-aged children. I also do not see a school nurse on staff at these schools, so I would like to propose sharing a school nurse FTE with the school district. Even if a part-time FTE, this will expose the children to the nursing profession and offer interaction with a nurse in a positive light as well as offer a resource for health screening, health education, and health management.I also noticed that there is a CNA course at Malad High School. I would like to continue to offer Oneida County Hospital as a clinical site with the opportunity for those students to job-shadow a registered nurse as well at the end of their CNA training.In recruiting RNs, I need to look at collaborating with a university to offer community-based nursing education so that students in the program have clinical experiences in Malad to learn how to function as a rural nurse. I need to recruit people with ties to my community. Oregon Health Sciences University school of nursing offers a BSN that is completed solely within the student’s community. This type of program would help me recruit students from my own community with a commitment to the community. OSHU utilizes off-campus course delivery (DVDs and webinars) as well as local community resources for clinical experiences. I want to offer the opportunity to any of my current staff—CNAs, phlebotomists, registration, etc.—that may have the desire to attend nursing school. The opportunity to job-shadow will also be provided during the annual Nurses’ Week celebration. Idaho State University has already implemented a Rural Nurse Internship program that can be utilized here. I appreciate ISU’s Rural Nurse Internship program as it gives nurses a solid foundation in order to become the generalist that a rural nurse is; however, this program is for students who have graduated from nursing school. I would like to work with ISU to institute a program of education within my own community (like OHSU offers) if they do not already have this program in the works.
In retaining my current nurses, I may not be able to compete with urban facilities’ pay practices but pay is not the only thing that drives nursing job satisfaction. In fact, in Molinari & Monserud’s study, salary was not even in the top 5 factors of job satisfaction related to organizational characteristics. I will pursue ANCC’s Pathway to Excellence certification as these standards are foundational to an ideal nursing practice environment which will translate not only to increase nurse satisfaction & retention, but improved patient care & better outcomes.I will not touch on all of these standards, related to time constraints, however, they are all important foundational standards:Share governance—starting a multi-disciplinary practice council with guidelines for decision-making abilities.Healthy work environment—Systems in place—can be addressed by the practice councilOrientation—utilizing the ISU internship program Leadership—transparency is imperative; must lead by example and always focus on ‘what’s best for the patient’.Professional development—organizing a consortium with other rural hospitals in Idaho to offer monthly continuing education classes on topics that specifically apply to rural nursing. Helping nurses utilize government resources (US dept of health & human service) for nursing scholarships to obtain BSN. In addition to the current “Employee of the Quarter” program at Oneida, I want to institute a “spotlight” for nursing. Look for exemplary care and education advancement examples from my nursing staff and create a “Nurse of the Quarter” or “Nurse of the Year” award to coincide with Nurses’ Week.Balanced Lifestyle –one of the least satisfying aspects of rural nursing, according to Molinari & Monserud, is scheduling issues. With rural facilities, there is not the resource pool for nurses to have the schedule flexibility they desire. I would like to institute self-scheduling at Oneida County Hospital. Self-scheduling can increase job satisfaction because it gives nurses the opportunity to balance home and work life. EBP—I believe with the initiation of my practice council, EBP will continue and even flourish as the council makes recommendations & changes in the facility based on current literatureQuality program—can also be addressed by the council and process changes.
Transformational leadership is the theoretical framework I chose for this presentation. I feel that with the impending ( & current) nursing shortage, I have nothing to lose by trying to change the ‘status quo’ of rural nursing. I have to think outside of the box to create a vision within staff to be able to impact behavioral change that will help me recruit and retain nurses. As I stated before, I might not be able to compete with the pay practices of urban facilities; but there are plenty of other way that I can creatively attract nurses to Oneida County Hospital. The four main concepts of transformational leadership are These leaders are charismatic—they are admired and respected by those they lead.They inspire others to work together enthusiastically looking for a ‘better outcome’They provide opportunity for intellectual stimulation and creativityThey are mentors and supportive of each individuals’ needs.Transformational leadership creates an environment in which the team is motivated to better performance because they have a vision of where THEY want to be. Transformational leadership is recognized as having an impact on employee attachment to an organization.In pursuing Pathway to Excellence certification, I am committing to transformational leadership. I am helping my staff catch a vision of where THEY want to see the organization and what they can do to get the organization to that place. Engaged employees are satisfied employees and satisfied employees typically stay within the organization.
The Master’s program here at ISU has prepared me to address healthcare issues in the rural environment by first providing me with a foundation of theoretical frameworks. Even in my undergraduate studies, I had difficulty ‘seeing’ the application of theory to bedside nursing. The more I have studied and learned about theory, the more I understand how intertwined bedside and theory really are…rural or urban. I find myself talking to my own staff differently—gently prodding them to think how theory affects bedside care. I like to think of it as ‘more tools in my toolbelt’ . I also have a more questioning mentality. I am not satisfied to stay with the ‘status quo’, but want to look for other opportunities for improvement and to raise the bar. In a rural setting, this is extremely important foundation to recruit and retain nurses. As I’ve said before, I may not be able to compete with the pay practices and some of the resources of my urban counterparts, but I can be creative in other ways that nurses find equally as attractive. I believe the Pathway to Excellence will help Oneida County Hospital address these issues by attempting to create an “ideal nursing environment” in spite of the disparities.I believe that my Master’s foundation has helped me to more consistently think outside of the box, never be satisfied with things as they are—but rather helping others to catch the vision of where the organization is going and then be content to sit back and let them determine the path to that vision while mentoring them through the process. In rural health, this collaboration is essential as the group must work more intimately together to provide excellent care for a unique population with unique health issues.As an undergraduate, I relished bedside care and how I affected patient care and never wanted to be anywhere else. Now, as a Master’s prepared nurse, I still affect patient care—but I get to motivate and mentor others in the journey to catch that vision and, to me, that is just as rewarding than bedside care because I can affect more patients and more practice.
The expected impact of my objectives is that I would have a higher retention rate of my current nursing staff as well as a higher recruitment rate of new nurses. By providing an ideal work environment, nurse satisfaction will increase, turnover will be minimal and this will also help with recruitment. Increasing the visibility of nursing within the community may help trigger an interest in nursing and create the opportunity for recruitment to a rural nursing program. By recruitment of new nurses within the facility and my own community, employees will already have deep ties to the community and less likely to leave Oneida County Hospital for an urban facility.
