Keeping nurses in the pipeline Because a vacancy of even one or two people constitutes a shortage in a small staff, rural facilities must constantly think of new ways to keep nurses in the pipeline, said Cella Janisch-Hartline, BSN, RN, nursing leadership senior manager and coordinator of the residency program at the Rural Wisconsin Health Cooperative. “It’s always been an issue. We always have to be creative, coming up with new ways to entice people, to engage people, to attract people to our organizations.” Evidence shows adequate pay and benefits are important in at-


tracting andkeepingnurses at rural facilities, Skillman said.Programs offering tuition reimbursement have successfully attracted new graduates to rural areas, “but they don’t stay very long,” saidAngeline Bushy, PhD,RN, FAAN, professor and chairwoman of community healthnursing at theUniversityofCentral Florida SchoolofNursing in Daytona Beach. Bushy has worked in a variety of rural health settings and researched and writtenextensively about rural nursing. Though data is sparse, a number of studies have shown rural


nurseswiththe highest job satisfaction rate prefer rural lifestyles and come from rural backgrounds. Some rural hospital administrators said nurseswith ties to the community such as a spouse or parents in the area tend to stay longer than those without connections. Programs that recruit high school students to become certified nursing assistants, then connect them with distance learning pro-


working with community colleges to have them teach a class, or having themcreate communitywellness programs.Online learning programsandaccess tospecialists throughtelehealth canhelpnurses feel less professional isolation, Bushy said. For all these things towork, rural facilities need leaders who rec-


ognize developing and keeping a strongnursingworkforce is crucial to providing quality care, which will in turn attract more qualified nurses, Fahs said. But convincing harried nursing directors and stressed financial officers they need more resources to attract and develop new nurses isn’t always easy. Partlybecauseof a lackof soliddataonwhat reallyworks, andpartly


because resources at rural facilities tendtobe scarce, fewpeople seem to be doing much planning to address expected shortages as older nurses retire, said thosewhoworkwith rural facilities. “They’ve had a tremendous culture shift lately,” Schou said, and are now dealing with the transition to electronic health records, population health, managed care, reducing readmissions and other changes as a result of healthcare reform. “They’re not doing a lot of planning” around workforce issues, Schou said.


Hurdles to reaching full staff Even thougha stable, satisfied and well-educatednursing staff would help themmanage the challengesof healthcare reform, Skillmansaid, many healthcare administrators feel they can’t afford education and residency programs. “The money is tight and the shortages overall are not as great as they were back in the early 2000s.” The leaders most open to evidence-based re-


cruitment and retention strategies are those who have more education and involvement in promot- ing nursing as a profession, Janisch-Hartline said. Rural hospitals need to be training leaders to look at delivering healthcare from a global perspective, Blumenthal said. “Howdo we create organizations of excellence so nurses will want to come here?” Even with its support and strong nursing lead-


grams to earnnursing degrees,have proven successful inmany rural communities, Bushy said. ThoughGrahamdid not growup ina rural area, her grandparents


live inSalmonandshewas familiarwiththe community.Anattraction for her was the residency program for new nurses offered by Steele Memorial, she said.She turneddownoffers fromother ruralhospitals that did nothave residency programs. She and other residents—all new nurses at rural hospitals—met online regularly to talk about whatwas happening at workwith their patients and colleagues. “It’s hard as a new nurse to talk about your problems when you don’t have a peer group,” Grahamsaid, and those discussions, as well as support froma preceptor, helped her feel less isolated. Somestudies suggestRNsin rural areas are especially concerned


about professional growth and continuing education, Skillmansaid. Some facilities have joined cooperatives that provide residency and trainingprograms,or pay for training inspecialties such asemergency medicine, trauma care andpediatrics. Some pay tuitionoroffer other support for education, encouraging nurses to get advanced degrees Small facilities need to figure out ways to keep nurses interested


and active as their careers progress, Schou said. “Nurses like to be challenged.” She suggested moving nurses into leadership roles,


18 JANUARY/FEBRUARY 2016 • MIDWEST


ership, SteeleMemorial seems to be constantly looking for nurses, Grahamsaid.The pay isnot enoughfor some to support a family, and couples can’t always find work in the community for thenon-nursing spouse. “It’s unfortunate because we have such a great program,” she said. Her own experience has helped her grow personally and profes-


sionally inways shenever could have imaginedhappening ina more urban setting. She has worked with patients in labor and delivery, orthopedic, general surgery, and medical. She’s looking forward to receiving training in the ED. In part because of her intense work schedule, Graham found adapting to a different type of social life one of the most challenging aspects of rural nursing, but she’s now enjoying skiing on “perfect powder” snow, playing pool and helping ranchers chase down cattle. “I had to reach pretty far out ofmy comfort zone,” she said, but


the results have been worth it. “You have to be brave. You have to trust yourself a lot and have faith in your skills to do rural nursing.” •


Cathryn Domrose is a staff writer. TO COMMENT, email editor@nurse.com.


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