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By Cathryn Domrose


Taylor Graham, BSN, RN, graduated


from nursing school hoping to find a job in or around Boise, Idaho, the city of 200,000 where she’d grown up, or another urban center.


But when larger hospitals turned her


down, she thought about SteeleMemorial MedicalCenter inSalmon, amountaincom- munityof some3,000people in the center of the state. She’d done a student clinical rota- tion there and had been impressedwith the leadership, support for nursing and quality of care inthe18-bed critical access hospital. The idea of rural nursing frightened


Graham. She couldn’t imagine being the onlyRNon a unit,300miles away fromthe nearest larger hospital.But SteeleMemorial administrators promised she would always have manageable patient loads, other RNs working with her, and a residency program that included training, sessions with a pre- ceptor and meetings with nurses at other facilitieswho also were newto ruralnursing. “I knewI was going to get the support that I needed andIwas going toget the opportuni- ty to learn,” she said. She decided to give it a chance.Ayear and ahalf later,Grahamis still at SteeleMemorial and in no hurry to leave. Her experience represents the payoff


some desperately short-staffed rural facil- ities hoped for about 10 years ago when they invested in ways to attract newnurses to remote areas where salary and benefits couldn’t competewith urban and suburban


counterparts, and many new recruits didn’t stay through the first year. Administrators began looking for people who wanted to be in a rural community or who had ties to the community, and then supporting them so they would stay—a policy called “recruiting for retention.” Despite sporadic shortages, healthcare organizations in many rural areas, like those in


the rest of the country, have seen an ease in workforce issues as older nurses have put off retirement, said rural health researcher Susan M. Skillman, MS, deputy director at the University of Washington’s Center for HealthWorkforce Studies in Seattle. Nurses who couldn’t find work in urban areas often returned to their rural roots. Partnerships between universities, community colleges and rural facilities successfully produced more newnurses who wanted to stay put. But recently, a number of areas are reporting increased difficulty finding RNs, say those


who work with rural facilities. Healthcare facilities in centralWashington, eastern Idaho, Wisconsin, Illinois and Montana report higher vacancy rates and more difficulty finding experienced nurses and new grads to fill positions, according to educators, administrators and regional association directors in those states.


Re-emerging shortage “Of late the nursing shortage is hitting us again,” said Pat Schou, MS,RN, FACHE, executive director of the Illinois Critical Access Hospital Network, which has 53 member hospitals. Within the last sixmonths—after several years of stability—hospital administrators are telling her they are having a hard time filling positions. Facilities inruralMontana are ina similar situation, saidCaseyBlumenthal,DNP,MHSA,


RN, CAE, vice president of theMontana Hospital Association. “In the last 13-1/2 years, I don’t remember such a universal cry for help.” The information is anecdotal and no one knows if the recent shortages are temporary fluctuations or portend a long-term situation. Workforce data show rural nurses typically are older than nurses in general. Retirement is a serious concern among rural facilities, said Pamela Stewart Fahs, PhD, RN, interim dean and professor at the Decker School of Nursing at Binghamton University in upstate New York, and editor-in-chief ofOnline Journal of RuralNursing andHealthCare. “I think we’re going to have a huge need again within the next five years.” There are about 2,000 rural hospitals in the U.S., according to the American Hospital


Association, including1,328critical access hospitals,which have fewer than25beds and are at least 35 miles away from another hospital. The facilities varywidely in patient population and staffing needs. “What’s rural inMontana is not necessarily what’s rural in Kentucky,” Fahs said. Shortages depend on how many nursing schools are in the region and whether area hospitals are primarily hiring bachelor’s-prepared nurses, she said. They alsomay depend on the local economy.ThoughNorthDakota isnot facing anoverall


shortage of RNs, an oil boom in the western part of the state has created a huge demand for healthcare in some rural counties, said PatriciaMoulton, PhD, executive director of the North Dakota Center for Nursing in Fargo, and president of the National Forum of State NursingWorkforce Centers. High-salaried jobs suchas truck drivers are competing withhealthcare facilities forworkers,


Moulton said. “All of that is impacting our supply.” In parts ofMontana, the oil boomhas driven up the price of housing beyond the afford-


ability of a nurse’s salary, Blumenthal said. Federalworkforce figures predict the countrywill have more than enough nurses by 2025


if demand and supply continue at the current pace. Butmany newgraduates can’t or choose not to work in rural areas because of obligations such as a spouse who can’t find a job in a small community or a salary that won’t support a family.Others may be intimidated by the isolation ofworking in a small rural facility, or don’twant to drive long distances, sometimes in bad weather, say administrators and nurses who work with rural facilities.


Visit us at NURSE.com • JANUARY/FEBRUARY2016 17


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