Posted July 30, 2014
When 29-year-old Rachel Schonbachler landed her first nursing job at Pioneer Memorial Hospital in Heppner, Oregon last September, she was thrilled.
She was working in her hometown and doing what she loved.
“I like rural health care. Every day is different,” said Schonbachler, a registered nurse. One day she might treat a child with a cold, the next an elderly patient with a breathing issue or a gunshot victim in the emergency room.
But here’s the rub. Many small critical-access hospitals have a problem retaining nurses. Some leave because of burnout, others seek jobs in urban hospitals where they can specialize in a particular field. The turnover in rural hospitals can strain existing staff and affect the quality of patient care.
So in 2008, Idaho State University’s Department of Nursing—with a $1.3 million grant from the Health Resources and Services Administration—created the Northwest Rural Nurse Residency.
The goal was to help rural hospitals—those with 25 beds or less— retain their nursing staffs by bridging the gap between transition and practice, said Dr. Beverly Hewett, grant project director and a retired ISU clinical assistant nursing professor.
“In a rural hospital, you do it all. You’re the OB labor nurse, the ER nurse, the medical surgical nurse and the pediatric nurse,” said Hewett.
The yearlong residency was free to hospitals and nurses and consisted of more than 30 interactive classes delivered to the workplace via video technology. Instructors included ISU faculty and national nurse practice experts. Topics ranged from the care of a patient with a severe allergic reaction or childhood illness to the treatment of a gunshot wound, crisis management and leadership training.
Many of the medical lessons were taught using human patient simulation—the use of high-tech mannequins to simulate real-world medical scenarios. Simulation gave the nurses the opportunity to practice decision making in a controlled setting, boosting their confidence levels and fine-tuning the skills needed in a rural setting.
“Participants had the opportunity to collaborate with other rural nurse participants, to share experiences and ideas, and to learn from each other,” said Dr. Kathleen Olsen, a retired nursing clinical instructor who taught the simulation sessions.
The residency program, which ended June 30, enrolled 323 registered nurses from 106 rural hospitals in 23 states. The initial goal was to have 85 percent of the nurses who completed the program stay on the job for one year.
“We exceeded that goal with an 88 percent retention rate—284 nurses stayed at least one year,” said Hewett.
As for Schonbachler, she says the residency was well worth her time, especially the session on treating gunshot wounds. “We live in a hunting community,” she said.
Schonbachler also made copies of the classroom lessons to share with her nursing colleagues.
Hewett says the success of the ISU Northwest Rural Nurse Residency demonstrates a need for nurse residencies, and she’s looking for ways to sustain the program now that the funding has ended.
“It proves there is a need for transition to practice for any health care provider. They do residencies for physicians, so why not nurses?” she said.