Kentucky Residency Program Focuses on Rural Nursing

RWJF Executive Nurse Fellow Alumnus is working with rural hospitals to create residency programs to attract and retain rural nurses.

    • September 22, 2010

Nurse residency programs are blossoming in Kentucky, in response to a state requirement for post-graduate training. To date, however, graduates who want to practice in rural areas have had very limited residency options in the state’s dozens of rural hospitals. But a new initiative led by Jane Kirschling, D.N.S., R.N., F.A.A.N., dean of the University of Kentucky College of Nursing and a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2000), will soon create new opportunities for rural nurses.

As Kirschling explains, health care institutions in the state’s larger cities have implemented effective residency programs, but none of the programs cover rural areas. That leaves a gaping hole. More than a third of the state’s 126 hospitals have 50 beds or fewer, and another quarter have between 51 and 100 beds. These smaller hospitals are handcuffed by economics when it comes to residency programs for nurses, Kirschling says, because they hire fewer nurses than urban institutions, and need the ones they hire to take on a full load.

Kirschling cites data from the University HealthSystem Consortium demonstrating that “nurses come into their first employment setting very optimistic and positive about the work they’re going to do. But within six months, their psychological well-being measures drop precipitously.” Over time, the numbers begin to go back up, she explains, but new nurses need connection and support.

“Given that we have many more applications for nursing school than slots, I think about it in terms of the ‘sacredness’ of a slot, and the time and money invested by the nurse and the institution,” Kirschling says. “We need to do everything we can to maximize our investment. That means getting the right students in the right slots, and keeping them in the workforce so that nurses can do what they came to school to do.”

In an effort to fill the gap in residency programs for rural nurses, Kirschling and six other alumni of RWJF’s Executive Nurse Fellows (ENF) program, together with representatives from the Kentucky Board of Nursing and Kentucky Hospital Association, secured a seed grant from the ENF Alumni Association and created online learning modules for rural nursing residents. They have also recruited rural hospitals in the state to participate in a pilot program this coming year, and expect three to five rural hospitals to provide residencies for up to 10 R.N.s.

The ENF Connection

Kirschling credits her ENF experience and the network it helped create for her for the program’s early success. At the time of her fellowship, she was living and working in Maine, and she says workforce issues “really got under my skin.” But as a result of her ENF experience, she channeled her energy toward securing additional funding from the legislature for nursing school enrollment. When she moved to the University of Kentucky, a call for proposals from the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation and RWJF, triggered her interest in tackling workforce issues in her new state. That led her to create the Kentucky Nursing Capacity Consortium, out of which grew the nurse residency effort, in which other ENF alumni figure prominently.

Before ENF, she says, “I’d spent my whole professional life in the academy—26 years. When I went into the fellowship, my focus was on whether I was going to progress in terms of higher education administration. But the fellowship shook me to my core, and made me understand the significance of my experience and the potential to still have an important footprint on the discipline.”

Brenda Cleary, Ph.D., R.N., F.A.A.N., director of the Center to Champion Nursing in America, agrees with Kirschling that addressing nursing workforce issues is essential to improving health care system. “We must build a nursing workforce that is highly-skilled, sufficient in numbers and distributed in ways that will give patients access to quality care, no matter the size of the communities in which they live.”

The three-year Executive Nurse Fellows program is focused on expanding the role of nurses to lead change in the U.S. health care system. It provides extensive leadership development for nurses in executive roles from a variety of fields, such as public or community health, science and research, corporate health, academia, government, or military health service. A key part of program participation is the development of an innovative initiative to improve health care delivery in the fellow’s organization or community.

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