Boise State University, Nursing Department

2. St. Luke’s Wood RiverMedical Center St. Luke’s Boise & MeridianMedical Centers Syringa General Hospital St. Luke’s Magic Valley Medical Center North Canyon Medical Center Elks Hospital St. Luke’s McCall Hospital Cascade Medical Center Boise State University, Nursing Department Weiser Memorial Hospital Elmore Medical Center

3. Mission* Vision* Values MISSION VALUES VISION Our decision-making guide… By 2014, Rural Connection will be nationally recognized for cost effective, wholistic models that demonstrate collaborative nursing care management strategies to improve quality across the care continuum. We exist to… Attainable Collaborative Sustainable Value to Membership Respect for Diversity and Uniqueness Provide a collegial environment for creative solutions to patient care for rural, urban, and academic partners. Rural * Urban * Academic

4. A 20 Year Legacy Rural Connection began in 1990 through a "Strengthening Hospital Nursing" grant funded by the Robert Wood Johnson Foundation / Pew Charitable Trust.  The grant ended in 1995 and Rural Connection continues to evolve and participate in projects that improve health care practices. Rural Connection is a consortium of nursing leaders who are innovators for patient care.  Through collaboration and a shared vision, Rural Connection provides a collegial environment for rural, urban, and academic partners. Education, performance improvement, research, sharing of resources, and ongoing communication and networking are a part of a Rural Connection tradition that has been nurtured since 1990.  Rural Connection membership is rural, urban, and academic.  Its membership includes hospitals throughout Idaho and also includes Boise State University, Department of Nursing.

5. “We do our best work within a trusting, respectful, and non-competitive environment.” (Ed Dahlberg, former President & CEOSt. Luke’s Health System)

6. Board of Directors Amy Bearden CNO, St. Luke’s Magic Valley Regional Medical Center Steve Frei CNO, Syringa General Hospital Lorraine Reinhardt CNO, Gooding County Memorial Hospital Anna Hissong Interim CNO, Elmore Medical Center Beth Gray VP of Patient Care, McCall Memorial Hospital Teri Coombs CNO, Cascade Medical Center Buffie Main, Executive Director Rural Connection Sharon Kensinger, President CNO, St. Luke's Wood River Medical Center Joanne Clavelle, Secretary Treasurer VP Patient Care Services and CNO, St. Luke's Boise and Meridian Regional Medical Centers Lisa Looney, President-Elect Director of Nursing, Weiser Memorial Hospital Judy Taylor Director of Clinical Services, Elks Hospital Pam Springer Nursing Department Chair, College of Health Sciences, Department of Nursing Boise State

7. Why “Rural” Connection….. • Of the 44 counties in Idaho, 35 are considered to be rural. Of the 44 counties… • 2 counties have between 0-2 RNs for every 1,000 people • 14 counties have 3-5 RNs for every 1,000 people • 22 counties have 6-9 RNs for every 1,000 people • 6 counties have at least 10 RNs for every 1,000 people Sixty-seven percent of Idaho residents are from rural or frontier counties. SOURCE: (Idaho Rural Counties) Idaho State Office of Rural Health (RNs Employed in Idaho Counties) Idaho Nursing Workforce Center

8. Telling the story: the dance of collaboration and our commitment to finding solutions where rural, urban, and academic partners meet…….

9. Characteristics of Rural & Urban Nursing SOURCE: Bushy, Angeline (2000). Orientation to Nursing in the Rural Community. Thousand Oaks, CA: Sage Publications.

10. Telling the story: the dance of collaboration and our commitment to finding solutions where rural, urban, and academic partners meet……. Boise State University, Nursing Department While hospitals work to create comprehensive and meaningful orientation programs, Rural Connection is working to ‘bridge the gap’ between preparation and practice by creating relationships and forums for dialogue between academics and industry. “New graduate nurses now comprise more then ten percent of a typical hospital’s or health system’s nursing staff and this number is certain to grow moving forward” (Advisory Board). The emergent need to prepare for the nursing shortage makes it imperative that Rural Connection and other nursing organizations help the universities and service providers to be prepared for an influx of students and interns.

12. Living & Working the Rural Connection Framework

13. Rural Connection Theoretical Framework Person:The person refers to those who are served by our actions. This may include other Rural Connection Board Members, faculty, and/or staff directly and patients and/or students indirectly and may represent individuals, groups, communities, or organizations. Environment: The environment is the intersection of urban, rural, and academia in Southern Idaho and the surrounding region. We understand and respect that the cultures of these areas differ; and we utilize those differences to support change. We target interventions and processes that positively impact all three areas. Health: Health refers to the climate of the organization of Rural Connection as well as the work climate in the facilities we represent. The projects we undertake positively impact the health of our organization(s), patients, students, and communities we represent. Nursing Leadership: Nursing leaders design processes and systems that allow organizations to prosper by providing a collegial environment for creative solutions to patient care. Leaders demonstrate accountability and integrity in actions.

14. Rural Connection 2014 Strategic Plan

15. 2014

16. Relationship-Based Care Across the Continuum: With quality patient care as the primary outcome, Rural Connection will strive to implement Relationship Based Care as a model for all Rural Connection Members. Rural Connection will explore implementing this transformative practice model across all aspects the care continuum.

17. Summary of Initiatives:Relationship Based Care across the continuum. Integrate RBC as a model for all Rural Connection members and throughout nursing leadership, and the transitional nurse role. Explore stretching the model across accountable care organizations, and disease populations (population-based masters). Intentional Presence: restructure Rural Connection meetings around a model that continually incorporates mentoring, relationships, and collective wisdom to support the collegial environment and strengthen intentional leadership.

18. Rural Nursing: A Specialty Rural Connection, in conjunction with state and national partners, endeavors to prove that rural nursing is a specialty through the creation of an academic certification in rural nursing and expanded professional development and acknowledgment for rural nurses and nurses who work across the continuum of care.

19. Preceptor Program Topics:Teaching & Learning Styles ~ Competency ~ Critical Thinking & Clinical Judgment ~ Communication & Conflict Management ~ Delegation ~ Team Building

20. From Preceptor to Mentor, Nurses as Teachers has been providing a foundation for supporting the development of nurses along the continuum from novice preceptors to expert mentors and leaders for the past 4 years. With over 500 graduates of the course, Rural Connection continues to provide a toolkit for teaching, leadership, mentorship and communication. The program’s core components live in the belief that preceptor and mentorship skills can be taught and developed through competencies such as critical thinking and clinical judgment, communication, storytelling, prioritization, delegation, and team building. Nurses as Expert Teachers & Mentors

21. Describe one way your practice will change after this offering………… I will be better prepared! I will try to actively listen more, try not to prepare my statement and listen. I am more aware of responsibility to my co-workers as a preceptor. I will be more organized and will do a better job assessing the needs of my orientee. I will now work on better communication between myself and orientee - - clarify, clear instructions, concise feedback. I will use a lot more communication & planning with my orientee when we start in order to find out their needs. I really needed help with communication and conflict management. I will be more open minded and hopefully understand the new employee better. Better understand myself and my teaching / learning style and how to better teach others with different styles. I plan on really working on my active listening with my orientees.

22. Supporting and On boarding Registered Nurses • SOAR: Supporting And On boarding Registered Nurses • Monthly sessions that are learner driven • Dynamic dialogue that builds capacity in each nurse resident • Experiences that enhance a resident’s capacity as a member of the team &your organization • Curriculum that augments and enhances the resident’s capacity as a practitioner • Building blocks for the resident to expand their capacity as a member of the profession

24. SOAR Nurse Residency FY 2010: Total Residents: 101 Participating Facilities Include: • Elmore Medical Center • North Canyon Medical Center • St. Luke’s Boise/Meridian • St. Luke’s Magic Valley • St. Luke’s Wood River • Syringa General Hospital • Weiser Memorial Hospital

25. ROI for Rural Hospitals: 4 nurses Wages/benefits to attend 12 days of off-site training = $10,560 Program participation fees = $4,000 Travel expense (120 miles per trip) = $700 Total Organization Costs = $15,260/4 nurses Replacement Cost/Nurse = $57,200 ($44,000 + 30% fringe) 75% retention  375% ROI

26. 9 student placed in 4 communities: Grangeville, Ketchum, McCall and Gooding Rural Nursing Elective – Summer 2010 Coming Soon…..Rural Nursing Elective – Summer 2011

27. The Idaho Nursing Action Coalition, which includes representatives from professional nursing associations, hospitals, health insurers, governmental entities, and colleges and universities statewide, will work to implement the recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health. Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and an improved information infrastructure. 

28. Where can you find out more? www.ruralconnection.org