THE NURSING COMMUNITY APGAR PROGRAM PHASES I-IV
Rationale/Conceptual Basis/Background: In rural and frontier areas of the United States, the nursing shortage is particularly severe. Current changes in our health care system may result in a surge of newly insured individuals seeking care and further strain the rural health workforce. Drs. Baker and Schmitz previously developed a program to address rural family physician recruitment and retention issues. The development of a parallel nursing program serves to provide a unique interventional package with which rural hospitals will be able to address their workforce needs. Conceptually, the project drew upon Bushy’s application of the core nursing concepts of person, environment, health, and nursing to the unique aspects of rural nursing.
Methods: The Nursing Community Apgar Program resulted from interprofessional, collaborative efforts of university, medical residency, and rural nursing personnel. Phase I of the project was the development of the Nursing Community Apgar Questionnaire (NCAQ). In Phase II, the NCAQ was piloted at eleven critical access hospitals in Idaho and a comparative database established. The Nursing Community Apgar Program was initiated in Phase III and provided CAHs insight into how they compared with other CAHs across the state. Phase IV allowed CAHs to compare two years of their results on the NCAQ, identify strengths and challenges, and receive strategies for solutions to their persistent challenges.
Results: Critical access hospitals from across the state have participated in the program as it progressed from simply identifying factors that influence nurse recruitment and retention to development of solution strategies. Data analysis allows CAHs to see how their results compare with the data base means and assess their progress over time. Collection of recruitment and retention practices that result in positive improvements in NCAQ results has begun as an initial step in identifying best practices.
Implications: The Nursing Community Apgar Program can be utilized by rural communities and hospitals as a real-time assessment tool which can be used to strengthen their advertising and interviewing, tailor their negotiation and contract strategies, and track their progress over time. The program serves to identify solutions to common challenges and develop best practice policies for rural nurse recruitment and retention. Application of the program in other rural states may identify trends and themes at regional and national levels.