The following article is reprinted with permission from the October, 1995 edition of
Nursingmatters.
Cooperative provides link between rural hospitals
By Sherry Kudronowicz, RN, Kaaron R. Keene, RN, MSN and Sherry L. Quamme, RN, MS
"As a nurse executive in a rural hospital, the Rural Wisconsin Health Cooperative Clinical and Executive Roundtables have become lifelines of information and opportunities for sharing current knowledge. In the spirit of cooperation and collaboration with each other, sharing in the process of policy development and learning through a variety of experiences has proven invaluable to me," said Beverly Hoege, RN, assistant administrator at Reedsburg Hospital.
Cooperation and collaboration are words of the '90s for health care providers, just as competition frequently is. For nursing leaders and nurse executives, financial resources have been shrinking as budgets continue to get tighter. Holding the line on cost to patient populations is a primary concern.
Competency has also become an important issue for nurse executives and nurse managers to address with their respective nursing staff members. One way the member hospitals of the Rural Wisconsin Health Cooperative have been successful in addressing all five issues is through the implementation of the Clinical Nurse Specialist consultation contact. Member hospitals who need ongoing consultation, staff development and quality improvement / process improvement work, along with competency validation, development or documentation can seek this support through a contractual relationship with the RWHC.
Member hospitals like Columbus, Edgerton, Sauk Prairie, Richland Center and others could not individually afford to hire and retain a CNS for critical care and medical/surgical nursing. As a collective, the RWHC can employ the CNS and then contract with the hospitals that want the services to develop their nursing staffs and maintain those skills. Investing in the development of a skilled nursing staff translates into good business. For example, at Columbus Community Hospital, Intensive Care Unit utilization has increased appropriately in a 12-month period from April 1, 1994 to March 31, 1995. Rhonda Reals, Nurse Manager for the unit ties the increased utilization to the education add training provided by Linda Briggs, RN, clinical nurse specialist through the RWHC CNS contract. Linda spends one full day per month at Columbus Community Hospital working with the nursing staff to strengthen clinical skills. Physicians admit and manage the care of more complex patients because of the competence of the nursing staff and confidence in their ability to care for a broader range of patient conditions.
The CNS relationship and contract has been beneficial to improving job satisfaction and pride in the quality of care. ICU and ER registered nurses work together to train other staff on how to respond in cardiac and respiratory arrest emergencies. "without the CNS Service, we would not be where we are today with our clinical skills," says Laura Warren RN, ICU Unit Care Coordinator at Columbus.
Benefits of Networking
Perhaps the most valuable, yet intangible, benefit of the Rural Wisconsin Health Cooperative Nurse Executive group is networking. RWHC member hospitals are distributed over a wide geographic area and with fairly separate service areas. They do not consider themselves competitors. Sharing of policies, ideas, and solutions to problems all occur within an atmosphere of cooperation and willingness to assist. This happens on both an informal, call-a-friend basis, and through formal sharing at the meetings.
There are special challenges in managing a small hospital and members appreciate having colleagues to call on who are dealing with similar staffs, hospital structures and issues. Nurse executives are faced with the need to provide many of the same services, and meet the same standards as large hospitals, yet with far fewer human and financial resources. The ability to call a fellow member for support, advice and commiseration is an unexpected bonus which cooperative membership has provided. In addition, having a cheering section and "support group" makes the bumps in the road easier to face.
"The RWHC Roundtables offer an opportunity to speak openly about what is happening in facilities of similar size and circumstance. Analyzing industry changes affecting small community hospitals delivery of services - sharing how you or others have met challenges or collaborating on ideas for doing something new is helpful beyond words. It is a great forum for seriousness (and humor) that promotes realism in problem solving," said Myrna Garnett, director of nursing-Adams County Memorial Hospital.
Hearing from each other at the round-robin sharing portion of the nurse executive meetings gives members rich ideas. Much like brainstorming, the whole is greater than the sum of the parts, translating into solutions for individual hospitals and projects for the group as a whole. A sampling of activities, in addition to those discussed above, are writing/receiving a Robert Wood Johnson Strengthening Hospital Nursing grant, coordinating a cooperative-wide users group for hospitals using computerized nursing care planning system, sponsoring an education program by a nationally known speaker on clinical practice, development of management competencies, and initiation of an inter-hospital ethics committee.
History of RWHC
The Rural Wisconsin Health Cooperative is owned and operated by 21 rural acute, general medical-surgical hospitals and one urban hospital. The cooperative was initiated in 1979 by several hospital administrators in southern and central Wisconsin as a shared service corporation and advocate for rural health. RWHC as grown to become a significant force in rural Wisconsin which employs more than 100 physicians to proved emergency physician coverage. Today the staff and contracted professionals provide services directly in areas such as: advocacy, audiology, multi-hospital benchmarking and other quality improvement initiatives, grantsmanship, occupational therapy, respiratory therapy, per diem nursing, physical therapy, physician credentialing, speech pathology, emergency room physician staffing and ongoing rural specific continuing education opportunities.
Of the services offered, roundtable groups developed for many of the member hospital professionals such as RT, PT, materials management directors, laboratory, QA, social work, CFOs, business office managers, WIPRO/UR, and nursing. The Nurse Executive roundtable was developed and is comprised of nurse executives from member hospitals. The group's work plan consists of various areas such as developing competency based performance appraisals, providing the impetus for developing a CNS service, developing a per diem nursing service for member hospitals, and developing an ongoing clinical education series of inservices for staff nurses. In addition, it maintains communication with schools of nursing related nursing education and acts as clinical sites for BSN students, developing a Critical Pathway project, and support for dealing with various Federal, State, and JCAHO compliance issues.
Sherry Kudronowicz is director of Nursing/Assistant Administrator at Memorial Hospital of LaFayette County, Kaaron R. Keen is Director of Nursing at Sauk Prairie Memorial Hospital and Sherry L. Quamme is Associate Administrator - Patient Care Services at Columbus Community Hospital.