The State of Nursing: Third in a three-part series
When a nurse applies for a staff position at a hospital, he or she wants what we all want—a good, supportive working environment. They look at the people they might work with and check to see if the facility is modern and well equipped. Another key component is that they have opportunities to continue learning.
It's Sharon Kensinger's job to make sure that St. Luke's Wood River Medical Center is one of those attractive facilities.
A nurse since 1971, Kensinger is the hospital's chief nursing officer. She is also a board member of the Idaho Alliance of Leaders in Nursing, an affiliate of the American Organization of Nurse Executives.
"We have the ability to staff with a lower staff-to-patient ratio than urban or suburban hospitals can," she said. "Graduate nurses continue to learn over the course of two years. The staff here has embraced the learning environment. That's where the affiliation with St. Luke's Health System comes into play."
Registered nurses are the largest health-care occupation, holding about 3 million positions in the United States. About three out of five nurses work in hospitals. St. Luke's Wood River has 80 registered nurses and 36 doctors on staff. The majority of those nurses are in-state trained, and 25 of them worked at the now defunct Moritz Community Hospital in Sun Valley.
Nurses are the link that unites doctors, patients and families. It's nurses who provide the most patient care, carrying out doctors' orders, administering medications, supervising the use of medical equipment, and observing and directly caring for patients. They are integral to a hospital's success. As a rural hospital, St. Luke's Wood River faces particular challenges with the nursing shortage.
"It would be easy to assume that because it's small that it's easier," Kensinger said. "It's a mistaken assumption. The complexities stay the same no matter the size. This is a very robust community hospital. To have these services in a rural hospital is very unusual."
Nurse Manager for Medical/Surgery and Intensive Care Cindy Mosier said much of that is due to the commitment and investment from the community.
"They know what they want," she said. "Patient care is what people come to the hospital for. We want them to leave feeling they had the most positive patient experience. We work hard here. We have pride in our product."
Despite the fact that St. Luke's Wood River is currently "overfilled," the nursing shortage always looms in the future. To deal with it, St. Luke's Wood River Foundation has sought to support staff nurses when they return to school for more training and those who have a particular connection to the area.
"Shortages are normal," Kensinger said. "Every time they license a nurse in Idaho we fill out a survey on shortages. The average age of nurses is in their late 40s, so within 10 years we'll see a lot retire. But based on our experience, 9/11 made a difference. People changed careers, including those who became nurses. We have several on staff—Carrie Renner, Melissa Webb and Alison Smart. One of our grads, Cassie Shelly, has a degree in bio-mechanical engineering."
Both Mosier and Kensinger are career nurses.
"I went in at 17. I thought I knew everything—that it'd be easy to be a nurse," Kensinger said. "It was the perfect storm for someone just out of high school to go right into a nursing program, while simultaneously getting college credits. There's no longer a time when someone—like I did in 1969 with an associate degree, who went through a two-year program—can funnel into a wait list."
In the current environment, someone would need to complete basic college coursework prior to entering into nursing studies, but a shortage in nursing faculty is where the problem begins.
"Colleges and universities are really trying hard to work it out, but salaries for medical faculty don't compare with senior nursing salaries," Kensinger said. "Nursing faculty has not gotten the funding."
In fact, for certain faculty positions, a registered nurse must also have either a doctoral degree or a master's degree.
"It's much harder for a qualified nurse who is willing to accept the lower salary to be a faculty staff, because of those qualifications," Kensinger said.
Mosier has been a nurse for 22 years.
"I couldn't decide what to do so I tried numerous different things," she said. "Then I cared for a dying friend. I got over the queasy part. I worked as a nurse technician in Joplin, Mo. I really liked and thrived at it. So I went to school and was 18 years at Friedman Memorial Hospital in Joplin."
Before moving to Idaho to be nearer her grandchildren, she was at the Cleveland Clinic in the cardiothoracic department.
"I like being in a smaller facility," she said. "Here I bring in a new grad and take them through surgical, orthopedic, neuro, diabetic, pediatric, post-partum moms and ER. They have to be able to do everything. It's general versus specific."
Despite what Mosier called this "silo" training, it's important to continue building and maintaining a level of expertise even when the nurses don't see something on a regular basis.
"We frequently float nurses to other St. Luke's medical centers, for new employee training or to specialty training," Kensinger said. "Here we have a well-resourced education department and lab with a full-time educator, Karen Morrison, and Susanne Miller, who works part-time leading the preceptor task force. The education department is responsible for clinical and non-clinical information for the whole facility. We work in partnership at all times. This is not your average place. It's a learning environment for the clinical staff and because of this our patient care is stronger."
Nevertheless, between the long hours and constant state of change, nursing can be grueling work.
At one point Mosier was going to resign and return to Joplin.
"There was nothing local to make me stay," she said. "It was totally logical to move. My husband wanted to go. But I changed my mind. I formed really good relationships in this community and hospital. It's a family. I respect who I work with, the management, nurses, doctors, the community, the beauty. I had unfinished business. I wasn't ready. Pretty exciting things are happening around here."
Carol Mosier, left, and Sharon Kensinger team up to run the nursing staff at St. Luke’s Wood River Medical Center. Photo by David N. Seelig
