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New nursing challenge: Hudson Hospital is ready

Despite a recent state report citing a shortage of registered nurses and other medical workers in the state, Hudson Hospital has been able to buck the trend and maintain a high level of staffing.

The Wisconsin Hospital Association released the Wisconsin Health Care Workforce Report 2007 that said Wisconsin hospitals and health care facilities report it's increasingly difficult to recruit the number and type of employees needed to fill specific vacant positions, including nursing. The number of vacant RN positions in the state (2,759) is large, especially as the current workforce ages. Wisconsin hospitals employ 30,000 nurses.

Hudson Hospital's registered nurse turnover rates for the past three years were 25 percent in 2005, 20 percent in 2006 and 5.8 percent in 2007.

"It reflects the success we've had with our registered nurse recruitment, training and retention initiatives," said Karen Hansen, marketing and community relations manager at Hudson Hospital.

"Three years ago, long shifts, staff fatigue, staff retention and a nurse shortage were primary concerns for nursing leadership. Realizing staff satisfaction and retention directly impact patient care delivery, and ultimately patient satisfaction, efforts began both on organizationwide and department levels to more intently engage all staff in the hospital's mission and vision. Having the best and most satisfied employees became one of the organization's major long-term goals."

"Results (from an employee survey) indicated there was the opportunity to increase employee satisfaction and staff engagement across the organization," said Carolyn Milbrath, director of human resources for the hospital.

The hospital began efforts to recruit, train and retain registered nurses. Initiatives, including competitive wages, are:


Better known as "perks" to HR staff, recruitment efforts include the selling of amenities such as Hudson Hospital's healing environment philosophy -- it doesn't look, feel or smell like a hospital. Facility features include the Wintergarden indoor and outdoor gathering areas, the Healing Arts program, the meditation labyrinth,and the family kitchen (family space for patient guests).

"Once a candidate visits, they're usually sold," said HR staff member Cindy Johnson.

Attractive benefit and work schedule options are appealing to younger workers who, today, are more focused on work-life balance. The WHA workforce report states that workers entering the workforce today are less interested in working the number of hours that retiring workers may have worked.

For nurses in Hudson, the eight-week block schedule (days/nights/every fourth weekend) provides employees advance coverage notice and the ability to plan ahead outside of work. "Most hospitals do not offer block scheduling," said Johnson. "It's proven to be a great 'perk' for prospective nursing candidates."

Additionally, hospital officials say it hires enough nurses to provide optimal care and ensure staff stabilization with built-in replacement time (to cover vacations, shift rotations, etc.) to alleviate staff shortages.

No one has ever turned down the Health Reimbursement Account (HRA) - $1400 (FT) and $700 (PT) offered to employees annually to help offset medical expenses. And once recruited, new nurses know that they will not be left to fend for themselves; a comprehensive orientation/training program awaits them.

For registered nurse Melissa Wittstock, it was the eight-week block scheduling that initially hooked her. Having been an employee since 2006, she said "Hudson Hospital is competitive with Twin Cities hospitals and gives me the opportunity to provide my family, friends and neighbors with quality care close to home. I have the ability to impact care locally."


Training is offered at various levels to nursing students, new graduates and new hospital nursing staff. Hudson Hospital offers a greater number of preceptorships (80-96 hours of clinical on-site training) to nursing students through their school nursing program -- a requirement to complete their degree said Philip Hughes, manager of professional development.

In 2007, the hospital provided preceptorship opportunities to 30 nursing students, one of which was Caroline Yoerg, a WITC nursing student at the time and now a registered nurse and hospital staff member.

"Training in a small hospital gave me the opportunity to cross-train in multiple areas including specialties such as surgery, Yoerg said. "My preceptors were committed to the program. Not only did they lighten their loads and dedicate time to me, they encouraged me to experience all areas of interest."

Sixteen students from four nursing programs are already scheduled to participate in preceptorships between March and June of this year.

New graduates, residency

Beginning in 2007, registered nurses (new grads) beginning their career at Hudson Hospital joined nurses from across Wisconsin and Minnesota and participated in a nurse residency program. It is a multi-faceted, year-long program designed to meet individual nursing needs and help with the transition from school to practice. Monthly learning sessions are offered. Five new grads are attending this first year and have been partnered with a clinical coach, an experienced nurse working at the hospital, who takes special interest in their professional development.

Registered nurse Angie Adams said "transitioning from student to staff is often overwhelming for a new grad. Not only is there the realization that you are responsible for your patients, but the warning heard in school still lingers -- 'Beware the older nurses; they eat their young!' As a new nurse at Hudson Hospital, I couldn't disagree more. The experienced nurses eagerly teach, support and encourage new grad participation. I look forward to the day when nursing students or new grads look to me for advice."


Orientation for new nursing staff at Hudson Hospital, unlike most hospitals, is customized to fit each individual and is based on demonstrating core competencies, not length of orientation. It may take a week to orient an experienced nurse, but 10 weeks to orient a new grad, depending on their critical thinking skills and comfort level. Orientation is specific to the nurse's job at the hospital.

"My orientation process was substantial and very thorough. I was asked repeatedly how I felt things were going -- where did I feel comfortable and where did I need more experience," said Wittstock. "Positive patient outcomes were always of primary importance throughout orientation."

Nurse skills fairs, online learning, specialty courses in trauma nursing and basic critical care are some of the continuing education also offered.

To retain nurses, the hospital offers regular opportunities for nurses to meet with board members, medical chief of staff, chief nursing officer, senior leaders and department managers.

Quality program

Last summer, Hudson Hospital was selected to participate in Transforming Care at the Bedside, sponsored by the Institute for Health Care Improvement and the Robert Wood Johnson Foundation. The hospital was selected from over 500 applicants and was the only critical-access hospital chosen to participate nationwide.

The focus of bedside program was to improve the quality of inpatient care by making it safer, more reliable and more patient-focused. The goal is to get nurses back at the bedside spending more time, 70 percent of their time, providing direct patient care. Studies show increased time spent with patients translates into better patient outcomes.

"We want to be able to provide the exact care the patient wants/needs exactly when they want/need it," said registered nurse Deb Brisch-Cramer, vice president and chief nurse officer. TCAB is about giving bedside nurses the ability to recognize the need for improvement and make the necessary changes.

"Nurses have seen what this quality initiative is about and want to be more involved; they want to be part of the solution," said RN Jennifer Osterbauer. "TCAB has brought great changes to Hudson Hospital and reminded nursing staff that we are respected and valued for the hard work we do and that we can impact patient care, and that's important."

Based upon a paper written by Osterbauer on the hospital's participation in TCAB, she and Mary Brooks, CRN, will present at the national American Organization of Nurse Executives conference in April. Both look forward to presenting to nurse leaders from across the country and sharing the successes the hospital has achieved in transforming care at the bedside.