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Nursing at a rural hospital like Pipestone County Medical Center is very different from working at a hospital in a large city.

In larger metropolitan hospitals, nurses often specialize in one particular area. They might work in the trauma center, the emergency room, obstetrics, surgery or another specific area of the hospital. Meanwhile, their rural counterparts could work in all those areas in a single day, rushing from one department to the next as needed. That can lead to exhaustion, burnout and ultimately a high turnover rate.

To address those issues, Idaho State University developed the Northwest Rural Nurse Residency program in 2008 with federal grant funding from the Health Resources Services Administration.

“They finally acknowledge that rural nursing is different than nursing in Sioux Falls or the cities,” said Tara Langswierdt, a Registered Nurse who recently became the first PCMC nurse to graduate from the program.

The program uses online courses, continuing education and hands on experience with a mentor to address the challenges new rural nurses face.

Nurses in the program are paired with a certified mentor who has at least two years of rural nursing experience and has undergone 16 hours of education in critical thinking development, education practices, role transitions and rural nursing theory to help guide the resident nurse through the program.

Julie Carrow, a 12-year veteran nurse at PCMC, volunteered to serve as Langswierdt’s mentor after they learned about the program from former Interim Director of Nursing Barbra Brown last year.

“I believe the residency program is valuable in building confidence in new nursing staff as well as helping the newer staff nurses to transition from a novice nurse to an advanced beginner,” Carrow said.

Langswierdt started the program Jan. 20, 2010. She said the first 12 weeks consisted of online specialty education via web conferencing with other rural nurses from around the country. There were about 60 participants in the program with her, and only five from Minnesota.

“I felt kind of honored just to be part of the group,” Langswierdt said.

Resident nurses also had to complete weekly online surveys about their experiences at the hospitals where they work. The surveys asked about things like mistakes made by them or other nurses, nurse to patient ratios, and whether anything occurred that they felt unprepared to handle.

After the online portion of the program, Langswierdt spent time with Carrow reviewing various topics like teamwork, evidence-based practices, quality improvement, safety, case management and utilization of health information technology.

Carrow also helped Langswierdt develop a residency plan that highlighted 10 job responsibilities that Langswierdt felt she needed more experience with. When those duties came up, Carrow provided guidance about how to properly handle them.

Langswierdt said she focused on understanding codes, reading EKGs, reading arterial blood gases and other more technical things that nurses at rural hospitals don’t encounter every day. She also chose to focus on leadership, ER traumas and obstetrics emergencies.

The program included 36 hours of free continuing education credits specific to the resident nurse’s needs. Langswierdt said she focused on diabetes, sexual assault, the endocrine system, wound management, end of life care and EKG reading.

“I love every aspect of nursing I do, so getting to take these classes for free was really exciting,” Langswierdt said.

Nurses are required to take at least 24 hours of continuing education every two years. Langswierdt, a self-described ‘school nerd,’ said she’s accumulated over 100 hours in the past 12 months thanks to the electives and online education from the Northwest Rural Nurse Residency program, and 40 hours from her Sexual Assault Nurse Examiner (SANE) training.

Langswierdt said her love for a wide variety of nursing responsibilities is what attracted her to the Northwest Rural Nurse Residency program and rural nursing in general.

“It keeps you on your toes and you pretty much retain all the nursing skills you learn,” Langswierdt said. “There’s nothing you really lose.”

Langswierdt said the most important lesson she learned from the program was about herself and what she is capable of. Now that she’s completed the program, Langswierdt is eligible to be a mentor for other new nurses in the future, which she said she’d be happy to do.

The program is available for nurses at any facility designated as a rural or critical access facility. Eligible nurses must be recent graduates, transitioning from an urban to rural facility or reentering the nursing field. Over 100 nurses have participated in the program since it began Jan. 1, 2009.

Tamara Hollinger-Forrest, MS, RN at Idaho State University, said the university is hoping to receive a three-year extension of the grant to extend the program through 2014 and expand it to reach more nurses.

More information about the program can be found at