Source: UNIV OF MINNESOTA submitted to NRP
HOUSING AS A STRATEGY FOR RECRUITING AND RETAINING RURAL HEALTHCARE WORKERS
Sponsoring Institution
State Agricultural Experiment Station
Project Status
COMPLETE
Funding Source
Reporting Frequency
Annual
Accession No.
0214485
Grant No.
(N/A)
Cumulative Award Amt.
(N/A)
Proposal No.
(N/A)
Multistate No.
(N/A)
Project Start Date
Jul 1, 2008
Project End Date
Jun 30, 2012
Grant Year
(N/A)
Program Code
[(N/A)]- (N/A)
Recipient Organization
UNIV OF MINNESOTA
(N/A)
ST PAUL,MN 55108
Performing Department
Design, Housing & Apparel
Non Technical Summary
While approximately 20 percent of the United States population lives in rural areas, only 9 percent of physicians practice there. Physicians consistently and preferentially settle in metropolitan, suburban, and other non-rural areas (Geyman et al., 2000). This uneven distribution of physicians is expected to further disadvantage rural communities as the overall shortage of physicians continues. For example, the University of Minnesota first-year medical school class of 2005 consisted of 165 students (Profile of Entering Class 2004). This number of students will fall short of the number needed in greater Minnesota alone. According to the Greater Minnesota Health Professional Demand Survey 2006, 2,464 physicians were employed in 79 responding health care facilities. In addition, the 79 employers reported that they were in the process of recruiting 249 additional physicians. Recruiting and retaining physicians is a challenge everywhere, but especially in small communities and rural areas. While access to health care in rural places typically focuses on primary care physicians, a national network of 1,300 small critical access hospitals has been established to assure access to medical care in rural areas (Medpac 2007). Yet for these facilities to remain viable recruiting and retaining their complete workforce ranging from physicians and medical directors to cooks and custodial staff is essential. The purpose of this study is to examine the workforce demands of small rural hospitals and the role of housing in employee satisfaction. The research will focus on the Northern Great Plains States of Iowa, Minnesota, Nebraska, North Dakota, and South Dakota. A survey of the Critical Access Hospitals will be conducted to determine the labor force employed by these hospitals and employee's satisfaction with their work, community, and housing situations. In addition, employer strategies will be identified to meet the workforce housing needs. Expected outcomes include increased knowledge by researchers, hospital administrators, and government officials of the economic impacts of hospital payrolls in rural communities as well as the range of housing needed to meet healthcare employees' needs. Awareness of possible employer involvement in workforce housing development will be increased. There is a potential for employers to adopt best practice strategies and increase their involvement in workforce housing as well as adoption of policy incentives by housing agencies or legislative changes that facilitate ways to meet the healthcare workforce housing needs. Anticipated benefits of the project include the development of a holistic approach to recruiting and retaining healthcare professionals and other employees' of Critical Access Hospitals. Through increased viability, Critical Access Hospitals will maintain their ability to provide healthcare to rural residents and facilitate the economic and community development of rural areas.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
60860503080100%
Goals / Objectives
The project consists of three primary objectives: Objective 1: To identify workforce requirements of Critical Access Hospitals (CAH) in the Northern Great Plains Region and examine the extent to which housing factors contribute to existing and potential (students/trainees) employees' satisfaction with their work and community. Objective 2: To identify short-term housing needs for healthcare providers and trainees in rural communities. Objective 3. To determine best practice examples and employer strategies for meeting short-term housing needs of the healthcare professionals and trainees in rural areas. Output activities include developing, implementing, and analyzing a survey of Critical Access Hospital labor force requirements and employees' satisfaction with their work, community, and housing situations. Best practices for healthcare employers involvement in workforce housing will be identified and summarized. Graduate Research Assistants will be mentored. Dissemination of best practice findings will be shared with participating Critical Access Hospitals, community planners, and healthcare professionals through presentations at regional conferences and published materials. Research presentations will be made at professional conferences including Rural Sociological Society Annual Meetings and the Community Development Society. Manuscripts will be submitted to refereed academic journals.
Project Methods
The geographic area covered by this project is the Northern Great Plains Region (NGPR) states of Iowa, North Dakota, South Dakota, Minnesota, and Nebraska. The study will include communities with a Critical Access Hospital. A research advisory team will incorporate user input in the study design, pilot testing, case studies, and final evaluation of the project. Institutional Review Board (IRB) Human Subjects Review will be completed prior to initiating the research survey and interviews. To meet Objectives 1, a pilot study regarding existing staffing and wage/salary levels and employee housing needs and satisfaction will be tested using two representative hospitals in Minnesota. Following a revision, a workforce and income survey will be sent to the 310 Critical Access Hospitals (CAH) in the Northern Great Plains Region (NGPR). Data analysis will determine housing affordability levels for staff employed in NGPR Critical Access Hospitals based on federal housing affordability measures. A revised employee satisfaction survey will be sent to 500 randomly selected CAH employees. Advanced notice of the survey will be provided to each selected hospital including a poster notice for employees. A postcard will notify employees that they have been selected to participate in the study. A reminder postcard and second survey will be mailed to non-respondents. Respondents' housing needs and preferences will be analyzed in relation to existing countywide housing characteristics identified by public data sources from the Census Bureau, community planning documents, and websites. Using a SPSS computer program, data from the two surveys will be analyzed using descriptive statistics and logistic regression determining significant factors related to employee satisfaction. Objective 2 focuses on short-term housing needs for healthcare professionals and trainees. Case studies of at least three communities will include interviews with hospital administrators and city officials discussing short-term housing needs and housing aspects of recruiting and retaining the healthcare workforce. Where possible, short-stay workers and trainees will be included in on-site interviews. Detailed notes will be analyzed to identify themes and develop thick descriptions. Objective 3 will be met by on-site reviews in five communities where successful housing strategies are identified. Community selection criteria will be developed in conjunction with the Research Advisory Team. Research procedures will include observation, photographs and interviews with hospital administrators and city officials. Qualitative analysis will identify themes, key processes and strategies, and significant actors. A set of best practices for communities will be developed. Given limited Agricultural Experiment Station resources, additional funding will be sought to support Research Advisory Team meetings, survey expenses, and travel costs for case study interviews and on-site observations.

Progress 07/01/08 to 06/30/12

Outputs
OUTPUTS: During 2012, research efforts focused on conducting the online survey with nursing students. A data file of the survey results was developed. Ongoing analyses of data from both qualitative and quantitative phases of the project continues. A manuscript was prepared and submitted to a peer reviewed research journal and subsequent revisions were made. After three rounds of reviews/revisions the research team decided to pull the manuscript. Revisions are ongoing and we anticipate submitting the article in an alternative venue. A briefing sheet was prepared and provided to the Critical Access Hospitals participating in the qualitative portion of the study. Graduate students involved in the project have learned survey development skills and implementation of web-based survey techniques. PARTICIPANTS: In addition to the research team consisting of the principal investigator, Dr. Ann Ziebarth, and graduate research assistant Heidi Wagner, a number of organizations facilitated the focus group interviews with nurses and online survey of nursing students. These included seventeen nurses who participated in focus group interviews in three Critical Access Hospitals in Minnesota. Five of the 36 Colleges and Universities with nursing programs in Minnesota and an additional North Dakota program assisted with distribution of the web-based survey of nursing students. TARGET AUDIENCES: Community level target audience includes administrators of Critical Access Hospitals and local decision makers including economic developers, planners, and elected officials. In addition, case studies are being developed for use in classroom instruction. PROJECT MODIFICATIONS: Not relevant to this project.

Impacts
A national network of 1,300 Critical Access Hospitals (CAHs) has been established to assure access to medical care in rural areas, yet, to remain viable staffing these hospitals is essential. Recruiting and retaining healthcare professionals is a challenge everywhere but especially in small communities. By identifying factors that enhance the work/life balance and satisfaction of CAH nurses and examining factors influencing nursing students to consider future employment in rural locations, this University of Minnesota research project provides strategies for staff recruitment and retention that potentially reduces labor costs to hospitals. More importantly maintaining adequate staff in CAHs enhances high-quality accessible healthcare for the 1:5 rural Americans, including the 39.6 million elders. Additional impacts of the project include enhanced methodologies for sampling, survey design, and use of web-based survey formats. Adoption of more systematic sampling strategies has been employed and strategies for presenting mixed-method research findings are being developed and implemented. The project findings have been utilized in proposals for research that is targeted toward rural communities with high proportions of recreational/second-homes. The research team anticipates further qualitative and quantitative data analysis and the development on further dissemination of study findings directed at practical policy and use by local decision-makers.

Publications

  • No publications reported this period


Progress 01/01/11 to 12/31/11

Outputs
OUTPUTS: During 2011, Kelsey Imbretson completed her term as the graduate research assistant for the project and I hired Heidi Wagner to replace her. The University of Minnesota Human Subjects Continuing Review was approved by the Institutional Review Board for both the focus groups with nurses and the online survey with nursing students. Two focus group interviews were held with nurses in rural communities. Data collection began with the student survey. PARTICIPANTS: The Principal Investigator for this project is Ann Ziebarth, a professor in Housing Studies at the University of Minnesota. She is a rural sociologist who is interested in the economic, demographic, and policy changes that impact rural communities. In particular, she looks at housing as an indicator of these changes and as a strategy for addressing broader rural concerns. Kelsey Imbertson and Heidi Wagner are graduate research assistants on the project. TARGET AUDIENCES: Target audiences include administrators of critical access hospitals and local decision makers in rural communities who are interested in address the health care needs of rural residents. PROJECT MODIFICATIONS: Not relevant to this project.

Impacts
Change of knowledge continues to contribute to the research team's understanding of the factors that motivate health professionals and trainees to conduct professional practice in rural communities. The research assistant gained expertise in survey methodologies and online survey reporting. Additional changes in the knowledge regarding use of qualitative data analysis continued to develop. Research participants also expressed a change in their level of awareness regarding the factors that influence the recruitment and retention of nurses in critical access hospitals.

Publications

  • Ziebarth, A. & Imbertson, K. 2011. Getting and Keeping Nurses in Critical Access Hospitals. Reshaping Rural America in an Urban Society: Innovative Approaches for Community Change. 75th Annual Meeting of Rural Sociological Society in conjunction with the 43rd Annual Meeting of the Community Development Society. Abstracts, p. 28. Available online at rss2011.ruralsociology.


Progress 01/01/10 to 12/31/10

Outputs
OUTPUTS: During 2010, I hired Kelsey Imbertson, graduate research assistant. The University of Minnesota Human Subjects Review was obtained for focus group interviews with nurses in Minnesota Critical Access Hospitals and also for an on-line survey of students enrolled in health profession programs that include rural experiences. The first focus group was conducted and a content analysis is in progress. Findings from the focus groups and on-line survey will be combined with previously developed case studies. PARTICIPANTS: Kelsey Imbretson, a graduate research assistant, began working on the project in September 2011. A rural Minnesota Critical Access Hospital served as a partner organization in conducting the focus group with nurses. Additional networks are being developed with the University of Minnesota Medical School and School of Nursing to facilitate the on-line survey of health professional students. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Change of knowledge has contributed to the research team's understanding of the factors that motivate health professionals and trainees to conduct professional practice in rural communities. Further knowledge change has occurred with regard to the use of qualitative methodologies and qualitative data analysis (e.g., content analysis techniques).

Publications

  • No publications reported this period


Progress 01/01/09 to 12/31/09

Outputs
OUTPUTS: During 2009, I mentored a graduate student regarding research methodologies related to the project. Preliminary case studies were examined and findings disseminated at the Rural Sociological Society Annual meeting in Madison, WI. A grant proposal was submitted to fund primary qualitative data collection; funding was not awarded. PARTICIPANTS: The graduate student research assistant on the project has resigned. The Principal Investigator will need to hire someone starting January 2010. Preparation of the grant proposal resulted in creating new networks and potential collaborators within the School of Nursing as well as the College of Human Development and Education. Since the funding was not awarded the project was delayed and further collaborative research has been put on hold. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Feedback from participants at the Rural Sociological Society Annual Meeting research session indicated that there was a change of knowledge regarding rural hospitals' strategies for recruiting physicians and nurses. The case studies presented helped put the problems into perspective and provided "real world" examples for secondary data analyses.

Publications

  • Ziebarth, A. 2009. Recruiting and Retaining Health Care Professionals in Rural Communities. Page 83 in Proc. RSS Annual Meeting Final Program. Madison, WI.


Progress 01/01/08 to 12/31/08

Outputs
OUTPUTS: External reviewers of the project proposal recommended that an advisory committee be established prior to conducting research. The purpose of the committee would be to provide user input in the planning of the research project and interpretation of study findings. A list of prospective advisory committee members has been identified at this time. A further review of literature has been conducted and a review of existing database information has begun. A listing of rural health organizations is being developed. In addition, a graduate research assistant has been hired and the Principal Investigator has mentored her in developing the research project strategies. PARTICIPANTS: The principal investigator of this project is Dr. Ann Ziebarth. Dr. Ziebarth is a rural sociologist who has studies small towns and rural areas using housing as an indicator of the demographic, economic, and political change and the resulting impacts for these places. She initiated the project, wrote the proposal, and is conducting the research. Dianna Krogstad is a graduate research assistant assigned to the project. Contacts with the AHEC representatives and other rural health care organizations were facilitated by Sara Axtel, Health Outreach Coordinator, Department of Family Social Science, University of Minnesota. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Contact with the Area Health Education Coordinators (AHEC) in Minnesota has resulted in a strong interest in the project. Awareness of the role of housing in the opportunities to place medical students in community-based rotations was confirmed.

Publications

  • No publications reported this period