In 1977, Deaconess Medical Center, Spokane, Washington, was receiving requests for assistance from rural hospitals in the four-state service area. These requests included the need for help with educational classes to be brought to the facilities; clinical experiences at Deaconess, policies, and procedures, etc. An advisory committee of department directors was formed to develop a program to help meet the needs as requested by the rural hospitals. In 1978 the "Outreach Program: Sharing Knowledge" became a reality. The administration appointed Anna Mae Ericksen director of the program.

Grants were next received to assist Deaconess to administrate the project and to make it cost effective for the rural hospitals. Sixteen rural directors of nursing service and educators were asked to serve on a nursing advisory committee and work with the Deaconess directors and to meet monthly at Deaconess. Educational classes requested by the individual hospitals were designed by Deaconess specialists in consortium with the requesting facility to meet each hospital's need. Deaconess specialists were the presenters and scheduling was done by both parties. In 1984 the nursing advisory committee voted to plan a 1985 conference for rural nurses by rural nurses. 285 RNs and LPNs attended the first conference. Plans were made to annually present a conference with the nursing advisory committee serving as the conference planning committee. A logo for the conference was designed depicting a rural theme. At the 1987 conference, Anna Mae Ericksen was presented with a medallion designed with the logo. At the 1988 conference, Anna Mae spoke to the registrants about her vision for a rural nurse organization. The idea was enthusiastically received and plans made to move ahead with forming the organization. Seed money was received from the registrants to assist with costs. A steering committee of 25 nurses from three states and one Canadian province met to develop the purpose and definition of the organization as well as define the term "rural". Goals and objectives were established. Committees were formed and requested to have reports ready for the 1989 conference.

The 1989 conference was historic as the Rural Nurse Organization was formed. Officers were elected, bylaws finalized. Conferences would be under the direction of an RNO conference committee. Dues were established at $25.00. Anna Mae was appointed Regional Director and office space was provided by Gonzaga University Nursing Department. Printing and mailing costs were donated by Deaconess Medical Center. In January 1990, the first RNO newsletter was published. That year the logo became the official logo (with RNO Rural Nursing My Specialty) appearing on stationery and newsletters. The Medallion with the logo was presented to the first president. The Medallion would be presented each year to the outgoing president. The Bylaws were approved. In 1991, the RNO brochure was developed and printed. The Articles of Incorporation were approved by the Washington State Secretary of State. The Board of Directors elected to be an exhibitor at rural health conferences and rural nursing education programs.

By 1992 the membership pin was designed using the logo. Each member receives this pin. The Anna Mae Ericksen Award was established. Criteria was written for the award to be presented annually to an outstanding rural nurse nominated by her/his health care facility/agency. Awards were established for rural administrators and others for their financial support and dedication to RNO and rural health care. In 1993 the 501 ( c ) 6 tax exempt status was granted. Quarterly Board meetings were approved. An annual retreat to be held in conjunction with the Board meeting following the yearly conference was approved. Board members were responsible for their expenses incurred for the meetings. A special award was presented to the CEO of Deaconess Medical Center for coninued financial support. In May 1993, a contest was held to name the newsletter. Rural Nurse Connection was selected as the official newsletter name.

In 1994, the criteria for forming chapters was developed and published. Criteria for the Howard Gamble award was established. Mr. Gamble received the first award in his name. Mr. Gamble, a Northwest rural hospital administrator, is recognized nationally as the longest serving rural administrator in the United States. Howard has been a champion for RNO, supporting the organization from the beginning.

In 1995, the first RNO Chapter was formed in Delhi, New York by Debra Caiola, an RNO Board member. Each committee wrote goals and objectives. The Board of Directors agreed to recognize graduating nursing students with an interest in rural health care in the form of a complimentary one year membership in RNO. Criteria for the awards were written. Nursing schools in states where RNO has members were contacted and asked to submit the name of an outstanding graduating nurse meeting the criteria. Whenever possible, an RNO member would present the nurse with her one year membership and pin and a certificate at graduation. Participation has been successful. Grants were applied for, however, RNO needed to apply for 501 ( c ) 3 status.

An annual Lois McCray, RN Memorial Lecture was established. Lois, a rural nurse for 26 years, died of cancer in 1995. She was a charter member of RNO, a Board member and chair of various committees. An advisory committee of past presidents was established. The Board decided to have a poster designed for RNO using a rural theme. A board member paid for the artist to develop the poster. Recommended changes were made to the first draft. Conference calls to include Board members unable to attend meetings was approved. The cost of the calls is paid by participating Board member. Committees also use conference calls for their business. Received $1,000 from a Spokane Foundation with some of the money used to purchase a printer for the office. The title of Regional Director became Executive Director. The second RNO chapter was formed in Washington/Idaho by Joanne Shears, Past President and Jeannier Eylar, President-Elect.

1997 saw the Legislative Handbook developed and published. The logo became a registered trademark. The Rural Emergency Room RN Triage Project developed by the Columbia Basin nurse administrator counsel in Washington state was presented to RNO for our use. The program is being reviewed with an update of algorithms. 501 ( c ) 3 application included an Articles of Incorporation amendment. Joseph Lillard, a Northwest administrator, received the second Howard Gamble Award. A past president was appointed liaison for chapter formation. Internet access was established. A web page and Electronic Journal developed. The poster was presented and approved at the 1997 conference. Funding for production is sought. The prospective member packet was developed.