Erica DeBoer - Sanford Health News

What shared nursing governance looks like in North Dakota

Alan Helgeson:

“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic is a conversation on nursing with discussion on shared governance, nursing senate, and Magnet designation. Our guest is Wendy Kopp, Sanford Bismarck vice president of nursing. Our host is Erica DeBoer, Sanford Health chief nursing officer.

Erica DeBoer (host):

As part of this podcast, we’re really trying to highlight the essence of nursing excellence, and what a perfect time to be able to do that as the team has just celebrated their fourth Magnet designation. From your perspective, Wendy, I’m curious, tell me a little bit more about what this achievement for fourth designation means to your teams.

Wendy Kopp (guest):

So the achievement for the fourth designation is pretty incredible. You can look at statistics. So less than 2% of health care organizations in our country have achieved four Magnet designations, and so that’s pretty incredible. It really puts us in with an elite group of health care organizations.

Erica DeBoer:

So shared governance is an important part of our culture across Sanford, but more importantly at Bismarck. Could you explain what shared governance is and how it empowers nurses in shaping practice and policy changes?

Wendy Kopp:

Absolutely, Erica. Shared governance in Bismarck, I’m super proud of. We have a very strong shared governance structure, and when you think about what does shared governance mean in its essence, it’s really like autonomy and shared decision making. And so it’s really a framework and it’s a collaborative approach where our front-line nurses participate in their decision making on practice issues and policies. And so it’s really coming to the table and being present in those conversations that directly impact the work that they do.

Erica DeBoer:

And their energy is amazing. I love spending time with your senators, Wendy. You’ve done a great job leading that team. Tell me a little bit about a couple examples that have impacted nursing practice that have come through that shared governance structure.

Wendy Kopp:

Every year the list just gets bigger and bigger. I think some of the things probably that the senators would say they’re most proud of, that they’ve had a hand in, are probably developing our ICU nurse consult. That has been an incredibly successful initiative, the code blue debriefing. So that also came forward and really we’re implementing now, we’ve had huge success and we’re putting that across even more disciplines and specialty areas looking at in that NICU and OB space. So that really is a perfect example of what coming to the table and voicing your practice needs and concerns.

Charge nurse training and onboarding is another really great example of nurses coming to the table and really kind of sharing what their needs are and where the gaps are and what they feel needs to change.

Another one is point of care glucose testing, again, where we’re doing some pilots based on some things brought forward from senate.

And let’s see, another simple one would be just the need for more lactation spaces for our health care workers. And so we were able to give additional lactation spaces and get creative because they brought forward that need.

Erica DeBoer:

So what’s amazing about the examples that you gave, Wendy, is it highlights not only critical nursing practice pieces, but it also highlights the important health of your environment and making sure that they have that space to pump or really to make sure that there’s a safe space to debrief after a code blue.

I think as we navigate, and I’ve had a chance to talk with some of your ICU team, and they used evidence-based practice to actually support the information that they were gaining from our front-line teams. And to your point, they tested the science of it, they brought a collaborative group together and really met a need of – we don’t have as much experience with code blues or those urgent situations. How do we actually address that? And then how do we support our team? So I think the comprehensive approach that your teams are taking are just really impressive and actually addressing some of the needs of your front-line teams.

Wendy Kopp:

Absolutely. And one more thing, Erica, you reminded me when you talked about wellness, that’s another big initiative and a gap in what we were able to provide for our front-line workers. And they kept bringing the need on work-life integration and balance and needing a place to reset. And so we will be opening up before the new year our Zen Den, and that is an opportunity for our frontline workers to have a place for respite and to reset and rejuvenate. And so we’re really excited about that and that’s a testament to their voices coming to the table.

Erica DeBoer:

And I love the name Zen Den. I can almost smell the lavender. It’s amazing. I think it’s great. Tell me a little bit about the benefits of having your various councils and front-line representatives involved in that decision making.

Wendy Kopp:

Well, that’s quite an easy question. The benefit, it’s the patient. The patient is the one that benefits. When you think about our shared governance structure, and you look at our model, the patient is in the center of every decision that we make. And so when you think about where our shared governance, we call it our nursing senate, is that’s the next layer. And then all of our councils spoke out after that, if you think about it in a wheel fashion. And so it’s bi-directional. And so those councils report into the senate. The senate reports into the councils, and it’s just, I guess you wanna call it a beautiful marriage and how that works.

Erica DeBoer:

And it benefits so many more, not just our colleagues, but also the other people that are part of the collaborative team too. So that’s fantastic.

I wonder if we shift just a little bit to expertise and certification. I know I’m passionate about the role that certification plays in recognizing nursing expertise. How does it contribute to mentorship within the field?

Wendy Kopp:

Certification? Really, I mean, when you advance your knowledge and skills with certification, that mentorship just falls naturally because with certification you demonstrate that you have that advanced knowledge and skills. And so inherently that mentorship role just naturally or organically takes place.

Erica DeBoer:

I think that’s well said. What support does Sanford Health provide to nurses pursuing x certification and how does this support demonstrate a commitment to growth and advancement?

Wendy Kopp:

We definitely have that commitment to growth and advancement, and I think we’re really fortunate. Our learning and development center annually brings in, based on survey results, they bring in typical courses that are very, very popular or will be high users. So they bring those in, and those our nurses can take for free. Exam fees are covered, two attempts for an exam are covered, and then upon successful passing of that certification exam, there is also a bonus that goes along with it.

And so we feel that we do a great job not only initially supporting that, but then sustaining that we recognize our certification, our nurses that are certified annually, and it’s also additional support then for recertification.

Erica DeBoer:

It’s definitely something to be proud of. I know each of us as VPs of nursing and as a chief nursing officer, those are some of the things that I hold very close to heart because it’s really that expertise that’s really core to our commitment, not only to our patients, but to those around us to continue to learn and be that lifelong learner.

Wendy Kopp:

Absolutely.

Erica DeBoer:

Since we’re talking about certification, I wonder if you don’t have your own personal experience or a story of a nurse who benefited from the certification process and went on to become a mentor within the field.

Wendy Kopp:

I think of an example probably with certification process. As you recall, I mentioned the ICU nurse consult in a previous question. And so that particular nurse who brought it forward was certified and so based on advanced knowledge was able to kind of determine best practice. And so that was really a pretty cool moment to see that come to fruition based on that advanced knowledge.

And for myself, I can say for personally becoming certified in executive nursing practice, I want to be able to pay it forward and be able to continue mentoring our emerging leaders as well.

Erica DeBoer:

Yeah, and you do that extremely well, Wendy. When we shift to patient-centered practice, it’s really central to the focus. You’ve highlighted it already very well. How does Sanford Health ensure that all discussions, decisions and change revolve around optimizing patient care?

Wendy Kopp:

I think we could probably look at our differentiated practice model when we think of patient-centered care and the uniqueness that each of these specialties bring to the table. Erica, that was probably the easiest way to kind of summarize that.

Erica DeBoer:

Can you explain the role of evidence-based practice and how that’s important? Being at the forefront of all of our nursing endeavors?

Wendy Kopp:

I think having probably that problem solving approach and that decision making based on the evidence is really sort of ingrained in all of the work that we do. When we look at our professional practice model, research and evidence-based practice is a huge component of that. And so it’s really important to look at what are those influences, both internal and external, that influence our practice and affect our practice to really cause us to critically think about what changes should happen and then going to the evidence and research to help drive that change.

Erica DeBoer:

I think change is definitely a part of what all of us are trying to work on. And how do we do that with evidence-based practice in the forefront? I think you’ve got great examples of a really united and collaborative approach to your evidence-based practice group. It’s been amazing to see how it’s grown, not just in nursing, but also in some of your interdisciplinary teams through physical therapy and some of those last couple questions.

So when we think about the impact that happens through collaboration, how does fostering an open dialogue and knowledge exchange benefit nursing professionals, patients, our teams and the organization as a whole?

Wendy Kopp:

I know I keep going back to our professional practice model, but really interprofessional care and collaboration is another key component. And so when we think about our nursing senate, when we think about professional management, these are all councils and committees specific to Bismarck. Every one of those councils has an interprofessional or interprofessional members on there. We don’t make decisions in a silo. We collaborate and bring all of the entities to the table to really bring up the topics, the initiatives, the ideas, what are the opportunities, you know, how do we move forward again to make decisions that really will benefit not only the front-line workers, but also the patient.

Erica DeBoer:

I’m so excited that the team’s been able to celebrate their fourth Magnet designation. Speaking of collaboration, can you tell me how Magnet embeds that collaboration into that designation and that maturation over time?

Wendy Kopp:

Absolutely. And so I know we talk about Magnet being a nursing excellence award, and I always say, yes, it is. It is the foundation, but there is so much more to it. Not only one Magnet designation, but four designations is really a testament to the culture. We have been able to not only practice but sustain over the course of the years that we’ve been magnet designated. And so it’s the culture that really allows our teams to thrive. It’s all teams, our interdisciplinary teams, that culture again, where teams can have those conversations together, the good, the bad, and the ugly. And so again, just really hats off to all of the teams that allow great care to be given.

Erica DeBoer:

Absolutely. Something to be super proud of. That fourth designation in the MA maturation that you’ve seen, and I’d say even more importantly, you did that maturation, you did a lot of that work throughout the pandemic. And so important to recognize the challenges that came along with that.

Are there any particular innovations or practices that contributed to the remarkable achievement and how that’s influenced your organizational culture? You mentioned how important the culture is, how important the interdisciplinary team is. I’m just curious if there’s specific initiatives that help to drive that.

Wendy Kopp:

I don’t think I could probably list one initiative again, when you think about kind of the things that we focus on, it’s our quality, it’s our nurse, this nurse sensitive indicators. It’s really our patient experience and then it’s our nursing satisfaction. And so everything that we do touches each of those components in a very unique way. And so all of the exemplars have just have had a tremendous impact.

And we don’t do anything different the year that we go up for Magnet designation. We are that gold standard each and every day because of what we do and who we are. It’s not something we turn off and turn on just because we’re in our year or we’re up for re-designation. It’s really just who we are.

Erica DeBoer:

And it’s a magical culture that you’ve helped to create. Wendy, it’s been an absolute pleasure to speak with you today and share a little bit more about your shared governance structure as well as celebrate the Magnet journey with you. Anything else you’d add?

Wendy Kopp:

We want to reflect on Magnet. I think when patients come to Bismarck to receive care, they should know that they are going to receive some of the highest level of care in the nation. And again, we’re in with an elite group and we’re just extremely proud of who we are and what we’ve been able to accomplish as a rural health care organization.

Erica DeBoer:

I feel like Bismarck certainly emulates this in their daily practice in solving problems in the moment, no matter what might come your way. So congratulations and it’s great to have you.

Wendy Kopp:

Thanks, Erica. Thanks for having me.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

Learn more about this topic

• How SDSU is preparing nurses for rural care
• NDSU’s advances in nursing school keep human touch
• USD collaborates for the next generation of nurses

Get more episodes in this series

How SDSU is preparing nurses for rural care

Alan Helgeson (moderator):

Hello, and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low cost services in rural and underserved populations.

Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic is a conversation on nursing education and collaborative partnerships in developing the next generation of nurses. Our guest is Dr. Mary Anne Krogh, dean of the College of Nursing at South Dakota State University. Our host is Erica DeBoer, Sanford Health chief nursing officer.

Erica DeBoer (host):

It’s my honor to welcome you today, Mary Anne. I wonder as we kick off the next session of our podcast about reimagining health care, do you mind just introducing yourself and a little bit about yourself?

Mary Anne Krogh (guest):

My name is Mary Anne Krogh. I’m the dean of the SDSU College of Nursing, and I have been at SDSU since July of 2019. So just finishing up my fourth year. And it is an awesome place to be. It’s really a great time to be educating nurses.

Erica DeBoer (host):

That’s awesome. Thanks for being here with me today. I know that I’ve had an opportunity to chat with several different folks around reimagining health care and really more importantly why we’re here today is that how do we train and prepare our next generation of nurses. So I wonder if I might just ask a couple questions of you. So from your perspective, what do today’s nurses need to be prepared that’s different from in the past?

Mary Anne Krogh:

Well, our health care environment has changed pretty tremendously. I’ve been a nurse since 1985, and it is, could not be more different (laugh) today than it was back then. You know, in the ‘80s, pretty minor surgeries, procedures, patients were hospitalized at least overnight.

Today, most of health care happens in the community. We just do not hospitalize patients the way we used to. And so nurses today have to understand that, be nimble, able to think about what the patient’s needs are when they leave the health care environment, navigate all the complexities of the patient’s home environment, how they might find resources in their community.

And I think about our rural communities and how do we help patients find their health care needs in rural environments? So nurses just really have to navigate the whole spectrum of the health care environment in ways that are completely different than they were 30 years ago.

Erica DeBoer (host):

Agreed. And you well know my passion for SDSU as my alma mater, and I had the opportunity to start my nursing career at Sanford right out of SDSU with my clinicals happening in lots of the spaces where I had the privilege to work after I got my degree. How do you think the process of training future nurses has changed since I was in school? I know when I look at even the college of nursing on the outside, it looks different on the inside. We have a lot more technical components that I see inside the walls, but I think the curriculum has had to probably adjust and change as well.

Mary Anne Krogh:

Yeah. So our curriculum is completely different than when you or I went to school. We right now have a concept based curriculum, which really means that we wrap our whole curriculum around different concepts, acute care, primary care. We no longer have separate coursework for OB or peds or –everything gets threaded around different concepts. So students really learn about nursing care from across the lifespan that way.

We also are really working toward competency-based education, and that will transform how we look at educating nurses and nursing students in a way that I think will transform health care. Because one, you know, one of the challenges about educating nurses is that health care providers expect that a nurse, no matter where they graduated from, will have a certain set of competencies. And so that’s the direction that we’re going with that. So that’s really exciting. So that’s the curricular piece of it.

The other piece that has changed pretty dramatically is that we use a lot of technology today in how we train nurses. When I trained, all of the clinical education happened at clinical environments, some in the community, but primarily at hospitals and health care agencies. Today, much of our nursing training happens in simulation centers, much more in the community. We use virtual reality. We use telepresence robots, lots of different technological ways that we can train nurses in safe environments. They’re not going to harm anybody. And it allows nurses to really practice over and over the same skills so that they can become experts in the skills that nurses need to provide that expert care that we’ve all come to expect.

Erica DeBoer (host):

That’s awesome. Tell me a little bit more about virtual reality and how you use that as part of your curriculum, because I think to your point COVID forced us out of the clinical spaces to the same extent that it did before. But what it has done, if I were to look on the silver lining side of this, is it’s forced us to really explore other ways to do our work, both virtually and in person. So I’m curious, tell me a little bit more about how you use virtual reality in what types of scenarios for your nursing students.

Mary Anne Krogh:

So virtual reality at SDSU College of Nursing is relatively new. We’ve just gotten the technology over the last year or so. So we’re starting it as makeup simulations and clinical experiences for students. The beauty of virtual reality is we can reprogram things so students can have a wide variety of experiences through that virtual reality experience. We can reach students across the state in virtual reality. We have virtual reality experiences no matter where our students train in Aberdeen, Rapid City, Brookings or Sioux Falls. So it provides that.

The other thing is that if we had a student who was perhaps at a rural site, they could put on the virtual reality goggles and get the same experience as a student in Brookings. And so it really provides a lot of flexibility and a nimble educational environment for students as well. I think the opportunities are endless in virtual reality.

Erica DeBoer (host):

I appreciate you sharing your sentiments specifically related to that rural setting. I know that your team has invested a lot based on a grant to really bring nursing students to a separate experience in some of our rural settings. So I really love the idea about virtual reality, how that contributes to some of that flexibility as well as giving our nursing students a glimpse into what is rural care and how do I actually care for patients across their entire longitudinal lifespan.

To your point before around the concepts, how do you feel like the virtual simulators, virtual reality, and some of these practice environments are gonna benefit our patients?

Mary Anne Krogh:

Well, the more variety that students experience when they’re in the educational environment, the better prepared they’ll be for the wide range of experiences they have as nurses. And really, I think that’s true whether a new nurse takes a job in an urban community or a rural community.

So let’s think about Sioux Falls, for example. You know, many of our students take positions at Sanford in the Sioux Falls hospital. In that environment, they’re caring for patients who might be from a rural community. And so they have to understand that rural community, the resources that are available, how do they access those resources all for the benefit of the patient. So we do have programming built right in for students to opt into some rural experiences, both in primary care and in acute care.

So often what happens is that the students select the primary care option and then where they go and they work in a rural clinic, and then they also have the opportunity to use their preceptorship in the acute care environment in that same community. I love that idea because the students see the entire health care system through that lens of both the acute and the primary care experiences. And become enmeshed in that community.

Erica DeBoer (host):

Yeah. It’s so important cuz that is an important part of what our communities need. And when we think about the state of South Dakota, the majority of it is rural and everyone knows everyone, right? So we’re all a big, huge family. So that rural setting is really important.

I think that that technology is also gonna continue to benefit our new nurses as they just gain some of those experiences that maybe in some cases they wouldn’t be able to get during a clinical experience, during a preceptorship or an internship. I’m curious though, when we think about technology, so I think about technology and some of the digital tools. We’ve talked about VR, we’ve talked about simulators and things like that. How do these tools allow our nurses to be better caregivers?

Mary Anne Krogh:

When I think about the use of technology, the first place I go is the amount of data that it gives the nurse and just more information to make decisions, guide treatment and really just take better care of the patient that’s right in front of them, the patient and their family. And so I don’t think of technology and AI as things that replace nurses. It’s more that it gives them more information and better ability to care for that patient at point of care.

Erica DeBoer (host):

Yeah, I like that, Mary Anne. I think the other thing that I think a lot about is in the high tech inpatient setting, but I think the important other component that maybe we haven’t highlighted today is those simulation areas are more than just about a code blue scenario. It’s more than just about medication and administration. What I’ve seen and experienced in those simulation centers is there’s curriculum built around what is it like for that nurse to have that conversation with the patient because these are tough conversations that they’re navigating as new employees in different health care settings.

And so it helps them navigate those palliative care scenarios, those hospice scenarios, and even some of the behavioral health scenarios that don’t require high tech, but at least you have an opportunity to practice. What is that like, what does it feel like? So you understand how to react in those scenarios. Again, not always to an emergent situation, but to those day-to-day social interactions that are so important for the patients that we care for.

Mary Anne Krogh:

Yeah. You know, a couple of the simulation experiences that we have at SDSU that I think really speak to what you just said is we have one simulation that’s all about grief. It helps the nurses to understand, how do you speak to people who are grieving? How do you help them navigate that? And it, that’s really an important thing.

You know, one thing I say all of the time to students and faculty is that every patient care encounter is a behavioral-mental health encounter because people are going through some real crises sometimes and nurses have to help them navigate that.

The other simulation that we have that I think really is transformational for students is a poverty simulation that we have where they really have to look and see what, you know, what are the social resources, the cultural resources, the challenges within the community about poverty. You know, how does a patient or a community member pay rent? How do they find food? You know, all of those hierarchy of needs things that we know people are navigating and then how does that impact their overall health? And how do we think about preventive care when really they’re just trying to get through every day – feed themselves, house themselves, those sorts of things.

Erica DeBoer (host):

I’m so glad that the college is taking some of that on cuz that’s a true reality, not only in our rural settings, but in our metro areas as well. I think we call it social determinants of health and how those things impact our communities. I think we both know that as we look at our communities in which we serve, there’s top five things that really get in the way or that are big priorities for our communities and transportation, finances, housing, are three of those big things. The fourth that comes to mind is really food insecurities.

And so helping our nursing students understand that and have them be prepared for that is incredibly important just because when you think about the communities in which they live and some of those other spaces, there are resources that can help you have to know how to first gain that relationship and trust with that patient.

But then more importantly, how do you connect them with the resources that are gonna be adequately available to them so that they can meet some of those needs so they can take care of their health care issues as well? So love that that’s one of the simulations that help us really bring that reality to the forefront in management of our patients that we’re caring for today.

One last question for you, and then I promise I’ll let you ask me some questions as well. Why do you find that students are deciding to pursue a career in nursing? And maybe a secondary question, how did COVID change these motivators?

Mary Anne Krogh:

So I think what I hear from nursing students often is that they came to nursing because they had an experience with nursing. So either they or a family member had a health care need. And the tremendous impact that nurses made on the outcome for that family member, whether it was an end of life issue or it was, you know, a surgery or some recovery. And that’s what I hear over and over from students is that they’ve seen firsthand the tremendous impact that they’ve had.

Probably the secondary reason I hear from students is that they have a family member who is a nurse. And they just really respect and care about what they do on a day-to-day basis as a nurse. COVID I would say created some challenges initially, and during COVID we really saw an uptick in interest for nursing and I think people really saw the value of nursing and how it’s essential to care for patients in crisis. And COVID certainly was that crisis for our country I think. You know, really trying to make sure that everybody is healthy and recovering from those things.

Erica DeBoer (host):

That call to care, right? (Yes.) So we almost called it the Florence Nightingale effect that really they wanted to be able to make that difference. So we know that you at SDSU have been working hard to really expand some of the seats cuz I think we both know some of the workforce challenges that we have and it’s really basically a compression between the retirement of the baby boomers and just not having enough humans in the United States to necessarily fill all those chairs.

Now I know that enrollment’s been strong, and I know that you’ve got some very engaged nursing students that will be coming. I have the opportunity to connect with many of them on a regular basis. So we appreciate your willingness to partner with us and really look at how do we do our work differently? How do we partner differently so that we can meet the needs of South Dakota and the Midwest? So Mary Anne, I will stop asking questions for a little while and I’ll see if you have any questions that you’d like to pose to me.

Mary Anne Krogh:

So Erica, I know that you work pretty regularly with brand new grads from the various nursing programs across South Dakota and the area since Sanford has a big footprint. So what do you think are the biggest challenges nurses face in the early parts of their career?

Erica DeBoer (host):

That’s a great question. I think I would boil it down to probably two specific things. One in some cases, depending on their clinical experience, and I think that was very true during COVID that really that clinical experience wasn’t exactly what they pictured it to be. So I feel like really the reality of that, if they can get through that first year, year and a half, I want them to love the nursing profession like I do.

But it is a challenging environment. We’ve got a lot of workplace violence. We’ve got a lot of other challenging dynamics with the moral distress that our teams are dealing with. So in all actuality, how do we create that environment for our nursing students and our brand new nurses to make sure that they understand that call to care and how they can contribute? So that’s one.

The other thing that nurses face really early in their career is in some cases they don’t even realize the amazing possibilities that nursing really brings, in some cases, in this instant gratification world that we live in. Sometimes giving themselves a little bit of time to get used to the space that they’re in or find that niche that they love so that they can contribute and really build on that experience that they’ve had makes all the difference in the world. So in all actuality, our responsibility as an organization is to make sure that we create that safe and reliable environment. But more importantly, how do we prepare our teams and that culture to really embrace the brilliance that come from our new eyes that come into our facilities to help us really solve the challenges of the future?

Mary Anne Krogh:

You can do a lot of things with a nursing degree and that I think is really one of the beauties of being a nurse. It can take you a lot of different places that you maybe don’t even imagine when you’re a new nurse. So how is Sanford Health working to support these new nurses and help them grow and stay in nursing and find their passion?

Erica DeBoer (host):

That’s a really great question and it’s something that I think challenges us all the time is how do we maintain that motivation? How do we maintain that interaction? How do we make sure that they understand what a positive contributor they can be to the practice of nursing? There’s several different ways that I feel like Sanford really emulates that is through some of our well-being resources.

We also have a nursing residency program that really helps them guide through that first year, year and a half of their program.

I think the opportunity that nursing students as well as those brand new nurses have is to get involved and get engaged. We’ve got unit-based counsels both in the inpatient and the ambulatory setting so they can contribute and use their voice. And that’s what I ask all of them is sometimes we get blinded by what we think is the right answer cuz we’ve been doing it always that way. So I really appreciate their voice to help support how it is.

I think the other thing that I would say if I were to bring a bubble up, the third point is that we have worked really hard on retaining those wise individuals that have been with the organization for a long time. That wisdom is really important to help our brand new staff understand the best way to care for really complex patients.

As you mentioned before, I think maybe the fourth thing that I would suggest is that it’s really our commitment at Sanford to make sure that we continue to build that safe environment and make sure that they have the resources available, not just through technology, but it’s a hands-on profession. So how do I make sure that our nurses can function at the top of their license and they have the support teams around them so that they can be the best that they possibly can?

Mary Anne Krogh:

So we’ve talked earlier about how education has changed and how we have to think about training nurses differently, but how has nursing itself changed since you entered?

Erica DeBoer (host):

Fantastic question. I think the most important change that I share with people often is if when I graduated from college I was super scared I wasn’t gonna find a job because although there’s a lot of openings now, when I actually started at Sanford on the pulmonary unit, there was six of us that graduated all at the same time and only one position that was open on pulmonary. So fortunately I was the one that was able to be blessed with that position and start my career on the pulmonary unit where I did my residency.

But that’s probably one of the biggest differences is that we had the opportunity to really have a lot of longevity and I’ll commit to you that teamwork that I experienced was really incredible and still to this day my preceptor still works on the pulmonary unit and so when I go to visit, it’s always fun to see Kay on the unit.

I think the other thing that’s changed quite a bit as it relates to what’s different is the amount of technology that we have. And I think many people know this about me, but I love technology and how it contributes to high reliability and how do I help my staff do the right thing? But on the same token, some of that technology has taken away or created a barrier to a certain extent that relationship that you can have with your patient. And so I think that’s the other thing that’s changed a lot. Obviously with my background in ICU, I love technology, I love data cuz it helps to contribute to the problem solving that we can create.

The third maybe that I might suggest is that there is a demand for better work-life balance, which is a little bit different than when I was growing up in the nursing profession. And I respect and really want to lift up the teams that really put that on the forefront for that work-life balance. So it’s really up to us at Sanford and our communities to figure out the best way to support them. So one of the ways that we do that is really making sure that not only we have good retention strategies, but we recruit and are bringing in internationally educated nurses to continue to build really our workforce to help support the patient care we wanna deliver.

Mary Anne Krogh:

So Erica, you’ve been very successful in your profession and you’re a strong leader here at Sanford. How do you support nurses toward leadership within your institution?

Erica DeBoer (host):

Ooh, I like that question too. So I think you well know, Mary Anne, I seek mentorship from a host of different people, you being one of those. But I try to serve as a mentor to many others as well. So if there’s someone that’s seeking advice or insights, I’d commit a lot of time to really mentoring those new leaders and even new nurses in different programs or even informal ways.

I think some of the other ways that Sanford’s invested in really building leadership skills is through a couple different programs. One is the Becky Nelson fellow program. And the Becky Nelson Fellowship Program is really an opportunity for a rising star, a director or above that shows great promise to have a yearlong experience as an executive. So 20% of their time is actually spent attending meetings, going to annual meetings and having unique experiences as an executive within the nursing realm, which is a really fun, really, really fun scenario that we’ve built here.

I’d say the other differentiator at Sanford as it relates to leadership is the opportunity to connect with our World Clinics. Our World Clinic Mentorship Program was a program that we started last year. We just actually announced two of our new World Clinic Mentorship Programs, our new awardees, excuse me, who will be joining and helping with a project in both Ghana and then the other in Costa Rica. So some opportunities to really not only contribute locally, but also how do you contribute around the world?

Again, this isn’t just about nursing. We’ve got clinical teammates and support services teams all across our enterprise and we have a host of different ways that we try to mentor and lead folks through different journeys and pathways to continue to advance their career. We do that through online learning, but we also have a program called Sanford Leader, which basically builds somewhat of an academy around what are those gaps, what are those blind spots so that we can guide you on that journey and what does it look like to be a leader?

And it, again, it doesn’t have to be in title. It means you can be a leader at the bedside, you can be the CEO of your patient care that day no matter what environment you’re in. Cuz I tell you, in the rural care setting, they’re small teams and they really do take care of a lot in those spaces. I’d say even in our post-acute settings, when you think about caring for people in the space where they live, what a valuable asset our teams are and growing and learning from all those folks, no matter where they are on their life’s journey.

Mary Anne Krogh:

Say we had a nursing student who was looking for a job and where they might start their career as they graduate. What would you say Sanford brings to a new graduate that they should consider?

Erica DeBoer (host):

Great question. I’d say that Sanford has the opportunity to really differentiate in the opportunities that they have. Obviously there’s many nursing residency programs, but our lead team has taken our residency program really to the next level to really help them understand how to become a professional nurse, how to really embed themselves in the community of nursing that we have here.

Additionally, I think the amount of different experiences and different opportunities they would have, not only just in Sioux Falls but across our entire footprint, just like we talked about, the possibilities are truly endless as it relates to what are your goals and what do you hope to accomplish. We’ve got awesome teams that really help to create those pathways for our nursing staff to make sure that they can find a space where they can use their talents the way they want to.

Mary Anne Krogh:

You and your family were donors for our virtual simulator at SDSU. Can you just talk about your motivation for helping to fund that project?

Erica DeBoer (host):

Philanthropy is a really important part of how I live. I think my husband and I really are very fortunate in a host of different ways. And so in many ways us being able to donate to the simulation center at SDSU is just another important way for us to give back. I’ve always been really passionate about technology, as I mentioned, and I can recall taking courses about the importance that simulation plays in people learning and being able to respond in those code situations and things like that. So one, it was our, my responsibility to give back.

But more importantly, when you think about when our gift was completed, it was right during COVID, and simulation became a huge part of how our nursing students were prepared. And in all actuality, that’s the way it’s gonna continue to be. So now how do we transform that? I love that we’ve moved to virtual reality and some of those pieces. It’s these pieces of technology that are only gonna help us be able to respond to patients’ needs more effectively. And of course I love SDSU and my Jackrabbits, and so the motivation is really how do you continue to advance the science and the art of nursing? And simulation is an important way that I feel like we can do that.

Mary Anne Krogh:

Well I, for one, I’m grateful that you’re friends of SDSU nursing and I appreciate all you do for us and our partnership with Sanford as a clinical partner. It’s really been a strong partnership and I appreciate that.

Erica DeBoer (host):

Yeah, we appreciate all that SDSU does. I actually just had the privilege to be at pinning ceremony this last Friday. One of our senior nursing students, I had the privilege to mentor and she received a multitude of different awards at the pinning ceremony. So it was a great reminder for me about where we start and then where the possibilities could take us. So appreciate SDSU partnership, the advocacy of how we can do our work a little bit differently. How do we prepare our nursing students. So I really appreciate you being here with us today, Mary Anne. And I look forward to seeing you and talking with you again soon.

Mary Anne Krogh:

Thank you very much, Erica.

Alan Helgeson (moderator):

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

Learn more about this topic

• Ep. 7: Flexible work and well-being in rural health care
• Nurse residency program supports nurses in their first year
• Medical center and clinics achieve 5th Magnet recognition

Get more episodes in this series

A senior nursing student chats about her career path

Alan Helgeson:

Hello and welcome to the “Reimagining Rural Health” podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic is a conversation on the journey to becoming a nurse and insights and highlights along the path. Our guest is Maddie Fitch, at the time of the program, just weeks away from graduating as a new RN from SDSU and beginning a new career at Sanford USD Medical Center. Our host is Erica DeBoer, Sanford Health chief nursing officer.

Erica DeBoer (host):

Good afternoon everyone. This is Erica DeBoer. I’m the Chief nursing Officer for the Sanford Health system and I am so excited to welcome Maddie Fitch, one of our senior nursing students from SDSU and a current Sanford intern with us. And so she’s gonna be working in critical care and as many of you know, it’s my background. I love critical care and so I have the privilege to be mentoring Maddie over the last year. So welcome Maddie.

Maddie Fitch (guest):

Thank you, it’s great to be here. Very excited.

Erica DeBoer (host):

Thanks for coming. So we’re really trying to look at from the perspective of really our nursing students. I think we’ve had the opportunity to meet with a couple of our other colleges of nursing, but really the important part that I always talk about is how do we actually get the feedback and the conversation started with those that I serve? Which is not only our nurses that work at the bedside, but also the students that come and are entering our organization.

So as part of our conversation today, I’d love to talk a little bit about the importance that technology plays, not only for you as a student, but during your experience as an intern at SDSU. So I think for you, you know, how important technology is in that critical care space. I want our nurses to feel super empowered to continue to really use that technology not only to care for patients, but to understand more about the pathophysiology and how they can contribute to the care. Can you share a little bit about how you have used technology during your internship at Sanford?

Maddie Fitch:

I think the biggest piece is the Epic charting. Kind of looking through like different lab values. Like you get a critical from the provider or from the lab and you go and look into the chart and see, OK, is this a trending lab or is this like an acute incidence of it? And then like working with the provider you can kind of address, OK, do we need to order a new medication or whatever it may be. But then also just I feel like the Brain is kind of your guiding force as a nurse and it kind of gives you direction for the day of, OK, this is what I really need to get done and these are the things that are really important. And as a student kind of having I guess a rough outline is very helpful in understanding that things might change based on the different technologies, like if you need to titrate your drips or if you need to adjust your vent settings with respiratory. Just kind of letting the brain guide you but knowing that there are other resources within the patient room that kind of influence how you use the Epic technology.

Erica DeBoer (host):

I love that you mentioned the electronic medical record. I think sometimes for many of us it’s become just a part of what our daily work is. And so I love that you talk about the Brain. Now just for those that are listening online, the Brain is actually an electronic version of really all the different tasks and parameters that guide care for our patients. There’s orders from our docs in there as well as really a key communication strategy that’s constantly up to date when we use it. So thanks for using that. I know I come from old school (laugh) that I had my piece of paper that I had all those things right behind me.

But I think given the current state of where things are at, we have so many teams that spend time taking care of our patients that that the electronic medical record is such an important tool for us to play. So thanks for sharing that. I’m curious, just to step back a little bit, why did you choose to pursue a career in nursing?

Maddie Fitch:

I really wasn’t thinking about it at all. I volunteered in high school at the hospital in my hometown, which was a really great experience, but I was kind of just doing it for the hours I hate to say. And then my junior to senior year of high school, all three of my grandparents got really sick with cancer and kind of encountered a lot of palliative and hospice cares. And so it kind of opened my eyes to what bedside nursing looks like and how it like impacts the patient and family.

And so yeah, I toured SDSU thinking maybe I’ll do a bachelor of science and mathematics with a data science specialization. And then I also toured nursing and I was like, ah, this is an easy decision. (Laugh) Nothing against math, but I’ve really enjoyed getting to learn more about the nursing field and gain a lot more experience through it.

Erica DeBoer (host):

I think the other thing just because I’ve had the opportunity to get to know you over the last year, I think you have a really important philosophy that you’ve taken on the last two years as you’ve started the nursing career and it’s really about saying yes. So don’t be scared; just say yes. Do you mind telling me a little bit more about that? I love that philosophy.

Maddie Fitch:

I think it’s one of those things like as any high schooler, you kind of are in an identity crisis when you’re going to college and I really lacked a lot of self-confidence. And then I got to SDSU and I kind of struggled a bit to figure out what do I want to do? Like what should I get involved in and like how do I pursue nursing to make sure it’s the best experience for myself and my future patients?

And when COVID happened, it kind of shook the world and it was a negative experience for a lot of people. And there were many negative, I think, experiences that I had. But also from COVID I kind of realized, OK I need to get it together just a little bit if I wanna actually pursue nursing. And so it kind of made me realize like life is too short to be afraid and not just jump in and kind of figure things out as you go. And if you’re always nervous about, well, the what ifs or what if I am not good enough, then you’re kind of gonna limit yourself and what you can experience.

Erica DeBoer (host):

Yeah, I love it. You’ve gotten really involved in a lot of different ways, and I’ve been impressed with several different things that you’ve had the opportunity to contribute. Do you mind just sharing a little bit about some of those top three most important things that you’ve engaged in and what impact they’ve had on you?

Maddie Fitch:

I guess the top three, my big research project that I didn’t really intend to be that large, but it kind of got really, really crazy. So I was able to partner with our associate dean of research at SDSU and help with one of her grants focused on kind of transforming a palliative care intervention specific to South Dakota. I’m kind of, you know, using best practices and cultural implications to direct that intervention. So that’s been a really unique opportunity that I never thought I’d have the chance to participate in.

But then also serving on student senate at SDSU has been a really cool opportunity just kind of recognizing the impact that policy within SDSU, but then also across the state of South Dakota has on the student experience. And so it’s been a very challenging and unique environment to kind of voice my opinion in.

And then also just kinda serving on the leadership team in my sorority for the last few years has been a really cool experience to, one, get to know people and what their passions are and how can I help them recognize where their potential might lay. But then also just being challenged in how do I manage this large group of people and having the financial responsibility and time management with all of my classes? So those are kind of the big experiences I would say.

Erica DeBoer (host):

Love it. It’s a good measured approach to not, it’s not just about nursing, but it’s really about how are you actually envisioning yourself contributing in the future. And I think that’s the thing that I love most about your passion for the work. I think the other thing that resonates with me, although we’re talking about technology and the importance that technology plays, I think what resonates with me about you Maddie, is your ability to connect with people instantaneously. So I think some of the leadership skills that you’re gaining in the sorority, in the student senate, but also as a intern at Sanford has really contributed to you being very well-rounded. And I think you’re gonna challenge us (laugh) to be better at Sanford and really making sure that you have things that are gonna challenge you and continue to really promote that growth and learning.

Maddie Fitch:

Yeah, no, the internship at Sanford, I don’t know, I was talking earlier with someone and we kind of were like mentioning how did you get into critical care and how did you become interested? And I was like, well, the first week I was really wanting to not do critical care. I went home and called my mom. I was like, absolutely not. But kind of recognizing I guess just the acuity of the patients and the like aspect of critical thinking that requires a lot of the pathophysiology and pharmacology and using my resources from both school but then also the ones that Sanford offers, like through a lot of the technological resources, it kind of made it not so scary and I was able to get more comfortable after talking with preceptors and things like that. So it’s been really cool experience to yeah, kind of combine everything I’ve done at school into an internship and then kind of how that plays out into my future career at Sanford.

Erica DeBoer (host):

That’s awesome. So I know that simulation is a big part of the curriculum at S D S U and throughout really the nation, it’s really been something that we’ve had to lean on. Obviously there’s technologically advancements that help to support that work, but I’m curious from your perspective at SDSU, what part does simulation play in your training and how has it helped you actually as a student intern and a student nurse?

Maddie Fitch:

I think, well we started simulation like the first semester, which was really nice. We walked into a room and kind of established the basics of OK, this is a patient situation and here’s what you’ve learned in class and here’s how you can apply it, which I found really useful. And the professors and faculty do a great job to make it as real as they can with the resources they have, which thankfully at SDSU and I think across all the schools in the area, they have wonderful resources for their students.

But one of the biggest things I’ve taken away from simulation is when you have those higher acuity, like the code simulation, which we’re not supposed to know that there’s a code, but we do. And that’s OK, but you prepare for it (laugh). And then just our trauma unfolding simulation, it really played out into a lot of the things that I experienced as an intern, which I had the opportunity to experience those real life before I did a simulation. So it was kind of an interesting flip flop in it, but to see how well the actual experience was reflected and what a structured experience was supposed to look like was really unique and it kind of like confirmed, OK, like we’re doing the right things. Like, and I knew that in this situation regardless, but you know, it was a unique opportunity to kind of reflect on both.

Erica DeBoer (host):

Well, and I think simulation contributes in a lot of different ways. But to your point, I love that you had the opportunity during your internship in that safe space to be able to learn what that scenario might look like. I hope that not only did you learn what real life is like but then can contribute back and actually share it with your teams. Because that’s the other really important thing that I’ve highlighted over the last couple interviews is that collaboration and really us learning from one another is incredibly important. So as we look at transforming what health care needs to be, it means we have to make sure that our nurses are prepared well too.

Maddie Fitch:

Yeah. Yeah, I think like debrief after simulation is very beneficial for a lot of my classmates because we’re always asking the “why” questions. And I think my cohort is just really unique and we’ve gotten very close and have had the opportunity to bond a lot through those simulations and talking about personal experiences, but then like looking at, OK, how did the mannequin work and how did the questions that our professors ask us kind of guide us towards these other deeper meaning questions for lack of better terms. So it was really fun to kind of experience that too.

Erica DeBoer (host):

I think I also know you well enough to know that palliative care, and you mentioned it just a little bit already, is something that’s incredibly important to you. It’s something that you’re encouraging not only your preceptors but others to consider in some of these scenarios. Sometimes just because we can doesn’t mean we always should. And so I’m curious, I feel like simulation not only is about the technological components of it, but it also is about that scenario and debriefing to what you’ve mentioned. Is there scenarios that you found to be most beneficial in that palliative care space or in other components?

Maddie Fitch:

I think some of the more appropriate conversations for the palliative care is when we have our simulations with the older adult focus and then also the rural focus, which is one of the kind of big challenges that a lot of nurses face in this state. And so when we are focused on like, OK, the patient for example is driving 40 miles from the clinic to get to the acute setting, how do we, you know, best manage the symptoms at home so they don’t have to keep driving in to receive these intense treatments?

So it’s been kind of a fun opportunity to work with faculty and then also my classmates and saying, well maybe, you know, having them drive every week for this one injection or every three days for this one intervention isn’t necessarily appropriate. And then looking at what we’ve learned in class to apply that to the patient’s situation, it’s been reflected in a lot of the research that I’ve done, like for my research project as well. So that’s been kind of cool.

Erica DeBoer (host):

What an amazing segue. So I wanna just anchor on that just a little bit. Obviously I think you’ve heard, and if you haven’t heard, I’m here to tell you that Sanford is on the pursuit to be the premier rural health care organization in the United States. It’s a huge strategic position statement, but I think what you just said is one of those real life examples of what our rural individuals experience. So how can we reduce the friction for our front-line teams and how do we really look at what’s that scenario? And if it was us, if it was me, is that something that we would wanna do? So I really appreciate your perspective as a senior nursing student. You’re almost done, right? How many weeks left?

Maddie Fitch:

There’s three (laugh). Woo. I know. So exciting.

Erica DeBoer (host):

Three weeks, weeks left. That’s awesome. Yeah. So I’m curious since we’re talking a little bit about your career and as you wrap things up as a student nurse, is there any advice that you would give students early on in their nursing education? Or even somebody who hasn’t maybe considered nursing as a profession yet, what advice would you give?

Maddie Fitch:

I think specifically for nursing students or those considering nursing or maybe haven’t thought about it, just kind of looking at like everything that you’re learning in higher education or after and you enter the work field or whatever it may be, everything you learn has the impact to change a life. And so as a nurse, whatever you’re learning in class as daunting or tedious it might be, it does have the opportunity to change someone else’s life. Whether that’s learning how to say hi in an appropriate manner or you know how to titrate a medication to make sure your patient’s blood pressure is stable.

But then if people are maybe not thinking about nursing, but it has been like an idea that’s been bounced around, kind of looking at how can you like best impact a patient’s life. And I think as a nurse you have the opportunity to share your kindness with others. And so considering a profession that’s focused on sharing kindness to make sure the patient has the best experience possible and their family too is something I would encourage them to do.

Erica DeBoer (host):

That’s awesome. Thanks for that. You know, I’m kind of big on that kindness thing too. It makes a big difference in the chaos of the world today.

Maddie Fitch:

Yeah, no, for sure.

Erica DeBoer (host):

Thanks for bringing that up. I know that nursing wasn’t necessarily the career of choice in the beginning. Help me understand what was that trigger point? Obviously I heard you say when you walked on the campus you have some other talents that you were looking at as well. Tell me what you would’ve done if you would’ve done anything differently. Would you have done something different before you started your nursing career? Tell me a little bit more about that.

Maddie Fitch:

I think I was just really intrigued with the critical thinking of data science and the math behind it and kind of the challenge of solving problems. But I wasn’t necessarily impressed with the opportunity to translate that directly to people. Cause one of my favorite things to do is just talking to people. So this is a really fun opportunity to just chit chat. But I think looking at what I would do in my daily experience as a data scientist wasn’t really what I felt would contribute most to society.

And so kind of looking back to my experiences with my grandparents and seeing the opportunity I had to talk with the nurses and like how complex their situations were, it kind of intrigued me to think about nursing and there’s always a bigger problem with every patient, no matter how simple their diagnosis might seem. And so kind of looking at, OK, well I can one be on my feet every day, which I hate sitting around. It’s not my thing. And how can I also solve complex problems while making a big impact kind of is what changed my mind. It’s awesome.

Erica DeBoer (host):

It’s awesome. And I think all of you can hear in her voice. I get to look at her lovely smile and bright blue eyes that she’s going to be one of our up and coming data scientists. You can be a nurse and a data scientist at the same time. We actually are growing a whole crew of folks that try to look at problems in a different way. So yeah, really appreciate you being here with me today, Maddie. I’m curious, do you have any questions that you’d like to ask me? I know I’ve done a lot of talking so far.

Maddie Fitch:

No, not at all. I think biggest question is would you have done anything differently in your career looking back or where you’re at right now? Like would you have changed anything that’s led to where you’re at right now?

Erica DeBoer (host):

Oh, that’s an interesting question. So I think for many of you that maybe don’t know me, my career path has been a little bit unique. I think that starting as a nurse aide in a long-term care facility, knowing how important it was to take care of my grandpa while I was there was an important start to my career. I think I always, always knew I wanted to be a nurse and my biggest fear is not passing (laugh). And so as you think about getting ready to take your NextGen NCLEX exam, I can remember all the fears that came with that. I do believe I was put on this earth to be a nurse and I do appreciate every single one of the experiences that I’ve had. I have had absolutely some failures, but then what I try to do is take that and grow from it.

Yeah. And share with other people. I think the other important thing that I’ve learned, I don’t know that I would change a ton cuz there’s always tough stuff that you have to go through. But I think the learning that comes from it is probably the most important thing.

I will share with you that I never in a million years would’ve told you that I would be in this position someday. Never in a million years. I absolutely love our nursing practice. I absolutely love taking care of patients and I miss it every day. But I never pictured myself in a position like this (laugh). So I feel incredibly blessed to be in a position like I am.

Maddie Fitch:

Well it’s always nice to have someone leading the charge that cares. So it’s appreciated for sure. Thank you.

Erica DeBoer (host):

Thanks Maddie.

Maddie Fitch:

I guess another question I would have is like kind of the technology piece. How have you as a leader been challenged to implement that? Like with bedside nurses’ input and like with student input, I guess what’s been the biggest learning curve or the biggest opportunity that you’ve seen in conversations with bedside?

Erica DeBoer (host):

Thank you for that. I think people have heard me say often is it really, we do have so much brilliance at the bedside, we just have to ask. They experience it day to day, every day, and they probably have an innovative solution which may not even require technology. I think as we look ahead and as we even look back on what we’ve learned with COVID and our rural setting, technology does have to be part of the solution. And so we’ve constantly tried to look at what’s the biggest problem that we’re trying to solve. And really as I partner with our innovation team, I can bring a whole bunch of pieces and parts in, but if it’s not actually gonna solve the big problem that we have, I really don’t even wanna talk about it, which is a horrible thing to say maybe.

Maddie Fitch:

No, not at all (laugh). But it’s always appreciated. Like those small conversations that don’t contribute much, just like I really appreciate it, but like not the time or the place maybe, maybe in another time.

Erica DeBoer (host):

(Laugh). So I’ll never forget the conversation I had with the innovations team. Gosh it’s been at least two years ago now. But I said, I love that you’re trying to put some of this R and D practice in, but I honestly, it’s not helping me with my workforce. And so when you engage the right people to have the right conversations and look to the market to see what is it that’s out there that’s gonna help us solve this big problem, it’s amazing the magic that comes from it. And so as it relates to technology, we are in the process of putting together a proof of concept on two of our units – one in Sioux Falls and one in Fargo – to use computerized vision technology, to help us really use that to establish a virtual nursing program. Again, it’s technology, but we still have to have the brilliance that’s helping us accomplish that.

But it’s gonna allow our front-line teams to spend more time doing the things that bring joy to their work. So that care, that conversation with the front-line teams, how do we use our virtual nurses to share their expertise and wisdom with us? And bridge some of that gap that we have too? So that’s one technology. It is amazing. And luckily Sanford is willing to invest in some of those pieces, but it does take more time to implement.

I’d say some of the barriers that we have is we like to do things the way we’ve always done it because it’s comfortable. So transformation is super uncomfortable. And so I, my challenge to the front-line teams when I engage them is have we considered, have we thought about changing it this way? If it was our most precious loved one, the person that you care about most, what would you want for them? And so if we look at it from a couple of those different perspectives, it feels like the answer always becomes very clear.

But I think traditions get in our way and I think busyness gets in our way, but I think technology can help us, but it’s not the full answer. It’s really a collaborative effort with all of our teams.

Maddie Fitch:

That’s very cool. You bring those pieces together for sure. And yeah, as a future nurse, it’s always appreciated to know like the bigger picture of things is being looked at, especially on the days where you’re charting and it’s 8:30 and you’re supposed to leave at 7:30 and you’re like, OK, something needs to change. We need to figure this out.

Erica DeBoer (host):

Yes. Exactly. So using technology, using the tools that we have are really important. And then good, bad or indifferent, standardize at every opportunity. We know that we have to be able to have that conversation, but no matter what nurse, no matter what door they walk into, no matter what patient comes to us, if we have a standard process and a standard way that we manage that, it makes it easier for us to scale and actually have more interaction with our patients so that we know what to anticipate.

So I think it’s a journey. We haven’t arrived yet (laugh). But with the brilliance of all of our teams I think we can make a big difference not only in our patient care, but using virtual visits to help support rural access. And really just looking from the perspective of what does this mean for our patients?

I think we have some examples out there with some of our, all of our Sanford Health News stories about some of our specialists that are actually saving hundreds of thousands of miles to our patients. But the patients are still being able to manage their chronic illness, but through virtual visits. So I’m really excited about the opportunity that we have to continue that mindset of innovation and that engagement with our front-line teams.

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Maddie Fitch:

I guess another question I had is how does Sanford support nurses?

Erica DeBoer (host):

Great question. We actually have the opportunity to support in a multitude of different ways. I think first and foremost our culture, which I hope you’ve had the opportunity experience is our SAFE culture. So Sanford Accountability For Excellence, that high reliability journey that we’re on, we support our nurses through that practice, which really has to do with the relationship skills and it also has to do with those high reliability skills.

And we expect and are on the pursuit to continue to get to zero harm. And I think that means nurses cuz we’re the biggest workforce, it’s so important that we continue to lead the way. As it relates to speaking up for safety, that’s our, that’s our safety skill of the month is speak up for safety, but also then help be part of that interdisciplinary team.

If Jeremy Cauwels, our chief physician was here, he would say, we know that there’s a lot of orders that are given. The nurses are the magic that happens in the middle in order to deliver that care. And so I think outside of that high reliability journey and how they contribute and how we support our nurses through being able to speak up for safety, it really is showing the value of our front-line teams.

I think the, the pursuit for Magnet designation, obviously in Sioux Falls, we’ve gotten our fifth designation and that has a lot to do with all of our front-line teams. And really shows that support for the incredible nursing staff that we have. Bismarck is on their way to their fourth designation. And of course we’ve got some other really incredible work that’s happening to really elevate and help people understand the value that nursing brings.

I’d say the third and most important part is how do we engage with our front-line teams? And that’s through our shared governance structure as well as our unit-based councils. And so it’s really there that the voice of the nurse can be heard and then we can work with our interdisciplinary teams to make sure that we can accomplish those things that make the most sense. Because again, I’ll say it over and over again, the brilliance is really at the bedside and you’re the ones that can help us actually solve the big problems that we need to solve.

Maddie Fitch:

That’s great. No, I’ve definitely seen all the things you’ve touched on through my internship, so it’s nice to hear it from way up, but then also to see it every day and yeah. Very, very cool. I guess one other thing, as a senior nursing student, while I have chosen to start at Sanford, why should other students consider starting their career with this organization?

Erica DeBoer (host):

Another really good question. I love that. I’d say from a nursing student’s perspective, we really do try to be ambassadors to not only our patient care, but also to our nursing practice. I think we’ve got a unique nursing practice in the fact that we have a louder voice than maybe in some organizations across the nation that really we contribute. And the reason why our quality scores are where they’re at, our patient experience scores continue to raise is because of the important work of the interdisciplinary team of which our nurses make up the majority. And so, although we can’t do it by ourselves, I think they contribute to the positive nature of the environment. And I want anyone and everyone who is interested in a nursing profession to be able to experience what I did. It’s that team dynamic, it’s that community that you build with your nursing colleagues, day to day working in the trenches, taking care of patients and solving the big problems.

I think the other reason that I would say that there’s a differentiator at Sanford is that we do have a host of other opportunities. So we have a Becky Nelson Fellowship, which is really an opportunity for one of our newer leaders to actually join myself as well as the nurse exec team for a 12-week fellowship to spend time with executives and understand some of those pieces. I think the other thing I’m really, really excited about is our World Clinic mentorship program. Because Sanford has clinics across the world, we have the opportunity to actually engage our front-line teams in helping not only learn from our world clinics but actually us learn from them. I think the other challenge to any nursing student would be, I don’t think that many organizations have the opportunity to have such engagement from our front-line teams.

It’s a huge support system that we’ve built. And so I believe that that certainly makes us a differentiator as well as the opportunities are so grandiose when it comes to nursing. I think from front-line nursing to ambulatory nursing, we’ve got of course our post-acute business that helps us actually take care of individuals in the latter parts of their lives as well. So possibilities are truly endless. And of course I’m a great example. I’ve done so many different roles, had the privilege to develop some of my own roles. I think over the last four or five different roles were really roles that I was able to have the autonomy to develop myself.

So innovative spirit, a willingness to really allow us all to speak up for safety. So again, I’m a huge fan of nursing and so wherever your nursing practice is, we just want you to be a nurse and we want you to feel that fire in your belly cuz our society needs us.

All right. I think Maddie, I can’t tell you how much I appreciate the opportunity to spend some time with you today and really get your vantage point on as a senior nursing student. You are gonna be an incredible Sanford nurse.

Maddie Fitch:

Aw, thank you. I’m excited.

Erica DeBoer (host):

And I can’t wait to have you there. Yes. I like blue too.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

Learn more

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Get more episodes in this series

NDSU’s advances in nursing school keep human touch

Alan Helgeson (announcer):

Hello, and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic is a conversation on nursing education and collaborative partnerships in developing the next generation of nurses. Our guest is Dr. Carla Gross, associate dean for the School of Nursing at North Dakota State University. Our host is Erica DeBoer, Sanford Health chief nursing officer.

Erica DeBoer (host):

I’m so excited to have you here to really kick off our reimagining health care and what does it really mean for nursing. So we’re gonna pull a couple episodes together to really talk about what an incredible gift our colleges are in our states that help to support our nursing practice and the workforce needs that we have.

Carla Gross (guest):

And we are so fortunate to have practice partners like Sanford. I mean, we could not educate our nurses without a really strong relationship like that. So we appreciate you too.

Erica DeBoer (host):

Well, appreciate that. Now, Carla, do you mind just introducing yourself and the roles that you play, please?

Carla Gross (guest):

Yes, I am Carla Gross. I am the associate dean for the School of Nursing here at NDSU. I could probably tell you a little bit about it. We have two sites, as you know. We have our campus here at NDSU in Fargo, and then we have a site in Bismarck that we call NDSU Nursing at Sanford Health. That was a very careful title that we agreed upon. And so at those sites we have the pre-licensure BSN program in Fargo, we admit 64 each semester. And in Bismarck, we can admit up to 56 each semester.

And then we also have a family nurse practitioner program that is a doctor of nursing practice degree. And we have that on both sites as well. So we admit like about 12 every year in Fargo and six in Bismarck. And that’s face-to-face. Just, you know, a traditional taught course or program. And it’s – we put out really excellent graduates on that course.

Erica DeBoer (host):

Absolutely. Yeah. We appreciate that a lot. Again there’s also pharmacy here. I had the privilege of walking through your beautiful building and just really saw not only pharmacy, but also other allied health services, as well as public health. So, so amazing programs and people that you’re helping to contribute to the workforce. And we so need them. So, yes. Fantastic.

Well, obviously, so excited to be here with you today. I love that you’re willing to just take a little bit of time to spend time with me and really talk about what and how NDSU is contributing to our workforce challenges, but also getting super creative and using technology to help us address some of the needs that we have as well. So, really appreciate that. The hope is really to highlight some of the innovations that we’re using to help prepare our nurses of the future, as well as how do we partner as an institution, as well as our colleges of nursing to try to just prepare in this rural space that we live as much as you’re in Fargo?

Really, when we look at South Dakota and North Dakota and really where Sanford Health sits, it’s really rural. And so we have a unique set of challenges that we’re really trying to address. So, I wonder if you wouldn’t mind just telling me a little bit about what your thoughts are on what today’s nursing students need to be prepared that’s different from in the past. I know you’ve been part of the NDSU team for a really long time. And you’ve seen a lot of changes in health care. So I would love to hear your insights on that.

Carla Gross (guest):

Patients and families are more complex than they’ve ever been. At the same time, the health care system is so complex, so helping new graduates learn how to navigate that is, to me, it seems overwhelming what they walk into. But they’re able to do that, and they need to be able to analyze and interpret data and then appraise evidence so that they can give the best care possible and hopefully come with better patient outcomes.

And another thing that is so important is that they’re able to very quickly assess and adapt to these ever-changing environment – that is so important. And at the same time, health care has gotten more and more specialized. So they need unique sets of skills and knowledge more so than ever before, I believe. And health care has gotten more interdisciplinary, and nurses are often the leaders on those teams. So they need those leadership skills.

And they, I think our scope of practice has expanded so much, and nurses are more independent than they’ve ever been. And our students are excited about that. They feel like that’s a big challenge. Never before have they needed such high level critical thinking and clinical decision making skills. And think about it, now they have to be ready to take care of patients during disasters. I mean, it could have been the pandemic, but it could be a mass shooting or all these environmental disasters that are going on.

So there’s a lot of challenges in trying to help them develop the skills that they need. And I think we’re really realizing how important self-care is. It’s not just a luxury; it’s an absolute necessity. And we have really embraced that. And we start with self-care in our first introductory course. And we also start with learning what professionalism means and what they need to start developing their professional identity the minute they start in the program.

So we’re really trying to lift them up in that respect. And, you know, I also have to say that never before have we had the mental health issues that we have, not only in their patients and families, but in their colleagues. You know, so helping people through burnout or caregiver fatigue, that is like at the forefront of their practice. They also have to be prepared for the violence that we’re seeing in health care and how to keep themselves safe. I, so when I think about all the things that they need to learn, it seems overwhelming.

Erica DeBoer (host):

It’s not just about mamm-phys. It’s not just about assessment skills. It’s really a lot that has to do with mental health. It’s the things that, even social determinants of health and how that impacts not only well-being, but their physical health as well.

Carla Gross (guest):

That’s another thing that we’re introducing the first course. The only other course they’re taking is health promotion, and then they’re taking this introductory course. And so they had them design a community that would be cognizant of the social determinants of health. And it was really cool to see what they included, you know – health care, but schools and homeless shelters and, you know, starting to think like that right from the beginning is, it’s so important.

Erica DeBoer (host):

Well, I think that’s the key. And the huge, like, glimmer of hope that I have in our new nursing workforce is they do think about things differently. They do. They don’t have some of that traditional thought that some of us are steeped in. So I say that I’m steeped in it just like everyone else. Yeah. But they can see through a different set of eyes and they can help us get super innovative. So I love that activity. Yeah. And that is one of those things that just helps us actually. Just advance and understand through the lens of that patient.

Carla Gross (guest):

They come to us with – they embrace diversity, and they can teach us a lot about that. So I really admire that about this age group as well.

Erica DeBoer (host):

That’s awesome. So tell me a little bit more about how you use technology and digital tools to allow nursing students to be better caregivers.

Carla Gross (guest):

We do a lot in the simulation lab. That is becoming such an important part of nursing education. Well, really any health care field. And so we really try to make sure that every one of our students gets an opportunity to take care of patients in common situations. So everyone gets to take care of a mother giving birth. So the high fidelity simulators are cool you know, someone in shock. They do a code simulation with the pharmacy students. So we’re really trying to do like a lot of interdisciplinary things. But, you know, what is more powerful than these $150,000 high fidelity simulators is we hire actors to play the role of, for example, one scenario is a patient that has schizophrenia and is hospitalized and is hearing voices and having hallucinations. And so having the students learn how to interact with and communicate. It’s really powerful.

And another one, another thing that we learn from our graduates is how difficult it is to take care of a patient the first time a patient dies. So we have a simulation where they take care of a family during an expected death, and then we do it in an unexpected death cuz they’re such different situations. And so some of those are so powerful. And I think one of the other ones that’s really powerful is it’s an infant simulator and a shaken baby syndrome. And so that comes in with head trauma, but also the parents are there and learning how to interact with parents during that very stressful situation.

So we find that if we can help them practice those skills with our guidance, they’re gonna be better prepared for some of those situations when they get out. Yeah. And, you know, lots of stuff that they learn, even some of those simple communications transfer to other situations. It’s just like learning how to just meet the patients where they’re at and talk at their level and respond in with compassion.

Erica DeBoer (host):

It’s really amazing. I think what I’m hearing you say is, although technology is an important part of it, it really is the relationships and the scenarios that really build that expertise and build that comfort level so that they can manage in that real life scenario.

So I really appreciate the interdisciplinary approach, too. It’s super important for all of us to understand the important role that each one of our teammates play. It doesn’t matter if we’re talking about that hospital scenario in a rural setting, in a clinic setting, or in even our skilled facilities. So yeah, those relationship skills, the learning how to manage and be that leader for the team is really incredibly important. So I appreciate you calling out how much nurses are really looked to as leaders in that patient care.

Carla Gross (guest):

We’re there 24/7 and we’re the ones that are interacting with the patient and the family and all the rest of the health care team, and making sure that there’s that continuity and that high quality. And so that’s really important.

I think another really creative thing that we do is we have a poverty simulation. Faculty are involved, staff are involved, they play different roles. Someone might be the social worker, someone might be the police officer, someone, and they put the students through these. These are homeless, there is a – and so they’re having to figure out some really hard decisions. Like, I only have this much money. What am I gonna spend it on? Alcohol or groceries or … they can kind of see how people get desperate and do illegal things because it’s survival.

Erica DeBoer (host):

Well, and if you really start to think about it, those are those real life scenarios that they’re gonna have to work on navigating. When you think about motivational interviewing and really getting to the bottom of what’s forcing that patient to not necessarily contribute to their health in a way that’s most meaningful. And in some cases, it’s survival.

Carla Gross (guest):

Yeah. And to understand where they’re coming from, you know, what kind of life they’ve led and the shoes they’ve walked in. You know, it’s like they need to really develop that compassion and empathy.

Erica DeBoer (host):

Yes. And I think in the technologic world, it’s building those relationships, which takes time to develop over time if it’s not something that naturally comes for them. So I appreciate your emphasis on that.

What do you find, or why do you find students today decide to pursue a career in nursing compared to maybe what you had had in the past? Maybe it’s the same, but I’d love to understand if you’ve seen any changes or differences in their why.

Carla Gross (guest):

Our most outstanding students still feel a calling to nursing. They wanna help people and they wanna make a difference in their lives. And that we see that over and over again in their essays. But, you know, we also see some pragmatic reasons. OK. I mean, because nursing, you’ll always have a job no matter where you go. It’s so flexible, and the salaries are becoming much more attractive. And I think even the hours are becoming, you know, I think that it’s more attractive that way than it used to be.

But I think also students realize how many opportunities there are. If you have a BSN in nursing, you can do anything, you know? Yeah. So that’s what they see and they see that you can work with any age group, you can work in any setting, almost any setting. Absolutely. And if you want, you can go on and advance your education and be, you know, an advanced practice provider or a manager or leader or come into education. We need and welcome education, you know, and we have actually a mentor program in our lab skills. So we – once the students have taken the two, we have a beginning skills and an advanced skills course, and they can apply to be a lab mentor. And so they then spend time in the lab with more junior students.

Erica DeBoer (host):

That’s amazing.

Carla Gross (guest):

It’s powerful because they actually are harder on their peers than the faculty are. That’s great. The students are more receptive to their feedback, you know. So but a serendipitous finding that we had is they realized they love to teach. So then it’s like, oh, well we get more students that are interested in nursing education.

Erica DeBoer (host):

Nursing education, being a clinical instructor. To your point, the flexibility and the options are endless, but I think people don’t really understand that. They don’t. They make assumptions that in all actuality, I have to work here or I have to work there. Yeah. But obviously I think you’ve had a journey as have I. That I’ve done a host of different things across my entire career, and in some cases it wasn’t part of the plan.

Carla Gross (guest):

No.

Erica DeBoer (host):

And those doors open.

Carla Gross (guest):

Yeah. What other, what other discipline can you do that in? I mean, nursing is really unique in that way, and I think that’s what’s so attractive about it. We’re seeing more men in nursing too, so.

Erica DeBoer (host):

Absolutely. And I appreciate the way that they think about things and they problem solve differently, so, oh, they do. I think to your point about diversity and really leveraging some of the different schools of thought, it’s really incredibly important as we look to the future and reimagine how we take care of patients across the board. Do you feel like COVID had any changes or motivated people in a different way?

Carla Gross (guest):

Yes. I don’t think it was healthy for them to be isolated, and learning online was not ideal. So and our students were the first ones to say that they did not like – we saw a lot of mental health issues too. We were only out for half of a semester, thank goodness.

Erica DeBoer (host):

Good for you.

Carla Gross (guest):

Yeah. But we did see like a decline in motivation and, and we’re still recovering from that. And, you know, nursing education is cohort based, so that’s what I think makes it so strong because they get so close and they motivate each other and they, not being close to your cohort during that time was hard.

But I do know that when they came back, they were more anxious to get out and practice and help than ever. And especially at the beginning of the pandemic, you know, nurses were seen as heroes and respected, but as the pandemic became more and more prolonged, and we saw this vaccine, you know, vaccine hesitancy, and I think that that’s been a little bit hard too, because all of a sudden some of our patients are skeptical and as the most trusted and respected profession (laugh) that’s hard for us to understand. So I’m hoping that that’s just a phase and, you know, we’ll be able to reestablish that.

Erica DeBoer (host):

It’s so important. I can, I’ll never forget that when we started to have some solutions that came onto the market to help us and just how incredibly relieved people were that we had something that we could do instead of just supportive care: the vaccine, monoclonal antibodies. It really, everybody just wants to help. And that calling. That care. As well as really the silver lining of COVID for me was how incredibly connected everyone was as we navigated it and what problem solves – problem solving, excuse me – we could do.

Carla Gross (guest):

They were just so, I mean, so many innovative things, and I honestly think that nurses should partner with engineers and be entrepreneurial.

Erica DeBoer (host):

I love to hear you say that. So I do believe that we can be data scientists as nurses. Yeah. I do believe that we have an engineering mindset. Yeah. And if we partner and help people understand the why behind what we do, as well as the important role that engineers actually play at Sanford, we actually have some engineers that actually help watch some of our workflows.

So again, we talked about how important tradition is to nursing, but how breaking some of those traditions are really what it’s gonna be necessary.

Carla Gross (guest):

Yeah. We gotta do things smarter.

Erica DeBoer (host):

Yes, exactly.

Carla Gross (guest):

Yeah. And exactly. It’s interesting because, you know, we have engineers big on NDSU campus. Love it. You wouldn’t believe how many nurses and engineers get married.

Erica DeBoer (host):

That’s so interesting. That’s so interesting. Now also, I do have to call out since you brought up engineering that Sanford partnered with some of your engineering students. Solutions with different robots that could actually help transport supplies. Again, that efficiency and that effectiveness and that innovative spirit is just so exciting. It’s so exciting.

Carla Gross (guest):

It is. We had one time, we had a group of nursing working with a group of engineer students because they were going to create some kind of a device to detect seizure activity in infants, but they thought it would be no problem to just insert it in the brain (laugh).

Erica DeBoer (host):

Oh!

Carla Gross (guest):

Well that would just be fine. So our nursing students had to walk ’em through this, what this really means. So they do think differently.

Erica DeBoer (host):

Hundred percent (laugh). Hundred percent. It’s safer if we’re working at it together. Yeah. Fair, fair. So I really appreciate that partnership. Curious from your perspective, Carla, what can we do as an institution that’s bringing in and using students for our clinical experience? What can we do to help support that experience more effectively?

Carla Gross (guest):

Well, honestly, just welcoming the student. And make ’em feel like they’re valued. And for us, we kind of coach our students that we don’t want them just observing or sitting around. I mean, if you have extra time, you could see if someone needs help, you know, so getting that team spirit right away, you know, ingrained in them.

But yeah, I think it’s all about creating an environment where they feel welcome, where they feel valued, and they can contribute to, you know, what we all want: quality patient care, good outcomes, and a team, you know, a team that enjoys coming to work. And that’s what I think we really hope for is that we work so hard to make sure that our students are practice ready when they graduate.

And we just want them to be able to find an environment where they can practice, you know, at the highest level of their scope and feel like they’re valued and feel like they’re an important part of the team, because that’s what they want. They’re looking for that.

Erica DeBoer (host):

Yeah. When you think about some of our traditional nursing students, that’s a very important part of it, is making sure that you have colleagues that you can trust. And that I think all of us know, we spend a lot more time working than we do away from working. Yeah. And so it’s important. Yeah. And I appreciate how that’s elevated for them.

Carla Gross (guest):

I mean, that becomes your second family, really.

Erica DeBoer (host):

Absolutely. Absolutely. I’m curious if you have any questions for me, Carla?

Carla Gross (guest):

Oh, I think I do. So what is the biggest challenge that you see for nurses in the earliest part of their career?

Erica DeBoer (host):

The biggest challenge, and if I were to name one, I’d say that it’s prioritization. Yeah. So when we think about the complexity of health care and expecting our nurses to really be that leader, there’s a lot of stimulation that’s coming to them as it relates to especially that inpatient setting. But even in an ambulatory setting, those visits are really quick and there’s a huge set of expectations on the table. So I would say prioritizing that care and making sure that we’re constantly looking at the patient as the patient and at the center of everything. Yes. It’s difficult not to become a task master.

But they come to us at their most dire times. Doesn’t matter if we’re talking about an inpatient setting or the clinic, or even in our skilled facilities. That care, that compassion, that empathy is so essential to really making sure that they have a good experience and that they understand everything that’s happening. Again, it takes a lot to manage all the tasks, one, but then how do you prioritize that relationship that you have with your patient in that 12-hour day?

Carla Gross (guest):

Yep. And it’s gonna take ’em a while to get there developmentally. You know, because they’re so focused, like we learn, like our nursing students, they’re so focused on tasks right away. And so once we can just get ’em over that level, then they can see this higher level tasks that they, the, well, not even task responsibilities …

Erica DeBoer (host):

It’s the responsibility. It’s that critical thinking. I have the privilege to mentor a couple other senior nursing students. And my favorite calls are when they start asking me questions and they’re critically thinking through, if I had this super complex patient help me understand how I would manage. And so sometimes it’s really about just giving ’em that reassurance that it’s gonna take you some time.

Use your resources. Use those details and start asking all the questions that you can. Because there are resources available around them you can just talk through things. So it’s so exciting to see how the wheels start turning. And how they’re starting to try to process through how to do things. So I think our clinical experiences are extremely important. I think our internships are also super intentional. And essential for them being well prepared just to give them that extra experience that they need to be successful.

Carla Gross (guest):

Yeah. We highly encourage them to do one or two internships if they can. Right. So, I agree they can have all the technology at their hands that are, you know, available, but they have to trust their own assessment skills and their own gut. Don’t ever underestimate how important those are.

Erica DeBoer (host):

I’m not wearing my bracelet today, but it says, trust your intuition. Right? Yeah. So trust your gut.Makes all the difference in the world. And that gift that a patient, those words that they use, the things that they share with you, what a gift that is to your assessment.

Carla Gross (guest):

Absolutely. Because you can’t rely on that. Right. I mean, you’ve still gotta know, you know. Never underestimate your own assessment skills.

Erica DeBoer (host):

Agreed. Agreed. I think it’s super essential. I think all of us love technology, but I always say we have all these things in place for a reason. If you don’t use them or you skip those steps, if it’s, again, I think it’s up to us as an institution to make sure that we make their work as frictionless as possible.

So how do we reduce that documentation burden? How do we make sure that there’s value in the work that they’re doing? I have a, a word that, or a phrase that I always use, it’s called GROSS: get rid of stupid stuff. So it doesn’t matter if I’m talking to the nurses on the floor, if I’m talking to our patient access teams, but what are those things that actually don’t add value to your work? And so I think what I would love to hear from our front-line teams and especially people that come into our institution with fresh eyes is, what are those things that don’t make sense? And if people can’t tell you their real why, then, gosh, I think we should maybe just look at that and reevaluate. Is that adding value to your work and the care that you provide? And if it’s not, sometimes we just maintain some traditions because we think we have to, one, in all actuality, challenging the norm is what we need to do.

Carla Gross (guest):

And that’s, that was a gift of COVID.

Erica DeBoer (host):

Yes.

Carla Gross (guest):

You know, there, that was a bright lining we learned to do things differently. Anything we can do so that nurses can be present in the moment with patients and families will make a difference.

Erica DeBoer (host):

Absolutely. Absolutely.

Carla Gross (guest):

So another question I have is nursing has changed since you entered the field (laugh). So what do you tell nurses who are interested in a leadership role like yours?

Erica DeBoer (host):

Oh, that’s a really great question. So it has changed a lot. And I came up through the rankings, started as a nurse aide in the Good Samaritan Society near my hometown. So in that long-term care space was a nurse aide on the pulmonary unit. And at that time – this is what else has changed – there was only one position open and six of us that were graduating. Can you imagine?

Carla Gross (guest):

That was how it was when I graduated.

Erica DeBoer (host):

So I think times were different. When I think about the advice that I give to our front-line teams is you’re a leader every day. You’re the lead of that patient care. And so you need to do, and you need to learn as much as you possibly can every time you enter the walls and every time you take care of a patient, there’s so many things to learn.

The other thing that I share with people is don’t rush. Right. I know that there’s always maybe that next best thing that you feel like is gonna make a big difference, or it’s what you’re seeking. Follow your heart, follow your gut, and give yourself time to just learn and grow in the space where you’re at. I think, as we mentioned already, nursing is such an incredible field.

You can do anything. And so if you think about the opportunities that we have really to be in our shared governance, so as a senator to be part of performance improvement and quality improvement, we need the innovative spirit. We need that scientific brain that nurses have to help us solve the health care issues of the future. Yeah.

And to that point, we talked a little bit about internships during some of our other conversation. There’s actually a lot of other opportunities to actually shadow and spend time with our executive leaders to really understand really what is it? And how would I contribute in a positive way to that type? But again, giving yourself time to be in the moment and learn as much as you possibly can, seems to be a really important thing for me to share. That if it’s OK not to have a goal in the, in the next year, give yourself time to learn.

Carla Gross (guest):

They’re all so quick to get to the next step. And it’s like, you know, what we try to tell our students is you can do so much with a BSN degree. Oh, yes. And you can make such a difference at the bedside. And there’s probably not a more rewarding role than at the bedside with the patients and families. So for some reason or another, this generation thinks they’ll have to go on and get an advanced degree. And it’s like, no.

Erica DeBoer (host):

(Laugh) You really don’t. You don’t. There’s so many things that you can do within the scope of practice of what you have. Like you talked about being a clinical instructor, going back and helping teach courses, it’s a, there’s so much relevancy to the BSN degree. Yeah. Awesome.

Carla Gross (guest):

So why would, why did you tell nursing students, graduates, why they should choose Sanford Health as their place of employment?

Erica DeBoer (host):

Oh my goodness. That’s a great question. Thanks for that. I think, Carla, the most important thing that we try to do is differentiate ourselves from other organizations. And I think the two ways that we do that is, one, we’re on our high reliability journey. And so our culture of safety is at the best that we possibly could. We’re constantly looking, we’re constantly searching for those ways that we can continue to deliver high quality care without error.

So we engage all parts of our organization in quality and safe patient care. Not that everyone doesn’t, but I feel like our SAFE journey, Sanford Accountability For Excellence, has really taken us to that next level. So that’s one thing that we’re paying attention to at the highest part of our organization. Quality patient care, our patient experience, serious safety events, not only for our patients, but how are we actually making sure that our employees feel really safe within our walls.

I think the other thing that I am super proud of that Sanford has is our World Clinic program. And so we try really hard to build our mentorships around some of those unique experiences that they’ll have the privilege to be a part of. Obviously we can’t have everyone be a part of every program, but I think the opportunity not only to grow as a nurse in different parts of our organization, but also to have some of those other unique experiences.

Carla Gross (guest): 

Have they been traveling?

Erica DeBoer (host):

I’m so excited to share. We actually had several – we had six actually last year that were part of the World Clinic mentorship program. Several went to Ghana. We have someone who’s just coming back from New Zealand to finish up her experience. So Kelsey is one of our mentors from Brookings. She’s actually an ambulatory nurse there and helped with a host of different things around immunization and some of those workflows. Tiffany Johnson was in Ghana and did a lot with education in those teams. Costa Rica is the other location that we’ve had some teams actually go and spend some time specifically around education, setting up skills labs in Costa Rica. So, and I had the privilege for the first time to travel to Ghana just last month. And it was a life-changing experience.

Carla Gross (guest):

Oh. Yes.

Erica DeBoer (host):

The commitment, the love that they have for the communities that they serve is just unbelievable.

Carla Gross (guest):

At NDSU, nursing, before the pandemic, was like the second largest study abroad, had the second largest study abroad program. We’d gone to Kenya, Malawi, Haiti; we went to India once. Amazing. Yeah. Amazing. We’re just finally getting back. We’re sending a group, a large group of students to Malawi in about less than a month.

Erica DeBoer (host):

That’s amazing. I really do think that it’s a differentiator that we learn how fortunate we are in the United States. I think the other piece that to your point about technology, technology is incredibly important, but the basic back to basic skills are really even more important than ever. As we look at some of the supply shortages, some of the other challenges that we’re having to navigate in health care today, and we’re gonna have to get creative in Ghana, they call it improvision. And I said, I call it innovation.

Carla Gross (guest):

Improvision?

Erica DeBoer (host):

Yes. Yeah. Yeah. Improvise. We improvise. I said, well, I like to call it innovation. Right. So let’s discover what works. Yeah. Do a lot with a little and make a difference for patients.

Carla Gross (guest):

Yeah. So it’s amazing you know, the things that they get to do and see when they go on those study abroad.

Erica DeBoer (host):

Yeah. Yeah. It’s an eye-opening experience. Well, Carla, it’s been an absolute pleasure to get to know you a little bit and have some time to have conversation with you. Thank you so much for joining us today.

Carla Gross (guest):

Thank you.

Alan Helgeson (announcer):

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health Series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

Learn more

• Plane crash victim reunites with nurse at Sanford Fargo
• Sanford nurse starts skills fair at hospital in Costa Rica
• Once-homeless student will graduate with nursing degree
• Sanford recognized for commitment to workplace mental health
• Ep. 7: Flexible work and well-being in rural health care

Get more episodes in this series

USD collaborates for the next generation of nurses

Alan Helgeson:

Hello and welcome to the “Reimagining Rural Health” podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic is a conversation on nursing education and collaborative partnerships in developing the next generation of nurses. Our guest is Dr. Anne Pithan, department of nursing chair at the University of South Dakota. Our host is Erica DeBoer, Sanford Health chief nursing officer.

Erica DeBoer (host):

Anne, welcome. I’m so excited to have the opportunity to chat with you today about how USD and our partnership is helping to address some of the nursing workforce issues. So maybe to start, do you mind introducing yourself?

Anne Pithan (guest):

Thank you. Erica. My pleasure. My name is Anne Pithan and I am the chair of nursing at USD. I have been in the nursing profession for 36 years. And have really had a blend of nursing practice, academics and leadership. So it is really my pleasure to always let you know what USD is doing and how we can support your work.

Erica DeBoer (host):

Amazing. A long profession. And we are so privileged to be able to partner with you, and I appreciate all you do. I think to start off December of 2022, USD celebrated and welcomed to the USD’s newest home for health careers in education. I’m here today with you at the Center of Health Education in this amazing state-of-the-art building. Tell me how this is a differentiator for your nursing students who attend USD.

Anne Pithan:

Thank you, Erica. And we are so pleased that you’re here to be able to see our facilities. So what we love about our USD nursing facilities is we really feel that this is an opportunity where students can learn in state-of-the-art facilities and really learn in an environment that is safe for them. It really allows them to make mistakes. And it allows faculty to really mentor and talk them through how they can really perfect their nursing skills.

So we love our facilities in the fact that it really supports practice readiness. We have, again, state-of-the-art facilities in our simulation and in our lab where students can gain confidence, they can develop their nursing skills, their communication skills under the mentorship of our excellent faculty.

Erica DeBoer (host):

Yeah, I agree. I had the chance to meet a couple of your faculty as well as take a tour of the facility. And it makes me really excited cuz I think as you well know, I’m an ICU nurse by background, so to go in your simulation labs to see the high tech, the same beds that we see in our hospital setting, the pumps that we have, as well as just that environment and the attention to detail that the team has put into it. I’m really impressed.

I think the other thing that I have to compliment the team on is your commitment to interdisciplinary teams. So you mentioned how important the state-of-the-art facilities are, not only to our nursing professions, but what’s magical about this building, what I experienced, what I heard, and I can see how the interdisciplinary teams can come together to really create that experience that’s gonna prepare our nurses for the future. So, really incredible. So nice work.

Anne Pithan:

Thank you Erica, for saying that we really pride ourselves on our interprofessional education, and we know that as we move our graduates into practice, that is so essential to be able to work within that team to promote excellent patient outcomes. So thank you for recognizing that. We see that value as well. Our students see that value and when they graduate, they understand the importance of working within that interprofessional team. So it supports all of our programs here and it really allows that teamwork and that collaboration that is so important as our nurses get into practice.

Erica DeBoer (host):

Yeah, I do agree it’s likely a differentiator when you think about the rural footprint that we serve and the people that we have the opportunity to serve. Building those communities inside the walls of a university as well as what they might experience in building those relationships are so key.

I know that USD nursing had the opportunity to apply and they received a $1 million HRSA grant to grow South Dakota Nursing Workforce. I’m excited to hear a little bit more about your involvement in that and what we can see in the future.

Anne Pithan:

Oh, thank you Erica. We are thrilled about this. This is really exceptional for our nursing program, for our nursing faculty and our nursing students. So this grant is really focusing on that exposure to rural health. And as we both know, that is so important in the state of South Dakota. And it’s really giving our students an opportunity of awareness and just knowledge of how rural health works.

So what this grant will do, Erica, is it will provide the funding for 24 students per year to immerse themselves in rural health. And that is an opportunity that we haven’t really had before based on just the ability to get those students to these rural areas.

So we’re really excited about infusing that passion, that energy, and that love of rural nursing. So, and again, we’re so pleased with our partners, all of our partners, including Sanford, that has just stepped up to partner with us to really engage our rural health that is so needed in the state.

Erica DeBoer (host):

It is really important. And obviously what really brought us to our colleges of nursing and really brought this series together is how do we reimagine health care? How do we reimagine how we’re going to care for the rural nature in which all of us serve? Because there’s a different magic that comes with this population. There’s different challenges that come along with it too. And getting creative and really dedicating time and energy to that longitudinal plan of care for our patients is so important. Obviously my background is acute care nursing and critical care, but when we think about how much value nurses bring at all parts of our patients’ journey, a lot of that care can happen outside the walls of the hospital and those clinics. And so the importance of that rural experience is so important. So appreciate your commitment to that.

Anne Pithan:

Thank you Erica. And as you stated, you know, with South Dakota being so rural and, and our goal is really to serve the state of South Dakota. So we feel that this grant will really offer students that exposure that they might not have had before. And as you stated, it’s its own specialty. It has its own gifts and blessings and challenges. (Laugh) And, and we really are going to immerse these students in 135 clinical hours. And really give them that comprehensive view of rural health.

Erica DeBoer (host):

I love it. I can’t wait to see what we’re gonna learn from them. Cuz I think that’s the other privilege that we have as we reimagine health care and we reimagine how we work through what nursing looks like in the future. Our workforce needs are gonna be different. Our community needs are gonna be different. And so I appreciate the innovative thought that the team is taking to that.

So in having said that, from your perspective, what do today’s nursing students need to be prepared that’s different from the past? Obviously you’ve been in health care for a little while, so I’m curious what feedback you have.

Anne Pithan:

Yes, thank you. That is such a great question. And I think as we work with our students and they’re so innovative and they’re so passionate and creative. But I do believe that their needs are a little different perhaps than when you and I were in school. And I think one thing that has, that our students need is that ability to manage those complex patients.

They have really their complex patients and that ability to really look at social determinants of health and look from a really holistic view for our patients. So I think that’s one thing that’s a little bit different. And, and as you know, even our national licensure exam has really changed to capture that – that is a need that students have.

I think another need that I think our hospitals and our universities are doing a great job of, Erica, is really that mentoring. I think there has never been a time when new nurses and even our seasoned nurses, all of us need mentors. So I think that is a need that has really risen to the top. And we’ve seen that.

Another need that I have really seen is, again, that relationship management, using those communication skills to work with, you know, diverse populations, populations that have a lot of needs that perhaps we’re not as, maybe we weren’t as aware of. So I think conflict management, I think as you mentioned before, working within interprofessional teams is just essential as well as collaboration and teamwork.

And why I’m so excited to have this interview today with you, Erica, is it really puts a microscope on really the need for our partnerships that, you know, with regulatory, with universities and with practice partners, is really how we’re gonna really solve complex problems and really help students get what they need today.

Erica DeBoer (host):

Agreed. I think our nursing students, there’s a lot of pressure on our nurses. It doesn’t matter if we’re talking about our profession inside the walls, but as a nurse, I think you well know that we’re looked to as the most trusted profession. And so in many cases, maybe it’s not even our expertise, but really making those personal connections and building that trust.

Anne Pithan:

Absolutely.

Erica DeBoer (host):

So incredibly important. So tell me a little bit more about how technology and digital tools allow nursing students to be better prepared to be caregivers of the future.

Anne Pithan:

Yes, thank you. That is something that’s a great question. And I think we’ve all learned so much through the COVID pandemic. I think it’s really spurred our innovation and our creativity. And I think, Erica, what I love right now in this time is that technology has really allowed us to connect in ways that we have never been able to before.

And so, for example, what I’m excited about is here at USD, we are part of a global rural nursing exchange network. And that has allowed our nursing students to connect with students from Tanzania, Africa. And technology has just changed things in ways that we really didn’t anticipate. And it’s allowed our students and the students in Africa to develop that cultural sensitivity, that awareness, that ability to work with people that may be different than yourselves. And I think that’s one way that this will also transition into really making better caregivers, is they have more exposure. And it’s made a kind of a big world a little bit smaller for us, so that we can connect.

The other thing that I’m excited about is I think technology has allowed us to connect with nurses in a different way. So, for example, you, we talked about the importance of mentoring, and I think telementoring allows that, where we don’t have to be physically sitting next to each other, but we can still use technology in a way to mentor, to educate our patients, to use telehealth, to connect with our patients in ways that we haven’t been able to before.

Erica DeBoer (host):

I love that, Anne. I do believe that to your point, nursing is not ever going away. It’s always gonna be a hands-on field. It’s always gonna be a relationship-based field of practice, but we do use technology to connect with each other in different ways. I think some of what we’re hoping as we reimagine the rural health care footprint is how do we help our patients navigate the complexity in our health care system, as well as use technology as it makes sense to save the many miles that so many people have to drive in some cases, to receive specialty care.

Anne Pithan:

What I think we’re bringing to the workforce, and I’m sure you see it every day, is we are bringing technology savvy students that really can forge the way for us. And so, I, I love the students of today because I think they’re really gonna make a difference for us.

Erica DeBoer (host):

I agree. I think they are innovative spirits and their fresh eyes are gonna only help us continue to really forge different paths.

One other thing I wanted to chat with you a little bit about, Anne, is I love the commitment that you have to Tanzania and those experiences for our student. As you maybe know or don’t know, Sanford has world clinics across the world, and I just had the privilege to spend some time with our Sanford staff in Ghana. And when you stop to think about what that experience just gave me, it does make the world a little bit smaller. It also reminds us how fortunate we are and how innovative we can get with so little. So I’m curious what your students say about those experiences.

Anne Pithan:

Thank you, Erica. Last year, this is our, our second, we have a second grant with our global rural nursing exchange network. And last year we had six students. This year we have expanded to 16 students. And I agree with you, it was a very life-changing event for me as well. And I think what it did, Erica, is it really created a bond where I think what tied us together was that love of service, that love of making a difference and really caring for patients. And that’s universal.

And I think both are Tanzania and our USD students saw that. And it also opened eyes to, gosh, how we may be different, but how we’re so similar. And so I’m excited for you for, for the experience you had. And I, again, I think it makes our big world small where we’re able to connect with that love and passion for the profession.

Erica DeBoer (host):

I Agree. And of course, when we look at some of the solving for our workforce issues, there’s just not enough human beings in the United States to fill the need for our aging population and the nursing needs that we have. And so as we explore internationally educated nurses and how that could help us actually address some of the workforce issues, your commitment to having some of those experience only helps us actually guide some of those experiences. So again, I just wanna thank you Anne and the USD team for partnering and being innovative around those things.

Anne Pithan:

Oh, thank you. I agree with you, Erica. I think the more that we can expose our students to differences, I think it’s just gonna create a really strong diverse workforce.

Erica DeBoer (host):

I agree. I agree. Well, Anne, I’m curious if you had any questions for me. I know that I’ve spent a ton of time asking you questions, so I’m curious if there’s anything that you’d like to ask.

Anne Pithan:

Yes, Erica. I would love to. And, and one thing that I love to watch and learn from is the nursing leadership that I’m exposed to at Sanford. I have, am always so impressed by the relationship skills, the leadership abilities. So I do have a few questions that I would love to ask you.

Erica, as you are in your role right now, what are the biggest challenges that you see?

Erica DeBoer (host):

I’d say the biggest challenges from a nursing workforce standpoint is making sure that we listen and pay attention to what it is that they need. Not only are nurses that are coming out of school, how can they help us learn and see the world from a little bit different perspective, but also how do we support that incredible wisdom that we have in our nursing profession? And so, when I think about the biggest challenges, I worry about the burnout and I worry about our profession as a whole. How we can actually support them in loving the profession and knowing the gift that it is to be called to care. And the gift that we have the opportunity to, to give to not only our colleagues that we work side by side with, but also just to manage the message and the continued trust that our communities have in our nursing workforce.

So, preparing our brand new nurses, how do we support them in their journey and make sure that they can get over that hump? Cause nursing and the health care profession is so challenging, but so exciting at the same token. So as we reimagine health care, as we think about different ways to do the work, how do we listen to our new technology savvy students? But then how do we mimic that? And how do we partner that with the incredible wisdom that we have?

We are so blessed at Sanford with such longevity in our nursing staff. It’s really incredible. We have people that have been with us from anywhere from 35 to 47 years, and the privilege to just learn from them and gain that wisdom and insight about what they’ve seen, how things have changed, and how things in some cases need to continue to change to address really the health care needs of our society today.

Anne Pithan:

Thank you, Erica. That is such a great answer. And, I think that is our challenge, whether we are in academics or we’re in nursing practice, is we know that it’s a challenging profession, but we also know the gifts that this profession brings and the blessings it brings. So I love that on both sides here, our vision is to really make our nurses excited about this profession.

How is Sanford Health working to support your nurses?

Erica DeBoer (host):

Great question. I think as we reimagine how we’re going to have to manage the population of patient that needs us, we’re actually investing a lot in reimagining our workflows. I know it seems probably fairly simple and back to basics, but so complex. When we think about all the technology that we have the privilege to use to take care of our patients, how do we simplify that?

I always use the phrase, get rid of stupid stuff or gross. What are those things that nurses don’t need to do? How do we put the right people beside our frontline teams so that they can do their work and care for that patient and build those relationships? So we’ve actually invested in technology to help actually reduce that burden our, on our frontline team so that we can focus on that patient relationship.

I think the other piece is we’re asking ourselves really clear and concise questions about, is this something that nurses should be doing to allow them to work at the top of their license in the top of their scope? Or is there other teammates that could actually be supporting that work?

I think the other really important culture change that we’ve been working on for the last three to five years is our high reliability journey. So SAFE is what we coin it: so Sanford Accountability For Excellence. And it’s really truly how we’ve actually built those relationship skills built that culture of safety that everyone can speak up for safety. And we use patient safety stories to help us do that. But it’s not just about our medical teams.

All of our teams at Sanford Health are there to take care of our people and our patients as well as our communities of which USD is a part of. How do we continue to build really that culture of everyone’s contribution to making things better, to learning and to constantly looking for ways to make it safer for our patients, but also more reliable.

Anne Pithan:

I love that, Erica and I, I love – the two things that really stood out to me is really examining that workflow to really make that as with as much ease for our nurses as possible. And then I just love what you’re doing to continue to make this nursing such a trusted profession by really focusing on that safety, and allowing nurses to really be in that arena where they perform best. So that’s, it sounds like Sanford has, is doing, I know that Sanford is doing such great work.

Erica DeBoer (host):

Yeah. Maybe the other thing I might add, Anne, is our shared governance model, I think is also really important to make sure that that voice of the nurse is heard. So our shared governance, or we call it senate, is the opportunity for our teams not only inpatient, but ambulatory, and even our post-acute teams can come together, ask questions, problem solve those things that are those pebbles in their shoes every day. So how do we make sure that we’re lifting up that voice of the nurse to make sure that they’re contributing to the solutions, but also then that follow-through and what are those things that they can contribute? So shared governance is another really important initiative that it’s been part of the culture that I’ve grown up in, but it’s even more important now to make sure that they have that voice.

Anne Pithan:

I see that, Erica, so vividly when I have been on Sanford meetings, and often it’s exactly that, you know, we’ll have to take this back to our shared governance for their perspective. So I see that in your nurses. I see it in your leadership. So I think you’ve just done a great job of infusing that throughout your culture.

Erica DeBoer (host):

It takes, it’s a team effort and it’s a history, right? There’s a lot of really amazing people that have come before me at, in the Sanford team.

Anne Pithan:

Well, you guys are doing great work on that.

Erica DeBoer (host):

Thank you.

Anne Pithan:

Erica, how has nursing changed since you entered the field?

Erica DeBoer (host):

Wow. That’s a great question, Anne. So probably the first thing that’s changed is when I actually graduated, there was only one open position on the floor that I wanted to work. So when I look at the great number of open positions that we have in all types of nursing across the nation today, that’s one thing that’s probably the most different is that there was more competitive then.

I’d say the other thing that’s changed is our access to different pieces of technology. And I think sometimes that automation and that technology has created, in some cases a different way about thinking about how we do things. I love technology, I love data cuz it helps me make decisions. It helps me think through and process things in a different way.

I think the third thing that’s really changed about nursing is really the continued emphasis on them as the most trusted profession. They always have been, but I’d say the variety and the enhanced ways that nurses can contribute to health care is different than it was before too, which is really exciting. When I think about our, not only our nurses, but our family nurse practitioners and how they contribute in all parts of health care, it’s really quite incredible to see how the profession continues to grow and change.

I’d say the fourth thing specifically because of COVID is I think that our nurses are really scientists. They actually are innovative. They can figure out things in the moment and they get it done no matter what without a lot of fanfare. We’re just always the ones that are gonna get it done. And I think we’ve always been that way, but COVID really helped lift that, but it also created a dynamic in which there is a fatigue factor with our nursing practice today. So we certainly have to address that. But on the same token, incredible profession, the ability and the resources that we have are absolutely incredible.

Anne Pithan:

You know, Erica, I love what you said about really using data and also being scientists. That is something that I agree – we have students leaving, graduating and then entering the workforce and they know how to tackle problems, and they go to the evidence and they go to the data to do that. And, and I think nursing has done a great job of getting us to this point.

The other thing that I love that Sanford does is that, which is a little bit different, I think, than perhaps when you and I first started. And that’s the ability to present, to disseminate that information, to share that with your peers. And I think in academics we do a really nice job of getting them ready to do that, where they’re comfortable. But I think that our hospital organizations have just taken that to the next step where you’re really showcasing your nurses and I think that has just been a tremendous move, what our profession has done.

Erica DeBoer (host):

Our quality and safety scores show it, right? We’re the hands and feet that make that magic happen. And without the nursing profession and that commitment to high quality care, it makes it tough for it to happen. So it is amazing to use that data to continue to drive that competitive nature of how can we even be better.

Anne Pithan:

Absolutely.

Erica DeBoer (host):

And of course, we all wanna prepare so that we have amazing nurses to take care of us someday, right?

Anne Pithan:

Thank you, Erica. As I stated earlier, I love to watch your leadership team. I just think they’re very skilled leaders, and every time I learn something new from them at every meeting that I attend. What would you tell someone who is interested in a position like yours?

Erica DeBoer (host):

Oh, interesting. Now, my journey was a little bit unique compared to most and I actually obviously have just been in this chief nursing officer role for just two years. So if I were to tell, and I have an opportunity to mentor a lot of nursing students as well as others is my biggest piece of advice is give yourself time. There’s so many things that you can learn in every step of that journey. It’s not always about maybe going back for that master’s degree right now. Sometimes it’s just that one magazine or that one podcast. What can you do to contribute and learn every day so that you can continue to grow and change?

The other thing that I share with my nursing colleagues, especially if there’s a fatigue that they’re actually talking about is taking care of yourself is incredibly important. And having that balance. So what does that look like for you? Because it’s different for everyone.

Additionally, take every opportunity to get involved outside the walls of your facility. Getting and getting to know other people outside in different realms is so important. As we think about growing as a professional, as well as growing with others, relationships are so incredibly important. And building that trust, no matter if it’s in the health care field or outside, there’s always something to learn.

Anne Pithan:

I love that, Erica. And I think as I was listening to you, the other thing that really popped into my mind is what we had talked about earlier. And no matter at what level you need those mentors, you need those people to really seek guidance from and kind of that lived experience. So I love that you have and take the opportunity to mentor students because wow, what a great opportunity for them.

Erica DeBoer (host):

Well, and I learned from them in some cases more than I learned, than they learned from me. I had the privilege to actually mentor a student who’s has her preceptorship or her internship in ICU, and she just happened to send me a quick text and said, do you happen to know what an impella is? And I’m like, oh my goodness. Yes. I took care of the first patient who had an impella at the med center. I can tell you what room it was in. And then she sent me this two and a half minute long voice text about all the different questions she had about this particular situation. So again, once a nurse, always a nurse, we spent a good 45 minutes talking about pathophysiology and just, it’s amazing the questions and the insights that they bring to the table and how they won’t quit until they have their answer.

And so she was just astounding to talk to and actually work through this process. And then of course, I did even some follow up back with our front-line teams to say, gosh, what else do we need to do? If we couldn’t answer this question, do we need to have more clarity? So again, that voice, that brilliance at the bedside from our nursing students, from our frontline teams, you can learn so much by just listening to the magic in what they see and what they experience. So it’s fun once a nurse, always a nurse. And of course, I love talking about critical care (laugh).

Anne Pithan:

That is such a great story. And what I love about that is just that, that opportunity to, to be lifelong learners, right? And how much wisdom you gain, not only at the bedside, but that wisdom comes back to you, that you absolutely can share in this role now, and you can share that now with nurses. So I love, Erica, that you’re just such a great role model for our nurses, for those, for those nurses that really want to get to that next level of leadership. So I think that’s just great insight and, and great advice for those seeking that.

That kind of leads to my next question for you, Erica. And we so appreciate the support that we get from Sanford. They do a great job of coming to visit our students and really talking about all the great things that that Sanford has to offer. Why do you think, Erica, that Sanford is a great place to work for nursing students?

Erica DeBoer (host):

I love that question. I think that Sanford is a great place for our nursing students to come for clinicals as well as to start their profession because of our culture of high reliability, because of our SAFE culture, as well as the differentiators that we have in our nursing practice.

We have a couple different experiences, the Becky Nelson Fellowship, which is an opportunity for a individual high performer to spend a whole year with our nurse exec team and actually experience what it’s like to be in that executive role. So in some of those meetings, attending the annual meetings so that they can explore what that’s like. Part of the Becky Nelson Fellowship is an opportunity to do a project as part of that process too. Something that resonates with them and something that needs to happen. It’s about 20% of their work. So I think that’s another way that we help to continue to build our leaders of the future.

I think the other really important differentiator, and I mentioned this a little bit already, is our World Clinics. We actually have a world clinic mentorship program in which we select four to six nurses from our facility that get to partner with our World Clinic. So Ghana, Costa Rica, New Zealand, they have virtual calls with teammates from those other clinics. They get to partner on different projects, learn from one another, and then they do have the opportunity to travel there and experience their culture for at least a week as part of that experience.

So when I think about what differentiates us, one, we’ve got incredible nursing leaders, we’ve got our shared governance structure that helps us, but I do believe we have some other experiences that help people grow as a human being, but also in the profession of nursing. And of course, our SAFE culture is what’s fundamental to a lot of that.

Anne Pithan:

I just wanna kind of touch on a few things that you said there. I think what Sanford offers just from listening to you, Erica, is, is where your interest lies. Like they will find a way to support that. Whether it’s leadership, whether it’s leading shared governance, whether it is inpatient care, the opportunities are just endless as far as getting people where they want to go in their career.

And I think as you and I speak, that is one thing that I so love about this profession is there is so many avenues to go, and really, again, as you spoke about, just, you know, opportunities for humans. It’s really finding those strengths, working from those strengths to really give back to others. So again, I love that about Sanford. It’s just all the opportunities that they give their nurses.

Erica DeBoer (host):

Yeah. We know that nurses are the very backbone of how patient care happens. And so the partnership that we have with our interdisciplinary teams are incredibly important. And nurses are leaders at the bedside, no matter if it’s in that clinic setting, inpatient setting, or even in the post-acute space. Nurses help to lead and problem solve every day. So it’s a pretty amazing profession.

Anne Pithan:

Absolutely. And I have one last question for you, Erica. And here at USD, we really pride ourselves in our nursing department on our values. And so, we live those values, and again, we hang our hat on this, and our values are relationship centered, excellence, professionalism, and service. And I think you and I have talked a lot about those values and how we live those every day in the profession of nursing. How does nursing excellence at Sanford Health align to USD’s values of excellence, professionalism, service, and relationship centered?

Erica DeBoer (host):

I love that. So nursing actually has their own vision statement as it relates to really how we connect to not only health and healing, but also to innovation and discovery, as well as development as professional nurses. So I would say, when you think about the vision statement as well as the values that we live at Sanford, we connect really well to the commitment that we make to deliver high quality care, but also to share that through discovery, through innovation, as well as service to not only our communities, but to our, the patients that we serve.

Anne Pithan:

Thank you, Erica. I think that – I love what we share here, and that is really that commitment to a lifelong professional and how we can serve others and how we can make our communities and our organizations even stronger. And I, as we started this podcast, it’s really that partnership. And I think our partnerships and our excellent relationships that we have with each other are really how we’re gonna solve some challenging times that we will and always have experienced in this profession. So I, I so appreciate the alignment that we both share.

Erica DeBoer (host):

Yeah, I appreciate your time today, Anne. Thank you so much for sharing so much of your time as well as your expertise and the innovation that you continue to bring to our workforce.

Anne Pithan:

Oh thank you, Erica. It was my pleasure.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

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