NDSU’s advances in nursing school keep human touch

Podcast: High fidelity simulators are giving nursing students real scenarios to enhance learning

NDSU’s advances in nursing school keep human touch

Episode Transcript

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.

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