Episode Transcript
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.
Learn about the Nurse Residency Program at Sanford Health
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.
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