Episode Transcript
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
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