Nursingmatters May 2017 • Volume 28, Number 5
Neurokinetic Therapy changes lives
UW: Excellence recognized
Research agenda set for five years
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Coalition, college join forces Nurses needed on boards Associated Press Business
CHICAGO – The Nurses on Boards Coalition and the Chamberlain College of Nursing have finished the two groups’ year-long work developing a long-term strategic partnership. The partnership has two goals. 1. Increase awareness of the significant impact nurses can have on health care through service on boards at every level. 2. Co-create programs to help nurses develop the competencies and readiness to serve on boards. Chamberlain has committed to supporting the work of the coalition for a minimum of five years. The college will collaborate with the coalition to accomplish the coalition’s goals, positively impacting a culture of heath through the transformation of healthcare. “We are excited about our Founding Strategic Partnership with the (Nurses on Boards Coalition) as it exemplifies our
TENNESSEE ACTION COALITION
The Nurses on Boards Coalition’s goal is to ensure at least 10,000 nurses on boards by 2020, and to raise awareness that boards can benefit from the unique perspective of nurses.
alignment around the vision, mission and purpose of empowering extraordinary nurses to step into leadership roles and have a significant impact on health care from bedside to boardroom,” said Susan Groenwald, PhD, RN, ANEF, FAAN, and national president for Chamberlain College of Nursing. “Through the development of programs that improve nurses’ leadership skills and competencies, nurses – including
Chamberlain colleagues and alumni – will be more likely to participate on boards where they can make significant contributions to health care.” According to recent statistics reported by Trustee magazine, an American Hospital Association publication, the vast majority of the nation’s hospitals and health systems do not have a nurse on their boards. While America has 3.6 million nurses, only 5 percent of the nation’s hospitals have a nurse as a trustee or who serves on a board. Chamberlain aims to assist the coalition’s Please see NURSES ON BOARDS, Page 6
Start the board journey The Nurses on Boards Coalition offers practical advice for nurses who aspire to serve in board positions. 1. Find an organization you’re interested in. Nurses need not limit their participation to boards that are obviously health-related. A local food pantry could benefit from the input of a nurse on its board because of the
role it plays in community health. There’s an element of health in almost everything. 2. Know your strengths. Have a talk with yourself about how can you contribute. Then create a one-page bio and supporting resume that will show a nominating committee how you stand out from the rest of the candidates – and how you’ll be able to contribute to their mission.
Make it easy for them to see how your light can shine in their environment. 3. Express your interest. Pick an organization that has a mission the members feel passionate about; connect with the organization’s executive director or chairman of the board. Tell people if you want to serve on a board, Please see START THE JOURNEY, Page 6
May • 2017
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EDITORIAL BOARD Vivien DeBack, RN, Ph.D., Emeritus Nurse Consultant Empowering Change, Greenfield, WI Bonnie Allbaugh, RN, MSN Madison, WI Cathy Andrews, Ph.D., RN Associate Professor (Retired) Edgewood College, Madison, WI Kristin Baird, RN, BSN, MSH President Baird Consulting, Inc., Fort Atkinson, WI Joyce Berning, BSN Mineral Point, WI Mary Greeneway, BSN, RN-BC Clinical Education Coordinator Aurora Medical Center, Manitowoc County Mary LaBelle, RN Staff Nurse Froedtert Memorial Lutheran Hospital Milwaukee, WI Cynthia Wheeler Retired NURSINGmatters Advertising Executive, Madison, WI Deanna Blanchard, MSN Nursing Education Specialist at UW Health Oregon, WI Claire Meisenheimer, RN, Ph.D. Professor, UW-Oshkosh College of Nursing Oshkosh, WI Steve Ohly, ANP Community Health Program Manager St. Lukes Madison Street Outreach Clinic Milwaukee, WI Joyce Smith, RN, CFNP Family Nurse Practitioner Marshfield Clinic, Riverview Center Eau Claire, WI Karen Witt, RN, MSN Associate Professor UW-Eau Claire School of Nursing, Eau Claire, WI © 2017 Capital Newspapers
Neurokinetic Therapy removes compensation patterns Brenda Zarth
Neurokinetic Therapy looks at the overall function and interconnectedness of the body, from a mechanical point of view. It analyzes the connections and communications between muscles, bones, tendons, ligaments, tissues and their innervations. Neurokinetic Therapy was developed by David Weinstock, a Bodyworker who has been practicing Brenda Zarth and teaching in the field of Bodywork for more than 35 years. He is the author of “Neurokinetic Therapy, an Innovative Approach to Manual Muscle Testing.” Weinstock states, “Neurokinetic Therapy corrective-movement system is based on the premise that when an injury has occurred, certain muscles shut down or become inhibited, forcing other muscles to become overworked. By applying light pressure that the client then resists, the practitioner can evaluate the strength or weakness of each muscle, revealing the sources of injury and retraining the client’s body to remove the compensation patterns.” Erson Religioso III, DPT, FAAOMPT, writes, “Neuroscience tells us that the Motor Control Center of the brain in the Cerebellum stores movement patterns. This occurs in normal development in response to our repeated habits and activities, or as a result of injury as the body attempts to protect itself and avoid pain. Often times these movement patterns may be faulty or dysfunctional, and pain results from imbalance, overuse or overloading of tissues, and the site of pain may not even be in the area of the dysfunction, but merely is a result of it. (Neurokinetic Therapy) utilizes manual muscle testing to identify and address compensation Please see WHAT IF..., Page A3
Neurokinetic Therapy utilizes manual muscle testing to identify and address compensation patterns in which muscles may test weak or inhibited, and other muscles are forced to work harder and become overactive or facilitated.
Neurokinetic Therapy corrective-movement system is based on the premise that when an injury has occurred, certain muscles shut down or become inhibited, forcing other muscles to become overworked. By applying light pressure that the client then resists, the practitioner can evaluate the strength or weakness of each muscle, revealing the sources of injury and retraining the client’s body to remove the compensation patterns.
May • 2017
California weighs a huge remake JONATHAN J. COOPER, Associated Press
SACRAMENTO, Calif. (AP) – A proposal considered by California lawmakers would substantially remake the health-care system of the nation’s most populous state by eliminating insurance companies and guaranteeing coverage for everyone. The idea known as single-payer health care has long been popular on the left. It’s attracting a new look in California as President Donald Trump struggles to repeal and replace former President Barack Obama’s
Continued from Page 2 patterns in which muscles may test weak or inhibited, and other muscles are forced to work harder and become overactive or facilitated.” My friend Mary Ehle had pain in her left leg going down into her toes. She had deep pain in her lower back so she
health-care law. California’s proposal, promoted by the state’s powerful nursing union and two Democratic senators, is a long shot. But supporters hope the time is right to persuade lawmakers in California, where Democrats like to push the boundaries of liberal public policy and are eager to stand up to the Republican president. Hundreds of nurses were planning to rally this past week in Sacramento before a Please see CALIFORNIA, Page 5
couldn’t sit on a soft surface. She went to a chiropractor but the pain became worse. The pain became so bad she needed to lie down in the car because she couldn’t sit. A friend suggested she try Neurokinetic Therapy. Through muscle testing, a good history and palpation, John McMahon, a massage therapist in Janesville, discovered her right hamstring was weak. The problem was corrected by releasing the left peroneal longus
In this May 16, 2016, file photo, California state Sen. Ricardo Lara, D-Bell Gardens, speaks at a rally at the Capitol in Sacramento, California. California lawmakers are considering an audacious proposal that would substantially remake the state’s health-care system by eliminating insurance companies and guaranteeing coverage for everyone. Lara, who wrote the bill with Democratic Sen. Toni Atkins of San Diego, says they’re working on details.
muscle. He then instructed her in a muscle release and activation program – exercises – to help reinforce the treatment. She said it was a life-changer for her. Within four days her pain was gone and she was able to resume all her activities. Following that same system of diagnosing, symptoms like head and neck pain may be traced back to a sprained ankle. Every system in our body is interconnected. McMahon says Neurokinetic Therapy can
help headaches, neck and shoulder disorders, breathing disorders and even discomfort related to scars. He says being a good listener, taking time to get the whole story, and having a real desire to help combines to improve the lives of his patients and contribute to his personal success. Email BrendaZarth@gmail.com or visit brendashealthplan.blogspot.com with comments or questions.
Celebrating Nurse’s Week 2017 Celebr Correctional Nursing - Celebrating Ethical Practice and Quality Care Discover what you were meant to do. Find your purpose in Correctional Nursing. Philosophy: We believe that every individual person has intrinsic value and the right to health care. As professional nurses our responsibility is to the care, restoration, health and treatment of patients. As nurses we deliver care within the framework of a security environment and within the underpinnings of nursing practice.
Vision: To define and maintain a professional practice within nursing that embodies a dedication to excellence in patient care. Nursing within the WIDOC is an inspirational model for Correctional Nursing.
Mission: To enhance, foster, and promote the professional practice of nursing. To create a culture of caring and practice that is focused around respect for patients, restores and improves the health of our patient population, and contributes to the promotion of health through quality service. WISCONSIN DEPARTMENT OF CORRECTIONS
PASSION, COMMITMENT, AUTONOMY
They are the strong. They are the intelligent. They are the compassionate.
They are our nurses. They care for our patients. They care for each other. They inspire hope. They inspire love. They make a difference every day. They are our nurses. And they are our heart and soul.
To each and every one of our 10,000 nurses: Thank you, from the bottom of our hearts. Happy National Nurses Week.
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May • 2017
California Sen. Toni Atkins, D-San Diego, addresses the Senate in Sacramento, California. California lawmakers are considering an audacious proposal co-written by Sen. Atkins that would substantially remake the state’s health-care system by eliminating insurance companies and guaranteeing coverage for everyone. Hundreds of nurses were planning to rally April 26 in Sacramento ahead of a hearing in the Senate Health Committee.
Continued from Page 3 hearing in the Senate Health Committee. “We have the chance to make universal health care a reality now,” said Democratic state Sen. Ricardo Lara of the Los Angeles-area city of Bell Gardens. “It’s time to talk about how we get to health care for all that covers more and costs less.” The measure would guarantee health coverage with no out-of-pocket costs for all California residents, including people living in the country illegally. Private insurers would be barred from covering the same services, essentially eliminating them from the marketplace. Instead, a new state agency would contract with health-care providers such as doctors and hospitals, and pay the bills for everyone. However, an essential question is still unanswered: Where will the money come from? California health-care expenditures this past year totaled more than $367 billion, according to the Center for Health Policy Research at the University of California-Los Angeles. The measure
envisions using all the public money now spent on health care – from Medicare, Medicaid, federal public-health funds and “Obamacare” subsidies. But it would also require tax increases on businesses, individuals or both. Lara, who wrote the legislation with Democratic Sen. Toni Atkins of San Diego, said they are working on the details. Employers, business groups and health plans have mobilized in opposition, warning that the measure would require massive tax increases and force patients into lengthy waits to see a doctor. They say the state should stay focused on implementing Obama’s health-care law, which is credited with significantly reducing the ranks of the uninsured in California. “California can’t afford a single-payer health-care system,” said Charles Bacchi, president and CEO of the California Association of Health Plans. “It’s going to reduce the quality of care. We think it will restrict access to care, and it will be incredibly disruptive to all the Californians who currently get health-care coverage through their employer.” The idea faces significant hurdles.
May • 2017
Nurses on Boards continued from page 1
goal of ensuring at least 10,000 nurses are on boards by 2020, and raise awareness that boards can benefit from the unique perspective of nurses. “A nurse perspective helps boards achieve their goal of improved health, as well as more efficient and effective health-care systems at the local, state and national levels,” said Rita Wray, MBA, RN, BC, FAAN, and Chamberlain Board of Trustees member. “Nurses represent one of the largest segments of our health-care workforce. It simply makes good business sense to have the nursing perspective represented in all places where decisions affecting health are made.” Chamberlain is expanding its current board-member roster of nurse leaders. Dawn Gubanc-Anderson, DNP, MSN, RN, NE-A, BC, FACHE, and Chamberlain associate professor Gubanc-Anderson Dawn was recently appointed as Gubanctrustee for the Lake Health Anderson System Board of Trustees
Start the journey continued from page 1
because they’re not going to assume that. Some non-profit boards need more board candidates, and there’s no waiting list. So
and is responsible for oversight of the organization’s quality and strategic initiatives, as well as contributing to the strategic planning committee of the board. She also serves on the advisory committee for the American Organization of Nurse Executives Education Board, which aims to review priorities and develop educational offerings. Julie McAfooes, MS, RN-BC, CNE, ANEF, FAAN, and Chamberlain web-development manager McAfooes serves as a Julie steering-committee memMcAfooes ber for the Ohio Action Coalition on behalf of the Ohio League for Nursing, one of the leaders of the Ohio Action Coalition. The Ohio Action Coalition fulfills the mission of the national “Future of Nursing: Campaign for Action” through workgroups that mobilize nurses and consumers at the state level to promote academic progression, workforce data analysis, and leadership and inter-professional education. Adele Webb, PhD, RN, FNAP, FAAN, and Chamberlain-Cleveland campus president Webb serves as a partner with the
World Health Organization, focusing on its “Non-Communicable Disease Initiative,” and is committed to providing access to advanced eduAdele Webb cation to Seychelles nurse educators. Additionally, Webb is president-elect of the Greater Cleveland Nurses Association, part of the Ohio Nurses Association. “The (Nurses on Boards Coalition) is pleased to partner with Chamberlain College of Nursing to extend our reach and provide support to nurses as they offer their expertise to relevant boards,” said Kimberly J. Harper, RN, MS, CEO of the Indiana Center for Nursing, nursing lead with the Indiana Action Coalition-National Future of Nursing Campaign for Action, and Nurses on Boards Coalition national co-chair. Marla Weston, PhD, RN, FAAN, CEO of American Nurses Association Enterprise and Nurses on Boards Coalition national co-chair, said, “Placing nurses on boards is essential to transform and improve care for all people, particularly with the health-care system in transition.” Visit nursesonboardscoalition.org for
more information. Nurse leaders who are currently serving on a board, or who would like to be considered for a board seat, are encouraged to learn more. For more than 125 years, Chamberlain College of Nursing has been at the forefront of excellence in nursing education. Chamberlain is increasing access to nursing education nationwide with campuses offering the three-year Bachelor of Science in Nursing degree program and flexible post-licensure programs such as the RN to BSN option, Master of Science in Nursing degree program, Doctor of Nursing Practice degree program and graduate certificates. Visit chamberlain.edu for more information. The Nurses on Boards Coalition represents national nursing and other organizations working to build healthier communities in America by increasing nurses’ presence on corporate, health-related, and other boards, panels and commissions. The coalition’s goal is to improve the health of communities and the nation through the service of nurses on boards and other bodies, ensuring that at least 10,000 nurses are on boards by 2020. Visit nursesonboardscoalition.org or call 301-628-5203 for more information.
put your name on the list. 4. Don’t let your calendar talk you out of becoming involved. Different boards will take different amounts of time commitments, but in general board work does not take an overwhelming amount of time. Boards are strategic.
Many boards meet four or five times a year for a few hours. You’re not doing the work every day. Don’t opt out of being considered because you wonder about your ability to have the time. Nurses manage much more in their schedules that is more difficult than finding the time to serve on a board. And the
rewards are so meaningful. The Nurses on Boards Coalition grew out of the 2010 report from the Institute of Medicine – now the National Academy of Medicine – that called for nurses to play larger decision-making roles on boards in order to improve the health of all Americans.
Celebrate a Positive Image of Nursing Join colleagues and community members on Wednesday, May 10 for these special Nurses’ Week seminars featuring UW-Madison alum Dr. MarySue Heilemann, PhD, RN, associate professor at UCLA’s School of Nursing. Dr. Heilemann is internationally known for her expertise on how nurses are portrayed in the media and its impact on health outcomes. 9:00-10:15AM Reshaping the Image of Nursing in the Media Explore the value of improving how nurses are portrayed in film and television, based upon Dr. Heilemann’s extensive research and insightful conversations. Dr. MarySue Heilemann 1:30-2:30PM is a practical innovator on the use of media Powerful Transmedia Interventions in nursing science. for Symptom Management among Latinas Learn more about Dr. Heilemann’s new model through nursing science that features relatable characters in media as part of powerful and promising interventions with patients.
A heartfelt thank you to our nursing staff! Join our team! For a complete listing of our career opportunities, search “Careers” at
Both sessions will be held in Signe Skott Cooper Hall, H 701 Highland Avenue, Madison, Wisconsin. There is no cost to attend! AA/EOE MK17-35-0(04/17)A
May • 2017
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Roger Brown of the University of Wisconsin-Madison School of Nursing is being honored with the Chancellor’s Award for Excellence in Research: Critical Support.
Karen Solheim of the University of Wisconsin-Madison School of Nursing is being honored with the Chancellor’s Hilldale Award for Excellence in Teaching.
Academic staff honored for excellence Eight members of the University of Wisconsin-Madison’s academic staff have been selected as recipients of the 2017 Academic Staff Excellence Awards. Chancellor Rebecca Blank will present the awards at a reception honoring the winners. “As these awards richly illustrate, our academic staff members are scientists and scholars, communicators and creators, managers and mentors,” Blank said. “They inspire our students, strengthen the work of their colleagues, educate the world and ensure that the mission of this institution never falters.” Among those honored is Roger Brown, statistician and clinical professor with the School of Nursing. Across the nation and around the world, top statisticians
are much sought-after. UW-Madison has one of the best in Brown, according to the university. When campus researchers need help designing complex studies or calculating analytical approaches, they turn to Brown. With phenomenal versatility he can quickly delve into a new topic and arrive at the key points of a study, listening carefully to what the researcher is trying to achieve. It’s a skillset, colleagues say, Please see STAFF HONORS, Page 9
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May • 2017
Research agenda aims at better health care Bettering health-care delivery. Streamlining health-care costs. Improving safety using patient-centered outcomes. Targeting and improving care for specific populations. The National Association of Clinical Nurse Specialists is planning to focus its research agenda on these topics, and more, for the next five years. A task force identified six areas for the 2017-2022 Research Agenda. The top two are the association’s most strongly supported initiatives and are classified as National Association of Clinical Nurse Specialists’ 2017-2022 research priorities. 1. Clinical Practice Application – patient-centered outcomes, population health management and comparative effectiveness 2. Health Care System – delivery, services, costs, safety and nurse-sensitive indicators 3. Health Care Policy – scope of practice and regulation 4. Health Promotion – wellness, disease and symptom management, quality of life and functional status 5. Education – health-care provider and students, patients, families, populations such as vulnerable and unique, and communities
NATIONAL ASSOCIATION OF CLINICAL NURSE SPECIALISTS
The National Association of Clinical Nurse Specialists has teamed up with the Indiana University School of Nursing to provide, “Developing Your Skills as a Clinical Nurse Specialist Preceptor,” a new online training program for clinical nurse specialist preceptors working with students doing clinical rotations. The online self-study course will provide nursing programs and preceptors with valuable tips and tools for working with students, and allow them to complete the course on their own schedules.
6. Palliative Care Across the Lifespan “Nursing research builds the scientific foundation for clinical practice,” said Vince Holly, MSN, RN, CCRN, CCNS and National Association of Clinical Nurse
Specialists 2017 president. “Clinical nurse specialists are uniquely positioned to conduct and analyze research in all aspects of health care. Our work covers the entire spectrum of care – with patients and families, among nurses at the bedside and
within health systems. We look forward to better highlighting the frequent contributions clinical nurse specialists make to health-care research.” Clinical nurse specialists are advanced-practice registered nurses. They have advanced education and training in physiology, pharmacology and physical assessment. They have a particular area of specialty, such as cardiology, oncology or diabetes. Their skills and expertise allow them to identify gaps in health-care delivery and then to design and implement interventions. They then assess and evaluate interventions to improve overall health-care delivery. There are more than 72,000 clinical nurse specialists working in the United States. The association’s research agenda and priorities are the result of the National Association of Clinical Nurse Specialists Research Priorities Task Force, Please see RESEARCH, Page 9
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May • 2017
Rural health-care innovation saves lives Anna Gorman, Kaiser Health News Via Rural Health Reporter
ARCO, Idaho – Just before dusk on an evening in early March, Mimi Rosenkrance began to vaccinate a calf on her spacious cattle ranch. But the mother cow quickly decided that just wasn’t going to happen. She charged, all 1,000 pounds of her, knocking Rosenkrance over and repeatedly stomping on her. “That cow was trying to push me to China,” Rosenkrance said. Dizzy and nauseated, with bruises spreading on both her legs and around her eye, Rosenkrance, 58, nearly passed out. Her son called 911. An ambulance staffed by volunteers drove her to Lost Rivers Medical Center, a tiny brick hospital nestled on the snowy hills above this remote town in central Idaho. Lost Rivers has only one full-time doctor and its emergency room has just three beds – not much bigger than a
Continued from Page 7 that has helped the university land tens of millions of dollars in research grants. The breadth of his work is astonishing, as is his campus reach. He has authored or co-authored 256 published papers. Though based at the School of Nursing, he generously gives of his time and expertise across departments and disciplines to support and train faculty members, researchers and graduate students.
summer-camp infirmary. But in the first 90 minutes after Rosenkrance arrived she received a CT scan to check for a brain injury, X-rays to look for broken bones, an IV to replenish her fluids and had her ear sewn back together. The next morning, although the hospital has no pharmacist, she received a prescription for painkillers filled through a remote prescription service. It was the kind of full-service medical treatment that might be expected of a hospital in a much larger town. Not so long ago, providing such highlevel care seemed impossible at Lost Rivers. In fact, it looked like there wouldn’t be a Lost Rivers at all. The 14-bed hospital serves all of Butte County, whose population of 2,501 – down from 2,893 in 2000 – is spread across a territory half the size of Connecticut. Arco, the county’s largest town, has seen its population drop 16 percent since 2000, and now stands at just 857. Please see RURAL, Page 10
Also honored is Karen Solheim, clinical professor with the School of Nursing. A strong voice and role model for nursing students, Solheim combines extensive expertise in the field with an engaging classroom style that earns consistently high evaluations. She teaches nursing on a global scale, providing students with immersive experiences in public health in Thailand and Malawi. She draws on her considerable humanitarian work, including co-founding International Partners for Education Inc., a nongovernmental organization that
M. SCOTT MAHASKEY/POLITICO
Farmer Mimi Rosenkrance, 58, rests in her room at Lost Rivers Medical Center in Arco, Idaho, a day after she was trampled by a cow.
helps young women attend school who have been orphaned by AIDS in Malawi. A gifted leader in the School of Nursing, Solheim directs Global Health Initiatives and
the undergraduate program. In the latter capacity, she is spearheading a complex effort to redesign and implement new and innovative curricula.
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Continued from Page 8 established in January 2016. The task force formulated the research agenda and priorities after conducting a literature review, assessing priorities from the National Institute of Nursing Research and other nursing organizations, drafting a model, soliciting feedback from National Association of Clinical Nurse Specialists members and Board of Directors, and then revising the model based on that input. Members of the Research Priorities task force are: • Jan Foster, PhD, APRN, CNS, task force chair, and president of Nursing Inquiry & Intervention Inc. in Woodlands, Texas; • Cynthia Bautista, PhD, RN, CNRN, associate professor at Egan School of Nursing-Fairfield University in Fairfield, Connecticut; • Kathleen Ellstrom, PhD, RN, ACNS-BC, pulmonary clinical-nurse
specialist at the Veterans Administration Healthcare System in Grand Terrace, California; • Peggy Kalowes, PhD, RN, CNS, FAHA, director of nursing research, innovation and evidence-based practice at Long Beach Memorial Miller Children’s Hospital in Long Beach, California; • Jennifer Manning, DNS, APRN, ACNS-BC, CNE, acting associate dean of undergraduate programs at Louisiana State University Health School of Nursing in New Orleans; • Tracy Ann Pasek, DNP, RN, MSN, CCNS, CCRN, CIMI, advanced-practice nurse in the Pain-Pediatric Intensive Care Unit at Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania; and • Costellia Talley, PhD, ACNS-BC, associate professor at Florida M&M University in Tallahassee, Florida. Founded in 1995, the National Association of Clinical Nurse Specialists represents the clinical nurse specialist. Visit nacns.org for more information.
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May • 2017
Continued from Page 9 “Bears outnumber people out here,” is how hospital CEO Brad Huerta puts it. The medical center nearly shut its doors in 2013 due in large part to the declining population of the area it serves, almost becoming another statistic, another hospital to vanish from rural America. But then the hospital received a dramatic reboot with new management led by Huerta, who secured financing to help pay for more advanced technology, upgraded facilities and expanded services. He also brought in more rotating specialists, started using telemedicine to connect the hospital to experts elsewhere, and is now planning to open a surgery center and a long-term-care rehabilitation wing. If Lost Rivers had closed, the alternative would have been hospitals in Idaho Falls or Pocatello, each more than an hour away across high-altitude prairie. Instead, “I don’t have to go across the desert for hardly anything,” said Rosenkrance, resting at the hospital the morning after the cow attack.
Rural hospitals can thrive despite crisis Rural hospitals are facing one of the great slow-moving crises in American health care. Across the United States,
M. SCOTT MAHASKEY/POLITICO
Lost Rivers CEO Brad Huerta shows off the hospital’s CT scanner.
they’ve been closing at a rate of about one per month since 2010. About 14 percent of the U.S. population lives in rural counties, a proportion that has dropped as the number of urban dwellers grows. Declining populations mean a smaller base of patients and less revenue. And the hospitals are caught in a squeeze. Because many patients in the countryside are older and sicker, they require more intensive and often expensive care. Faced with these dramatic economic
and demographic pressures, however, some hospitals are surviving – even thriving – by taking advantage of some of the most cutting-edge trends in health care. They are experimenting with telemedicine, using remote monitors to track patients, and buying high-tech equipment to perform scans and other types of exams. And because many face physician shortages, they are partnering with universities and increasingly relying on nurse practitioners, paramedics and others to deliver care. In parts
of rural Oregon and Washington, veterans can get counseling through a tele-mental health program. Physicians in Iowa and North Dakota have access to virtual emergency room support. At Lost Rivers, Huerta’s strategy was to use technology and innovation to offer the kind of high-quality medical care that would keep patients like Rosenkrance coming back. “Necessity is the mother of invention,” Huerta said. “Small hospitals like mine are always going to be under the gun. You have to get really creative.” In the decades to come, America’s heartland and hinterlands will continue to be home to the people who run the country’s farms, forests and fisheries, and its wilder regions will continue to draw visitors who crave nature and recreation. And those people will need medical care. As a result, rural health researchers say hospitals like Lost Rivers are important test cases. They show that, despite daunting obstacles, rural America need not be left behind when it comes to health care. In fact, because they are being forced to innovate faster than their urban counterparts, they can provide a glimpse into the future of medicine. “Being in a rural place does not preclude high-quality medicine,” said Tom Ricketts, senior policy fellow at the Sheps Center for Health Services Research at the University
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May • 2017
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Ruby Horn, who recently turned 100, laughs while telling stories inside her home in Arco. She was treated at Lost Rivers Medical Center after falling in her home.
Continued from previous page of North Carolina, Chapel Hill. “They are under a lot of pressure, but there are rural places you can point to as places you would say, ‘This is how things ought to be done.’” It’s a Tuesday afternoon at Tara Parsons’ flower shop. She cleans as she waits for customers – or for an emergency call. Parsons, a fourth-generation Arco resident, is not just the town florist; she is also the county coroner, a sheriff’s dispatcher and a volunteer emergency medical technician. This afternoon she is on ambulance duty. “We all wear multiple hats out here,” she said. The town of Arco was founded in the 1870s as a junction for horse-drawn stagecoaches. Its quirky claim to fame is that in 1955 it became the first town in the world to be powered by nuclear energy, thanks to the Idaho National Laboratory down the road toward Idaho Falls. Every summer, to celebrate its history, the town puts on a celebration that features a rodeo and a softball tournament. The streets are lined with shuttered and boarded-up storefronts, some with their signs still on display: the Galloping Goose, the Sawtooth Club. Residents talk nostalgically about the town’s heyday, when there were banks, a bowling alley and a movie theater – back when residents drove to Idaho Falls only twice a year, to get school supplies and do Christmas shopping. Now most of the businesses are gone. The town still has a lumber shop, a hardware store and a few auto garages. There’s also a bar, a gym and a dollar store. And around the corner there’s the local diner – Pickle’s Place – where people come day and night for fried pickles and biscuits and gravy. Like so many other residents, Butte County clerk Shelly Shaffer has a personal connection to the hospital. Her mom worked there, her sister was born there and she would take her children there. Lost
Rivers Medical Center – which also has two outpatient clinics – is one of the town’s biggest employers. “It would be devastating if we didn’t have our hospital,” she said.
Dilapidated hospital sees turnaround That was the direction they were headed. When Huerta, the CEO, arrived four years ago, he found the nearly 60-year-old hospital in disarray, with dilapidated facilities, fearful employees, reluctant patients and a financial mess left behind by the former CEO. The hospital’s bank account held just $7,000 and morale was at an all-time low. “We were the poster child for everything that was wrong with rural health care,” he said. “It had been a slow, steady decline from neglect.” Shannon Gamett, 28, a nurse at Lost Rivers, said paydays were nerve-racking. “We would run as fast as we could to the bank to cash (a paycheck,) or it might not clear,” she said. After borrowing money to pay his employees, Huerta campaigned to pass a $5.5 million bond for Lost Rivers. He asked locals if it was worth $5 a month – one sixpack of beer or two movie rentals – to keep the hospital running. They answered “yes” at the polls, and the hospital emerged from bankruptcy. Next Huerta set his sights on overhauling the badly outmoded facilities. One of his top priorities was the laboratory, which he said looked like a high-school science classroom from the 1950s. He instituted a new philosophy – if it doesn’t happen at a “real” hospital, it doesn’t happen at Lost Rivers. That meant ending some local practices – nixing little things like letting staff members wear scrubs of any color they fancied – and big things, like allowing people to bring their horses in for X-rays. “I said, ‘I have no problem doing this, but you tell me what insurance the horse
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Thank you. To our nurses: When we promise parents that their children are in the very best hands, it’s often your hands that we’re talking about. From all of us at Children’s Hospital of Wisconsin, thank you for your hard work, passion and unwavering dedication to the patients and families you see every day. Happy Nurses Week! chw.org
May • 2017
Continued from previous page has,’” he said. “The practice stopped immediately.” To bring in more revenue, he applied for grants and got the hospital a trauma center designation – the first level IV trauma center in Idaho – so it could be paid more for the care it was already providing. He saved money by inviting the town’s residents to help renovate clinic exam rooms and by moving the medical records to a cloudbased system that didn’t require more information-technology employees. Despite Huerta’s efforts, however, the long-term success of Lost Rivers is not guaranteed. “If you don’t have enough people to support a clinic or a hospital, it has no economic reason to be there,” said Ricketts, the Sheps Center fellow. “It just disappears.” Arco and Butte County officials hope the local economy will receive a boost from a planned expansion of Idaho National Laboratory, which conducts nuclear-energy testing and research. Residents also are mounting a campaign to have the Craters of the Moon, a national monument in Butte County, designated as a national park. “It would literally put us on the map,” county clerk Shaffer said. But even if that happens, Huerta knows he can’t expect a big influx of new residents. Rural parts of the United States saw an absolute decline in population following the 2008 financial crisis, a trend that has since stabilized. But there is little or no growth. So Huerta needs to concentrate on keeping the patients he has, and giving them a reason to keep coming. And that’s working. The hospital is now making a small profit and has some reserves on hand
Parsons said many of the emergency calls she responds to are for older folks who have suffered strokes, fallen at home or are struggling to breathe. One 99-year-old woman she took to the hospital on this morning had fallen in her living room. Parsons said she has known many of her patients for years, through her parents or grandparents. As they grow old and become sick, she picks them up in the ambulance and drives them to Lost Rivers. “And before long, I’m doing their funeral flowers,” she said.
Long-distance medicine brings help M. SCOTT MAHASKEY/POLITICO
Podiatrist Timothy Tomlinson tends the foot of patient Steve Hadley, 63, at Lost Rivers. Tomlinson drives 100 miles to visit patients at Lost Rivers once a week.
for future projects. “If you are not offering the services, people are going to go somewhere else,” Huerta said. “And as medicine advances and reimbursement is still pegged to volume, you have to find ways to keep that existing population here.” One big challenge for Lost Rivers and many other rural hospitals is that their patients tend to be older, and thus sicker and costlier to treat. People 65 and older account for about 18 percent of the rural population, compared with 12 percent in urban areas, according to the National Rural Health Association. An older patient base can strain hospitals because Medicare, the public insurance program for the elderly, doesn’t pay hospitals as well as private insurance does. Elderly patients also may need more intense care than small hospitals can provide. Rural hospitals also have a higher
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percentage of patients on Medicaid, the public insurance for poor people, which pays notoriously low rates to providers. Some seniors move to Arco precisely because there is a hospital in town. But for others, what Lost Rivers offers simply isn’t enough. Residents Ray Westfall, 82, and his wife, Winona, recently put their house on the market after deciding it was time to move to Utah, closer to family and more specialized health care. Westfall has neuropathy in his legs, which causes numbness most of the time. He moves around with a walker. Winona has dementia. “We can get some care here at the local hospital, but mostly we have to travel to Idaho Falls,” he said. Westfall is a regular at Parsons’ flower shop. On a recent Tuesday, he bought a bouquet for his wife – carnations, her favorite.
At first the Bengal Pharmacy, on the bottom floor of Lost Rivers Medical Center, looks like any other pharmacy, with racks of over-the-counter cold medications, bandages, reading glasses and medical supplies. Shelves of prescription medications sit behind the counter. But it has no pharmacist on site. Instead, technicians and students from Idaho State University in Pocatello, Idaho, move about, filling prescriptions. Their supervisor is a pharmacist at the university, about 80 miles away, who checks their work remotely. Patients who want to talk to him go to a small private room with a phone and video link. The pharmacy is named for the university’s mascot. For rural hospitals, telehealth can make otherwise faraway services accessible to people where they live, said Keith Mueller, director of the Center for Rural Health Policy Analysis at the University of Iowa. That can be critical, especially during the winter when snowstorms sometimes cut off access
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www.nursingmattersonline.com Continued from previous page to rural towns. “We can, in effect, bring the provider to the community without physically doing so,” Mueller said. “Even in urban areas, people want more and more convenience in how we receive our services. Here we are talking more about necessity.” At Lost Rivers, patients can have telemedicine appointments with a psychiatrist. And doctors can get virtual guidance from specialists in trauma, emergency care and burns. Still, new technologies sometimes take time to become accustomed to. “When you lose that hometown community pharmacist, that human touch, when you turn it over to computers, that’s a concept that people have difficulty with,” said Martha Danz, who sits on the hospital’s board. Leon Coon, 83, said the concept is a bit foreign to him. “I just don’t do that stuff,” said Coon, who works loading hay. “I’m a little old-fashioned.” Sipping coffee at the truck stop early on a Wednesday morning, Coon said he doesn’t even text, so he’s a bit wary of technology that puts him in touch with a pharmacist all the way in Pocatello. But then again, he said he doesn’t rely on the medical system much at all. “Anytime you go to the doctor, it’s just like a mechanic,” he said. “They’re going to find something wrong. I feel good most of the time, so I just don’t go.” Shane Rosenkrance, whose wife was trampled by the cow, said he remembers when there were five community drugstores in the valley. Now he’s grateful to have the one pharmacy – even
May • 2017 if the pharmacist isn’t actually behind the counter. “To have health care, you have to have a pharmacy,” he said. “And through technology, they are able to do it.” Telemedicine is hardly a panacea. The projects often depend on grants or government awards because rural hospitals’ operating margins are slim. And some of the telemedicine and remote-monitoring technologies require high-speed internet, which isn’t always reliable or cost-effective in rural areas. “You can’t do home monitoring everywhere,” said Sally Buck, CEO of the National Rural Health Resource Center. “You can’t do telehealth everywhere.” Long-distance medicine also may raise more questions than it answers for some patients, and even create a need for in-person follow-ups. Orie Browne, the medical director for Lost Rivers, said he tries to keep patients from needing to travel. But if someone needs more advanced medical care – or a specialist that Lost Rivers doesn’t have – he will refer them to another hospital. The hospital has a helicopter pad, and patients with emergencies that can’t be handled at Lost Rivers can either be flown out or transferred by ambulance. “Ego is a dangerous thing,” he said. “If there is anyone who can do a better job, I’m going to get (my patients) there.” Nevertheless, Huerta said, he hopes to expand telemedicine, including such services as oncology. Huerta recognizes that Lost Rivers doesn’t have the staff or the expertise to do it all. He believes the hospital should try to do more when it can, and refer out the rest. “We aren’t trying to do brain surgery,” he said. “We’re not doing Level I trauma. But
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colonoscopies? Teleoncology? People in rural areas get cancer too, and it’s demanding driving hours back from a chemotherapy session.”
Providers work multiple sites Browne started work at Lost Rivers one recent day in March, then drove 45 minutes to one of its outpatient clinics in Mackay, 26 miles away. One of his first patients was Elizabeth Galasso, 59, who was worried because her heart rate was racing. “I was scared,” Galasso said, speaking with a hoarse voice as she sat hunched on the exam table. “I felt my heart pounding clear down into my stomach.”
An EKG showed her heart was beating normally. Browne told her it was likely a panic attack, but suggested a stress test just to be sure. He told her that her age, her smoking history and anxiety all put her at risk for heart disease. “But I think things are going to be just fine,” he said. Galasso reached over and hugged him. Browne, who took over as Lost Rivers’ medical director in 2015, said he was drawn to the outdoor activities in the area, as well as the variety of rural health care. He previously had a private practice in Idaho
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May • 2017
Continued from previous page Falls and rotated into Lost Rivers for a week at a time. Now he spends his days bouncing between the emergency room, the hospital inpatient beds and the primary-care clinic. “That’s good for a person who gets bored easily,” he said. Many doctors, however, don’t feel the same pull. Rural hospitals and clinics have long struggled to recruit doctors. In rural areas, there are about 13 physicians – of any kind – per 100,000 people, compared with 31 in urban areas, according to the National Rural Health Association. Doctors and other medical providers can be enticed by programs that repay their school loans if they work in a rural area. Some medical schools have programs designed specifically for students who plan to practice in rural or underserved communities. Another way to make treatment more accessible in rural areas is to expand the responsibilities of nurse practitioners, physician assistants and even paramedics. Lost Rivers relies on nurse practitioners and physician assistants to provide care for patients in the clinics and the hospital. In addition to Browne, the medical center has four part-time primary-care physicians, some who live hours away and come in once a week. Various specialists, including a cardiologist and an orthopedist, also rotate into the medical center’s outpatient clinics about once a month. And an MRI machine is driven to the hospital once a week.
M. SCOTT MAHASKEY/POLITICO
Lost Rivers medical director Orie Browne, the hospital’s only full-time physician, examines a patient.
Tim Tomlinson, a podiatrist who lives in Twin Falls, Idaho, and drives 100 miles to Arco once a week, spent a recent morning seeing a lineup of patients. One was a man who needed to have a toe amputated after a horse stepped on his foot. Another was a diabetic who needed a skin graft checked on his foot. Tomlinson said he’s been paid late before, and he has seen the hospital nearly shut down more than once. But he keeps coming because he has developed a practice and considers it important that patients have access to specialty care. Lost Rivers isn’t unique in its difficulties, he said.
“All those small towns are struggling as young people move out, leaving mostly old people,” he said. “That puts a drain on the hospitals.” Patients are living longer with chronic diseases now, so the demand for elderly care is only going to increase. If not the rural clinics and hospitals, Tomlinson said, “Who’s going to deliver it?” Even with the decline in the nation’s rural population, many people are rooted in rural America because of family or because they like the outdoors and a slower pace of life. One of them is Gene Davies, who has lived in Arco more than 60 years
and runs a mechanic shop straight out of a different era. Handwritten signs sit on a wooden chair next to the door: “Gone to Dr.” “Be back tomorrow.” “Hope to be back Monday.” Davies said he appreciates the remoteness of the region. “I ain’t got no plans to go anywhere else,” he said. “I’ve seen enough of the other world. I don’t want it.” Rosenkrance, the cattle farmer, said she’s not going anywhere, either. She’s been coming to the hospital since she was a child, when she ran through the halls while her father worked in the pharmacy. Now her husband teases her about having a standing reservation in the emergency room. Just before discharging Rosenkrance, nurse Celeste Parson told her she needed to rest physically and mentally. The accident had left her with a concussion, a lacerated ear and a black eye. Then Parson issued her the most important instruction: Don’t do anything that could cause another blow to the head. “We would really like you to rest up for at least a week,” Parson said. “But the doctor knows for you, two or three days is more realistic.” As she grabbed an ice pack and her purse, Rosenkrance reflected on the importance of Lost Rivers for residents across the whole valley. “This hospital is a big deal,” she said. “It’s saved a lot of lives.”
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