Access to simulation training could be a game-changer for nurses and other healthcare workers in rural Iowa, where training and continuing education (CE) has long been an ordeal. A nurse in the Iowa heartland may have to drive hundreds of miles to learn new techniques at a distant city hospital. Fortunately, healthcare workers in the state’s more thinly populated areas will soon be able to hone their skills thanks to a new $8 million dollar grant through the University of Iowa College of Nursing.
The grant money is coming from the rural healthcare program at the Helmsley Charitable Trust, which has donated millions to underserved rural areas since 2009. The program covers eight states: South Dakota, North Dakota, Nebraska, Wyoming, Minnesota, Montana, Nevada, and now Iowa. Walter Panzirer, a trust representative, said their aim is to build a sustainable, long-term simulation program to support health care providers’ continuing education in these states: “We hope to improve quality outcomes because the more you can train on something, the better the outcomes will be.”
According to the Daily Iowan, the grant will help launch the Simulation in Motion (SIM) project in Iowa. The SIM project, founded seven years ago by a group of South Dakota healthcare providers, spearheads the development of simulation training programs in midwestern states to help rural HCPs keep their skills fresh and learn how to implement new techniques and treatments for unusual conditions. The U Iowa College of Nursing is using the funds to invest in three mobile training units designed to look like emergency departments and ambulances. The ED/ambulance units will be equipped with patient simulators, medical equipment, and educators to conduct the training. Inside the trucks, educators will train students and local HCPs on the simulators, which have human-like anatomies that can mimic a range of conditions and complications.
Jacinda Bunch, the co-director of SIM – Iowa, notes that “Some emergency situations are not seen very often, and it’s hard to keep up on those skills and remember everything you should do.” Bringing the simulations to these areas helps rural health care providers train closer to home so they do not have to engage in lengthy, expensive commutes to city hospitals to develop these skills. Bunch remarked that for rural HCPs months or even years can pass without encountering certain medical situations, and when such situations do arise, rusty or outdated skills can result in worse outcomes.
The opportunity to work with simulations is a boon for nurses and other practitioners in Iowa’s remote parts, says Cormac O’Sullivan, clinical associate professor of nursing and co-director of SIM – Iowa. “Health care providers really remember what to do when they do simulations. As the students and providers practice, they become more comfortable in the scenario and more open to learning and retaining it better.”
Mary Barnett is one of about a dozen seniors who got a covid-19 vaccine on a recent morning at Neighborhood Health, a clinic tucked in a sprawling public housing development on the south side of downtown Nashville, Tennessee.
“Is my time up, baby?” Barnett, 74, asked a nurse, after she’d waited 15 minutes to make sure she didn’t have an allergic reaction. Barnett, who uses a wheelchair, wasn’t in any particular rush. But her nephew was waiting outside, and he needed to get to work.
“Uber, I’m ready,” she joked, calling him on the phone. “Come on.”
Seniors of color like Barnett are lagging in covid vaccinations, and the Biden administration plans to redirect doses to community clinics as soon as next week to help make up for the emerging disparity. Tennessee is one of a few states allocating vaccines to the network of clinics known as FQHCs, or federally qualified health centers.
In most of the states reporting racial and ethnic data, a KHN analysis found that white residents are getting vaccinated at more than twice the rate of Black residents. The gap is even larger in Pennsylvania, New Jersey and Mississippi.
“Equity is our north star here,” Dr. Marcella Nunez-Smith said at a briefing Tuesday, announcing vaccine shipments to the federally funded clinics. “This effort that focuses on direct allocation to community health centers really is about connecting with those hard-to-reach populations across the country.”
Nunez-Smith, who leads the administration’s health equity task force, said federally funded clinics — at least one in every state — will divvy up a million doses to start with, enough for 500,000 patients to get both doses. Eventually, 250 sites will participate.
The administration said roughly two-thirds of those served by FQHCs live at or below the poverty line, and more than half are racial or ethnic minorities.
Seeking People Out
In Nashville, more than a third of eligible white residents have gotten their first shot, compared with a quarter of Hispanic residents and fewer than one-fifth of Black Nashvillians.
Unlike many local health departments, Neighborhood Health is not fending off crowds. They’re seeking people out. And it’s slow work compared with the mass vaccination campaigns by many public health workers and health systems.
Barnett lives in a public housing complex that gathered names of people interested in getting the vaccine. She was lucky to have her nephew’s help to get to her appointment; transportation is a challenge for many seniors. Some patients cancel at the last minute because a ride falls through. Often, the clinic offers to pick up patients.
Aside from logistical challenges, Barnett said, many of her neighbors are in no rush to get their dose anyway. “I tell them about taking it, they say, ‘Oh, no, I’m not going to take it.’ I say, ‘What’s the reasoning?’”
Usually, Barnett said, they don’t offer much of a reason. Her own motivation is a sister with kidney disease who died of covid in July.
“You either die with it or die without it,” her brother told her in support of getting the vaccine. “So if the shot helps, take the shot.”
Same Story, Next Chapter
People of color have made up an outsize share of the cases and deaths from covid nationwide. And, predictably, the same factors at play driving those trends are also complicating the vaccine rollout.
Rose Marie Becerra received an invitation to get the vaccine through Conexión Américas, a Tennessee immigrant advocacy nonprofit. A U.S. citizen originally from Colombia, she’s concerned about those without legal immigration status.
“The people who don’t have documents here are nervous about what could happen,” she said, adding they worry that providing personal information could result in immigration authorities tracking them down.
And unauthorized immigrants are among those at the highest risk of covid complications.
Even with 1,300 total community health centers around the country, Neighborhood Health CEO Brian Haile said his 11 clinics in the Nashville area can’t balance out a massive health system that tends to favor white patients with means.
Haile said everyone giving vaccines — from hospitals to health departments — must focus more on equity.
“We know what’s required in terms of the labor-intensive effort to focus on the populations and vaccinate the populations at the highest risk,” Haile said. “What we have to do as a community is say, ‘We’re all going to make this happen.’”
Republished courtesy of KHN (Kaiser Health News), a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
The Texas Nurses Association (TNA) has a rich history of accomplishments and has played a key role in setting educational and workplace standards for nurses in the state. Today, the TNA is still tirelessly advocating for nurses and patients in Texas. As the state struggles with a frightening surge of Covid-19 cases, DailyNurse asked Cindy Zolnierek, PhD, RN, CAE, CEO of the TNA, about the most pressing healthcare issues in America’s second largest state. In Part One of this two-part interview, Zolniek spoke about the challenges of fighting Covid-19 in Texas. (Part Two will publish tomorrow.)
DailyNurse: Some aspects of Texas geography must present serious healthcare challenges even in the absence of a major public health crisis.
Cindy Zolnierek: “We do have these great expanses, and they tend to rely on critical access hospitals. [Critical access] hospitals take care of basic emergencies, but they’re very used to shifting patients off to larger facilities and other communities. This has long been standard practice in the areas of the state that have those largest expanses like West Texas. After you leave that El Paso, you go a long ways before you hit another decent sized city. [It’s] the same with Amarillo and Lubbock, Laredo, and the Midland Odessa area, which are some of the hardest hit areas [by Covid-19] in Texas. And now, with those hospitals being full, overflowing with patients to critical access, hospitals are left with no place to send their patients to. So it’s not just the communities themselves that are impacted—it’s the whole system, the whole infrastructure for providing health care, and care for cases like strokes and heart attacks and highway accidents is being impacted significantly.”
DN: So the whole healthcare system is being placed under severe strain during the pandemic?
Zolnierek: “Well, [normally] patients go to the nearest facility, like a critical access hospital, which patches them up, does the assessment and anything you need to do for life-saving. They then send the patient to a trauma facility. [During the pandemic] the problem has been. . . Click here to read the rest of this article.
Registered nurse Pascaline Muhindura has spent the past eight months treating COVID patients at Research Medical Center in Kansas City, Missouri.
But when she returns home to her small town of Spring Hill, Kansas, she’s often stunned by what she sees, like on a recent stop for carryout food.
“No one in the entire restaurant was wearing a mask,” Muhindura said. “And there’s no social distancing. I had to get out, because I almost had a panic attack. I was like, ‘What is going on with people? Why are we still doing this?’”
Many rural communities across the U.S. have resisted masks and calls for social distancing during the coronavirus pandemic, but now rural counties are experiencing record-high infection and death rates.
Critically ill rural patients are often sent to city hospitals for high-level treatment and, as their numbers grow, some urban hospitals are buckling under the added strain.
Kansas City has a mask mandate, but in many smaller communities nearby, masks aren’t required — or masking orders are routinely ignored. In the past few months, rural counties in both Kansas and Missouri have seen some of the highest rates of COVID-19 in the country.
At the same time, according to an analysis by KHN, about 3 in 4 counties in Kansas and Missouri don’t have a single intensive care unit bed, so when people from these places get critically ill, they’re sent to city hospitals.
A recent patient count at St. Luke’s Health System in Kansas City showed a quarter of COVID patients had come from outside the metro area.
Two-thirds of the patients coming from rural areas need intensive care and stay in the hospital for an average of two weeks, said Dr. Marc Larsen, who leads COVID-19 treatment at St. Luke’s.
“Not only are we seeing an uptick in those patients in our hospital from the rural community, they are sicker when we get them because [doctors in smaller communities] are able to handle the less sick patients,” said Larsen. “We get the sickest of the sick.”
Dr. Rex Archer, head of Kansas City’s health department, warns that capacity at the city’s 33 hospitals is being put at risk by the influx of rural patients.
“We’ve had this huge swing that’s occurred because they’re not wearing masks, and yes, that’s putting pressure on our hospitals, which is unfair to our residents that might be denied an ICU bed,” Archer said.
Hospital leaders have continued to plead with Missouri Republican Gov. Mike Parson, and with Kansas’ conservative legislature, to implement stringent, statewide mask requirements but without success.
Parson won the Missouri gubernatorial election on Nov. 3 by nearly 17 percentage points. Two days later at a COVID briefing, he accused critics of “making the mask a political issue.” He said county leaders should decide whether to close businesses or mandate masks.
“We’re going to encourage them to take some sort of action,” Parson said Thursday. “The holidays are coming and I, as governor of the state of Missouri, am not going to mandate who goes in your front door.”
In an email, Dave Dillon, a spokesperson for the Missouri Hospital Association, agreed that rural patients might be contributing to hospital crowding in cities but argued that the strain on hospitals is a statewide problem.
The reasons for the rural COVID crisis involve far more than the refusal to mandate or wear masks, according to health care experts.
Both Kansas and Missouri have seen rural hospitals close year after year, and public health spending in both states, as in many largely rural states, is far below national averages.
Rural populations also tend to be older and to suffer from higher rates of chronic health conditions, including heart disease, obesity and diabetes. Those conditions can make them more susceptible to severe illness when they contract COVID-19.
Rural areas have been grappling with health problems for a long time, but the coronavirus has been a sort of tipping point, and those rural health issues are now spilling over into cities, explained Shannon Monnat, a rural health researcher at Syracuse University.
“It’s not just the rural health care infrastructure that becomes overwhelmed when there aren’t enough hospital beds, it’s also the surrounding neighborhoods, the suburbs, the urban hospital infrastructure starts to become overwhelmed as well,” Monnat said.
Unlike many parts of the U.S., where COVID trend lines have risen and fallen over the course of the year, Kansas, Missouri and several other Midwestern states never significantly bent their statewide curve.
Individual cities, such as Kansas City and St. Louis, have managed to slow cases, but the continual emergence of rural hot spots across Missouri has driven a slow and steady increase in overall new case numbers — and put an unrelenting strain on the states’ hospital systems.
The months of slow but continuous growth in cases created a high baseline of cases as autumn began, which then set the stage for the sudden escalation of numbers in the recent surge.
“It’s sort of the nature of epidemics that things often look like they’re relatively under control, and then very quickly ramp up to seem that they are out of hand,” said Justin Lessler, an epidemiologist at Johns Hopkins Bloomberg School of Public Health.
Now, a recent local case spike in the Kansas City metro area is adding to the statewide surge in Missouri, with an average of 190 COVID patients per day being admitted to the metro region’s hospitals. The number of people hospitalized throughout Missouri increased by more than 50% in the past two weeks.
Some Kansas City hospitals have had to divert patients for periods of time, and some are now delaying elective procedures, according to the University of Kansas Health system’s chief medical officer, Dr. Steven Stites.
But bed space isn’t the only hospital resource that’s running out. Half of the hospitals in the Kansas City area are now reporting “critical” staffing shortages. Pascaline Muhindura, the nurse who works in Kansas City, said that hospital workers are struggling with anxiety and depression.
“The hospitals are not fine, because people taking care of patients are on the brink,” Muhindura said. “We are tired.”
Published courtesy of Kaiser Health News. This story is from a reporting partnership that includes KCUR, NPR, and KHN.KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
The ever-present nursing shortage is becoming dire during the pandemic. COVID-19 cases are surging in rural places across the Mountain States and Midwest, and when it hits health care workers, ready reinforcements aren’t easy to find.
In Montana, pandemic-induced staffing shortages have shuttered a clinic in the state’s capital, led a northwestern regional hospital to ask employees exposed to COVID-19 to continue to work and emptied a health department 400 miles to the east.
“Just one more person out and we wouldn’t be able to keep the surgeries going,” said Dr. Shelly Harkins, chief medical officer of St. Peter’s Health in Helena, a city of roughly 32,000 where cases continue to spread. “When the virus is just all around you, it’s almost impossible to not be deemed a contact at some point. One case can take out a whole team of people in a blink of an eye.”
In North Dakota, where cases per resident are growing faster than any other state, hospitals may once again curtail elective surgeries and possibly seek government aid to hire more nurses if the situation gets worse, North Dakota Hospital Association President Tim Blasl said.
“How long can we run at this rate with the workforce that we have?” Blasl said. “You can have all the licensed beds you want, but if you don’t have anybody to staff those beds, it doesn’t do you any good.”
The northern Rocky Mountains, Great Plains and Upper Midwest are seeing the highest surge of COVID-19 cases in the nation, as some residents have ignored recommendations for curtailing the virus, such as wearing masks and avoiding large gatherings. Montana, Idaho, Utah, Wyoming, North Dakota, South Dakota, Nebraska, Iowa and Wisconsin have recently ranked among the top 10 U.S. states in confirmed cases per 100,000 residents over a seven-day period, according to an analysis by The New York Times.
Such coronavirus infections — and the quarantines that occur because of them — are exacerbating the health care worker shortage that existed in these states well before the pandemic. Unlike in the nation’s metropolitan hubs, these outbreaks are scattered across hundreds of miles. And even in these states’ biggest cities, the ranks of medical professionals are in short supply. Specialists and registered nurses are sometimes harder to track down than ventilators, N95 masks or hospital beds. Without enough care providers, patients may not be able to get the medical attention they need.
Hospitals have asked staffers to cover extra shifts and learn new skills to cover the shortage. They have brought in temporary workers from other parts of the country and transferred some patients to less-crowded hospitals. But, at St. Peter’s Health, if the hospital’s one kidney doctor gets sick or is told to quarantine, Harkins doesn’t expect to find a backup.
“We make a point to not have excessive staff because we have an obligation to keep the cost of health care down for a community — we just don’t have a lot of slack in our rope,” Harkins said. “What we don’t account for is a mass exodus of staff for 14 days.”
Some hospitals are already at patient capacity or are nearly there. That’s not just because of the growing number of COVID-19 patients. Elective surgeries have resumed, and medical emergencies don’t pause for a pandemic.
Some Montana hospitals formed agreements with local affiliates early in the pandemic to share staff if one came up short. But now that the disease is spreading fast — and widely — the hope is that their needs don’t peak all at once.
Montana state officials keep a list of primarily in-state volunteer workers ready to travel to towns with shortages of contact tracers, nurses and more. But during a press conference on Oct. 15, Democratic Gov. Steve Bullock said the state had exhausted that database, and its nationwide request for National Guard medical staffing hadn’t brought in new workers.
“If you are a registered nurse, licensed practical nurse, paramedic, EMT, CNA or contact tracer, and are able to join our workforce, please do consider joining our team,” Bullock said.
This month, Kalispell Regional Medical Center in northwestern Montana even stopped quarantining COVID-exposed staff who remain asymptomatic, a change allowed by Centers for Disease Control and Prevention guidelines for health facilities facing staffing shortages.
“That’s very telling for what staffing is going through right now,” said Andrea Lueck, a registered nurse at the center. “We’re so tight that employees are called off of quarantine.”
Financial pressure early in the pandemic led the hospital to furlough staff, but it had to bring most of them back to work because it needs those bodies more than ever. The regional hub is based in Flathead County, which has recorded the state’s second-highest number of active COVID-19 cases.
Mellody Sharpton, a hospital spokesperson, said hospital workers who are exposed to someone infected with the virus are tested within three to five days and monitored for symptoms. The hospital is also pulling in new workers, with 25 traveling health professionals on hand and another 25 temporary ones on the way.
But Sharpton said the best way to conserve the hospital’s workforce is to stop the disease surge in the community.
Earlier in the pandemic, Central Montana Medical Center in Lewistown, a town of fewer than 6,000, experienced an exodus of part-time workers or those close to retirement who decided their jobs weren’t worth the risk. The facility recently secured two traveling workers, but both backed out because they couldn’t find housing. And, so far, roughly 40 of the hospital’s 322 employees have missed work for reasons connected to COVID-19.
“We’re at a critical staffing shortage and have been since the beginning of COVID,” said Joanie Slaybaugh, Central Montana Medical Center’s director of human resources. “We’re small enough, everybody feels an obligation to protect themselves and to protect each other. But it doesn’t take much to take out our staff.”
Roosevelt County, where roughly 11,000 live on the northeastern edge of Montana, had one of the nation’s highest rates of new cases as of Oct. 15. But by the end of the month, the county health department will lose half of its registered nurses as one person is about to retire and another was hired through a grant that’s ending. That leaves only one registered nurse aside from its director, Patty Presser. The health department already had to close earlier during the pandemic because of COVID exposure and not enough staffers to cover the gap. Now, if Presser can’t find nurse replacements in time, she hopes volunteers will step in, though she added they typically stay for only a few weeks.
“I need someone to do immunizations for my community, and you don’t become an immunization nurse in 14 days,” Presser said. “We don’t have the workforce here to deal with this virus, not even right now, and then I’m going to have my best two people go.”
Back in Helena, Harkins said St. Peter’s Health had to close a specialty outpatient clinic that treats chronic diseases for two weeks at the end of September because the entire staff had to quarantine.
Now the hospital is considering having doctors take turns spending a week working from home, so that if another wave of quarantines hits in the hospital, at least one untainted person can be brought back to work. But that won’t help for some specialties, like the hospital’s sole kidney doctor.
Every time Harkins’ phone rings, she said, she takes a breath and hopes it’s not another case that will force a whole division to close.
“Because I think immediately of the hundreds of people that need that service and won’t have it for 14 days,” she said.
Published courtesy of KHN (Kaiser Health News), a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
Mountain States editor Matt Volz contributed to this story.
The Department of Health and Human Services is hoping a $107.2 million-dollar award will help to expand care in rural and underserved communities. The special funds will go out to 310 recipients in 45 states and US territories in an attempt to increase financial and professional support for physicians, faculty, dentists, nurses, and students working in high-need areas.
According to HHS Secretary Alex Azar, “Supporting a strong health workforce is essential to improving health in rural and underserved communities. We’ve seen stark disparities in health and healthcare access contribute to the burden of the COVID-19 pandemic.”
Four nursing education programs will benefit from this award:
The Nurse Faculty Loan Program (NFLP), which provides funds to accredited nursing schools for loans to students in advanced education degree programs who are committed to become nurse faculty.
Scholarships for Disadvantaged Students (SDS), which supports school scholarships for students from disadvantaged backgrounds who are enrolled in a health profession program or nursing program.
The Nurse Anesthetist Traineeship (NAT) Program, designed to increase the number of Certified Registered Nurse Anesthetists (CRNAs), especially those providing care to rural and underserved populations.
The Nurse Education, Practice, Quality and Retention (NEPQR) Interprofessional Collaborative Practice Program (IPCP): Behavioral Health Integration (BHI), which directs funds to develop behavioral health services in nurse-led primary care teams in rural or underserved areas.