Bill Klaproth (Host):
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On this podcast, we'll talk about the challenges rural
hospitals face. And the solution that can help. So let's talk with Pam
Bradshaw, COO and Becky Fuentes, Chief Nursing Officer, both from Shannon
Medical Center.

 This is Today in Nursing
Leadership. A podcast from the American Organization for Nursing Leadership.
I'm Bill Klaproth. Pam and Becky, welcome.

Pam Bradshaw, DNP, RN, FAONL: Hi, Bill. Thank you so
much for having us.

Becky Fuentes, DNP, RN NE-BC, HACP: Thank you, Bill.

Host: You're welcome. Yeah, it's great to talk with both
of you. So let's jump into this. Pam, let me start with you. Where are we at
right now? Why is healthcare in a rural setting so challenging?

Pam Bradshaw, DNP, RN, FAONL: Thank you, Bill. I think
what we are faced with in a rural setting is truly a lack of resources, and
those resources could be people, it could be supplies. Any number of things can
happen. And then additionally, so many of our rural facilities face financial
challenges that are very difficult to overcome.

I was reading an article just this week that talks about
hundreds of rural healthcare facilities are on the verge of closing, and I
believe it was, in Texas alone, there are 60 that are imminently facing
closure. So in order to be able to serve that population that live in our
outlying areas, we have to figure out a way that we can collaborate, work
together, and provide care to those that don't live in or near a large
healthcare facility.

Host: Yeah, that's very well said. So a lack of
resources and then financial challenges, and you said we really need to work
together and collaborate on this solution. So Becky, what is the solution when
Pam talks about collaboration? Can you expound on that and how that works?

Becky Fuentes, DNP, RN NE-BC, HACP: Absolutely. Some of
the things we're doing here at Shannon are we're reaching out to our rural
facilities and we are meeting with them, going out to their facilities in the
critical access hospitals, the, the clinics. And just trying to form those
partners, partnerships, getting to know, putting faces with names, trying to
set up processes to help get their patients when they need to transfer them to
here to our emergency room or to our inpatient facilities.

We are working with several of them on education. They, some of
them don't have the funding for educational needs, so we have services, our
trauma services, our helicopter services, they go out and provide education to
them. Every quarter we have leadership get togethers where our leadership team
has educational symposiums and different things, and we invite their leaders to
participate with us.

And then we also have lunches for the CEOs and CNOs to meet and
get together with ours and the different hospitals or whatnot to get together
and brainstorm and share ideas so that we have, they can build that network not
only with us, but other regional facilities in the region.

Host: Pam, any thoughts on that? From what Becky was
saying on collaboration, education, support, routine meetings, your thoughts on
that?

Pam Bradshaw, DNP, RN, FAONL: We believe that building
those relationships is the foundation for ensuring safe patient care across our
region. And of course, the patient is always our priority. We also recognize
given fewer resources in those outlying community facilities, they may not even
have a physician in their facility. So we are critical to the care of those
patients and making sure that they are able to get the care that they need in a
timely manner.

Host: And Becky, let me ask you this then. How do you
identify these collaborating partners? What are the steps someone should take
to explore this?

Becky Fuentes, DNP, RN NE-BC, HACP: Part of that is naturally
within our vicinity, we serve 25 counties. A lot of those are in our Regional
Access Council which is part of a region in Texas. And then some of them, like
I said, they're in our 25 counties and we actually, some of them, we have
clinics that are, some of our specialty physicians go out and serve those
clinics.

Some of them reach out to us and just, you know, have said that
they would like to send their patients to us. So we collaborate with them on
how we can work together. Others, we just see a need in their county and a need
that needs to be served, and so we reach out to them and ask them how we can
help with them. Any kind of outreach or education or any kind of clinical
needs.

Host: So it really sounds like it's identifying a
regional partner or partners. Pam, do I have that right?

Pam Bradshaw, DNP, RN, FAONL: Yes, that is absolutely
correct, and in our region, we service as that tertiary referral center. So if
we aren't able to meet their needs, it really is our responsibility to help
them get they do need.

Host: So you mentioned the challenges earlier, Pam, lack
of resources, financial challenges. So by identifying these partnerships,
you're able to cover more ground where one system might be lacking or a
critical access hospital might be lacking. You're able to step in or vice versa
to provide the care that the community needs. Is that correct?

Pam Bradshaw, DNP, RN, FAONL: Absolutely, and I'll give
you a great example of how our collaboration worked during COVID in particular.
As the tertiary care facility, we were very, very busy and there were many days
when we were at or above capacity, but there's nowhere else to go. So we were
able to collaborate with our rural partners, and once we had stabilized those
patients, we had the ability to send the lower acuity patients back out to
their facility.

So it was good for us. And good for all the patients because we
opened up capacity and it supported the rural facility by allowing them to have
patients to provide care for and therefore improve their revenue cycle as well.

Host: That's really interesting. So 25 counties and
you're the main hospital in those 25 counties, is that correct?

Pam Bradshaw, DNP, RN, FAONL: That is correct.

Host: So Pam, did you do the reaching out, or were the
rural hospitals reaching out to you or both ways?

Pam Bradshaw, DNP, RN, FAONL: It actually went both ways
and still does. Almost every day we have a conversation with one of our rural
facilities, but that comes back to building those relationships. And we knew,
in particular during the pandemic, it was going to take all of us in order to
be able to meet the needs of our region.

Not any one organization would've been able to do that
independently. By collaborating together, we kept our patients here locally,
which is good for them and good for their family, and we were able to meet the
needs of more in our community because we compiled our resources in a way that
allowed all of us to function at the highest ability of our capability.

Host: Yeah, that makes sense. And then Becky, if there
was a rural critical access hospital that did have to close, I would imagine
you kind of sprung into action or the other hospitals in the other counties
came together to try to provide care for that community where the hospital is
no longer, is that right?

Becky Fuentes, DNP, RN NE-BC, HACP: Absolutely. We try
to work together and along with our Regional Access Council to try to help pick
up any needs, health needs that are needed in that, for that population.

Host: So it sounds like anybody listening to this
podcast now, if they're in a similar situation that you are, it sounds like
it's just really understanding the region, identifying potential partners and
then reaching out to try to collaborate. Is that right, Becky?

Becky Fuentes, DNP, RN NE-BC, HACP: Yes, I think
communication's the key and staying in communication with each other. I would
agree with Pam when we had the COVID patients and not always able to get the
patients here, but just staying in that constant communication and being able
to share the best practices on how to take care of patients with COVID, cause
it was an ongoing change every single day of how to take care of patients and
just constantly communicating with the nursing staff, the physicians
communicating with each other and being able to share that with each other.

Host: Absolutely. Well, you've both been very successful
at this. So, Pam, let me ask you this. What are, from your seat as COO, what is
the key takeaways someone listening to this podcast should remember?

Pam Bradshaw, DNP, RN, FAONL: I think the most important
thing is you have to go to them. You can't sit at your desk in the tertiary
care facility and understand what they are able to do. So what is their
capability? What type of care can they provide? You have to build those
relationships and trust when it's not a pandemic, so that when something
happens, they know that they can come to you.

And finally you have to remember that it's not what we think
they need, but we need to understand what they think they need and how can we
come together and meet their identified needs, not try and convert them to our
way.

Host: That's well said. So it sounds like do the work
and you need to do the work even beforehand. So you kind of have to establish
these relationships even before they might be needed or they might come in
handy. Right?

Pam Bradshaw, DNP, RN, FAONL: Absolutely.

Host: Yeah. That's really good. And then Becky, you are
the CNO there. So from your point of view, what are the key things to remember?

Becky Fuentes, DNP, RN NE-BC, HACP: I think, number one priority
is communication and build those relationships always. There may be one day
that things didn't go as well as expected and somebody may be upset, but
continue to communicate and try to repair what happened and build that
relationship, fix the processes. Sometimes transfers are not always as smooth
as you want them to be, but you've got to fix the processes and like Pam said,
understand what is going on in the region, not just what's going on here at the
hospital and getting the physicians and the nurses here to understand what's
going on out in the region because it's very different out there. And, getting
everybody to understand that we are here to help each other and be partners.

Host: Yeah. You have to understand what they're going
through not what you think they're going through, right? Well, I want to thank
you both for your time today. One last question. I'm going to ask you each the
same question, and Pam, if you could just wrap this up for us in your own
words, anything you want to add, any final thoughts?

Pam Bradshaw, DNP, RN, FAONL: I think we have to
remember that the rural area in our country is very broad, and if we don't
figure out a way as healthcare providers to deliver the care that's necessary,
we are going to have a significant portion of our population that does not
receive the care that they need, whether it's acutely or preventatively.

Host: Man, makes a lot of sense. And that's very well
put. And Becky, same for you. Anything you'd like to add?

Becky Fuentes, DNP, RN NE-BC, HACP: I think I will just
agree with what Pam said and then just always try to remember that the patients
out there in the rural area, is someone's mom, someone's grandma, someone's
father. So we want them to be treated just like we would want our mother, our father,
to be treated.

Host: Yeah, that's great perspective and a great way to
end. Pam and Becky, thank you so much for your time. We really appreciate it.

Pam Bradshaw, DNP, RN, FAONL: Thank you Bill.

Becky Fuentes, DNP, RN NE-BC, HACP: Thank you.

Host: And once again, that's Pam Bradshaw and Becky
Fuentes. For more information, please visit aonlcom. And if you found this
podcast helpful, please share it on your social channels and check out the full
podcast library for topics of interest to you. This is Today in Nursing
Leadership. Thanks for listening.