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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.