Jodi Sutton, Family Nurse Practitioner, on her time in Winner
Week One:
As my first week comes to an end, I cannot be more thankful for this opportunity. The staff has genuinely welcomed us with open arms, and has made every attempt to make sure we get to see and do a variety of different things. Although we have only been here a week, I have come to truly appreciate and admire the versatility and expertise that so many of the team members possess. Not to mention, everyone within the community has been absolutely wonderful. I sincerely love their cheerful manner, their willingness to converse, and the general hospitality.
This week brought about a variety of different things. On Monday, we spent the morning with Dr. McNamara, a maternal fetal medicine doctor, and his team. They educated us on the general basics of fetal ultrasound and further talked us through numerous high risk situations and problems. From there, we went on to have a tour of the hospital, nursing home, clinic, and town. Krystal, our facility’s REHPS coordinator, also helped us move in our belongings the hospital’s supplied loft, and we were even treated to a popcorn treat bar to celebrate nurse’s week.
On Tuesday, I got the unique opportunity to watch the surgeon perform a thoracentesis and paracentesis on a patient with increasing ascites and difficulties breathing. Although I have cared for numerous patients following these procedures, I never had, nor would I have had, the opportunity to see these procedures being performed. This experience truly helped me to comprehend the processes at hand, and gave me an idea of how to best care for these patients in the future. For the rest of this day, I went on to work with an Audiologist from Pierre who was in town doing outreach. He did an excellent job of stepping me through the process of hearing evaluation, general information on diagnostics, and important information I should consider for my future in healthcare.
On Wednesday, I began the day by seeing patients in the clinic with a nurse practitioner. Korie, herself, was simply excellent to work with. She made a note to thoroughly include me her decision making and often encouraged my feedback in developing a plan of care. From there, I helped assist with a wound vac dressing change and then went onto Radiology. Here, we were able to see 2 different types of CT scans being performed and were further shown a variety of recent, interesting scans.
Thursday was probably one of my favorite days this week. It began with me being able to assist and observe in the labor and delivery process of a beautiful little girl. From there, I got to scrub in to witness 2 cataract surgeries and then a D&C. I cannot say enough about the surgical staff and their willingness to explain everything that was occurring.
Finally, on Friday, I spent the day with another nurse practitioner that was responsible for the oversight of the ER, hospital, and nursing home that day. We did get the opportunity to evaluate an ER patient, so that was extremely beneficial given my relatively minimal ER exposure to date.
Overall, I had a great first week here in Winner. I am set to go to the Reservation for a day with one of the doctors this next week. I am definitely looking forward to this and hope the opportunity will continue to expand my understanding of the Native American culture and the challenges they currently face.
Week Two:
This week proved to be a busy, but exciting and educational one. For me, the week began by traveling to the local reservation with one of Winner’s family practice doctors and another medical student. The trip, itself, was uniquely humbling. It definitely brought prespective to the living conditions, financial restraints, and medical barriers that present to those residing in this area. Not to mention, I was extremely excited to practice my assessment skills on the numerous obstetric patients Dr. Henderson sees. This was something that I had limited exposure to within my studies this past semester, and thus it provided a great advantage to me when I enter these OB rotations this fall.
On Tuesday, we spent the morning interacting and teaching the community’s 2nd grade students about sunscreen and summer safety. With help from the hospital staff, we were able to integrate our community project into this pre-planned field trip. The kids loved interacting with us and were eager to tell us of their summer plans and what they do to stay safe. At the end of our presentation, we gave each student a little gift bag that contained a pair of sunglasses, packets of sunscreen, and of course, a little candy! The bags were definitely a hit! We joked that they were almost invisible with their surgical caps, masks, and sunglasses! J
The rest of my day Tuesday was spent with Dr. Anderson – an OBGYN from Mitchell, SD that does outreach in Winner and helps with some of the high risk OB patients. During this rotation, I got to assist and observe a few advanced clinical procedures that I have never done before. Not only did Dr. Anderson explain everything that was going on, but he made sure I got to visualize what he was doing throughout the exam. Once again, this opportunity was an exciting and beneficial one for me.
On Wednesday morning, I traveled to Gregory, SD to meet up with a Home Health nurse that was doing home visits across the area. Amber, RN, did a great job explaining the details and duties of her job, and further introducing me to the various patients and their clinical problems. This experience helped me better understand what qualifies a patient for home health services, the process to assessment, and the special equipment that can be used to effectively monitor those with chronic illness. In addition, it helped by observe, first hand, how important it is to consider a patient’s environment, resources, and support systems when looking to develop a plan of care. Upon returning to Winner, I assisted one of the PA’s in the ER. This proved to be a rather exhilarting experience, as we treated numerous patients for chest pain in a very short period of time. To date, I have never been on the front end of treating individuals with suspected heart attacks. So, having the opportunity to witness and interact with as many as I did was truly exceptional.
On Thursday, Elizabeth and I both spent some time working in the pharmacy. Here, they had us stocking meds, filling orders, and even learning the sterile procedures to mixing IV antibiotics. To be completely honest, I did not know that so much was involved in the prepartion of these IV solutions. Working in a larger healthcare facility now, I have come accustom to having access to pre-mixed antibiotics that typically come from the company. Yet, in Winner, they do not have the patient census to order pre-mixed solutions in bulk and thus the pharmacy staff, and sometimes even the charge nurses, are responsible for preparing these. Overall, I found this very interesting and I appreciated the opportunity to experiment in the IV room.
From there, I spent some time with the hospital’s Physical Therapist. And, eventually, we both went over to help prepare all the Nursing Home residents for their first ever Adult Prom! Delegated to hair and make-up, the PT and myself made our rounds through the halls and dolled up all the ladies! To say I enjoyed this, would be an understatement. I will never forget the smiles on some of the resident’s faces and the general elation for this event. The administration did a wonderful job planning the whole thing, and even included a grand march, photos, a beverage bar, and a local musician to provide some good ol’ polka music! Overall, it was a wonderful event and I was so happy I was able to help with it all.
Finally, on Friday, I spent some time with one of the hospital’s CRNAs doing epidural steriod injections for individuals with chronic back pain. Al was a wonderful teacher, and even let me get my hands dirty! Although we both realized this was not be something I would be physically doing in my future, Al made sure I understood the entire process so that when I was considering this for my patients later on I could correctly assess the problem and refer them to the proper resources.
As you can see, I have definitely found benefit and enjoyment from this program. I look for to the upcoming week and all it brings!
Week Three:
This week began with the opportunity to observe colonoscopies in Surgery. Although this is something most individuals probably don’t look forward to (in which I don’t blame them), it was rather exciting for me. Once again, it was a procedure I had not witnessed before and it was an opportunity for me to learn and observe the various things the surgeon might be looking for. Knowing that a large part of my upcoming job as an NP is to serve as an advocate for these screening procedures, it was nice to gain some experience in regards to the entire process. It would be my hope, that this experience would aid me in my future recommendations and guidance towards screening procedures such as this.
The following day, I spent the majority of the day doing rounds in the Nursing Home with one of the physicians. This was definitely a pleasant and conducive experience. I learned numerous things about care planning and the different situations that qualify someone for nursing home care. In addition, I got to partake in a small family conference in which we discussed the various legal rights of the family and patient. Though these processes may appear tedious and tiresome, they will be important aspects for me to understand in the future. In today’s healthcare practice, it has become essential that providers understand the various aspects of Medicare, billing, reimbursement, and legal obligations. Knowing this, I can truly appreciate the opportunity to discuss and witness these things first hand.
On Wednesday, I spent the day with Dr. Mahrous from North Central Heart in Sioux Falls. Lucky enough for this community, Dr. Mahrous comes at least once a month to see patients, facilitate cardiac stress testing, and evaluate echocardiograms. Overall, I was super impressed with Dr. Mahrous. I sincerely appreciated his willingness to guide and teach myself and another medical student, and even admit that he may have made Cardiology a little less intimidating for me! I know, that without this REHPS experience, I would not have had the opportunity to be so hands-on with this patient population so early in my education.
With the little downtime I had this week, I usually spent it following and collaborating with one of the Nurse Practitioners. Korie has been absolutely phenomenal and has truly taken me under her wing. I have gotten to see a variety of different patients within the clinic, evaluate a patient with chest pain in the ER, and even witness my first laceration repair. Not to mention, she let me perform the gynecological screening and testing on a patient. I guess you know what they say – practice makes perfect! I have appreciated her willingness to facilitate my experience, and especially when my rotations in radiology and laboratory weren’t as eventful.
To wrap up the week, Elizabeth and I got to observe dental surgeries with Dr. Lashley from North Platte, NE. During this day, we got to witness the process to nasal intubation, the different equipment needed to complete these procedures, and received specific guidance and teaching instructions in which we could incorporate for our patients. I truly appreciated this distinct look at dental care, and know that this is not something I would have gotten to do in my typical NP coursework. Yet, all the more, dental health is an important part of a patient’s health status and something that I cannot forget as a provider.
Over the weekend, I got to assist one of the Hospice nurses in locating, building, and transporting a bed for a deserving patient. We also made the trip to Gregory to delivery supplies and check on a patient who remains on respite care. On Sunday, Elizabeth and I were lucky enough to get a personal tour of the Ambulance barn and Fire hall from one of my family members. Not only did we get to see and fiddle with some of the equipment they frequently use, but I got the personal opportunity to practice some intubation techniques on one of the house’s practice mannequins.
Once again, I cannot even begin to voice how incredibly impressed I am with both the local and outreach providers. They have truly been some of the best teachers I have come in contact with to date. I have appreciated their guidance throughout this experience and look forward to what the last week will bring!
Week Four:
The final week of my REHPS experience began with the chance to work with Chris, one of the PAs at Winner Regional. During my time spent with Chris, I got the unique opportunity to observe the initial evaluation of a suspected stroke patient. This was definitely another first for me. As a nurse, I have many times been on the opposite side of a stroke recovery, but it was nice to first-handedly see what steps are needed during this crucial evaluation period. Furthermore, it was interesting to see the entire process that is required to subsequently transfer a patient to higher level of care. Overall, I genuinely appreciated Chris’ extensively knowledge base and his general willingness to teach and discuss the scenario extensively with me.
Later on in the week, I got to work alongside Dr. Scheer – an Orthopedic Surgeon from Colorado. A few times a month Dr. Scheer will actually come to Winner to see patients in the outpatient setting and to further perform general orthopedic procedures. Lucky for me, I got the extraordinary opportunity to actually observe one of his total knee replacement surgeries! Although I was worried the whole thing might be a little too gory for me (I mean, come on!), I found myself completely intrigued with the entire process and simply fascinated with what we can accomplish with modern medicine! Not to mention, I specifically appreciated the input and expertise of the medical device representative. This kind gentleman actually took the time to explain what the surgeon was doing, what tools they were using, and the overall process to completing the procedure. Overall, I can definitely say this was a great experience and it has definitely impacted my view of Orthopedics!
To end the week, Elizabeth and I gave a presentation to various hospital staff members, the local newspaper, and Cheri (the REHPS coordinator). During our presentation we highlighted a number of different things that we did beyond our time at the hospital. Some of these included: baseball games, bowling with the Med Students, roping competitions, country dances, the drive-in theatre, and so much more! Overall, the presentation was a great way to reflect on our various experiences and to thank the numerous individuals that provided these remarkable opportunities to us!
As stated before, I cannot even begin to thank all the wonderful people in Winner for providing Elizabeth and I with such an amazing experience! I will admit, I didn’t know what to fully expect when I began the REHPS program. Yet, the people, the community, and the general opportunities have simply blown me away! This was definitely a once in a life time experience for me, and I have so many take-aways that will definitely be integrated into my future practice. Although I am not sure what is in store for me following graduation, I do know that this program has made me look at rural medicine in a whole new light and has made the transition a true option for me!