Enlighten Me

Eddie Sanchez (00:07):
Hey, this is Eddie Sanchez.

Rodney Crouther (00:08):
And this is Rodney Crouther, and welcome to Enlighten Me. Hey Eddie, you know it's coming in to cold and flu season now we're finally getting some cool weather. When's the last time you've been to the doctor, man?

Eddie Sanchez (00:20):
I'll be honest with you, Rodney, the only time I go to the doctor is when I'm basically dying, so it's been a minute since I've gone. I should definitely be going in to get more checkups. But yeah, it's been a bit.

Rodney Crouther (00:30):
Yeah, I think that's normal. Most of us go when something's wrong. It's like no one is thinking, oh, I just got to get to the doctor. It's August or November or whatever. But it had me thinking about who actually provides healthcare at the grassroots level. So I thought maybe this month we should talk to nurses.

Eddie Sanchez (00:48):
That's interesting because last month we were talking about emotional health and physical health is just as important, so I'm curious, who did you talk to and what did you talk to them about?

Rodney Crouther (00:57):
Well, to start off, I was thinking nursing in the last three years has probably changed a bit and the way we approach community health has changed a bit, coming out of the pandemic. I wanted to find someone who could tell me how nurses have fared coming out of the pandemic. They were on the front lines as much as anybody, so I went to our nursing program and talked to Dr. Stacey Cropley.

Stacey Cropley (01:18):
My name is Dr. Stacey Cropley and I am a nurse leader. I work for the graduate program at Texas State University, teaching in the leadership and administration program.

Speaker 4 (01:29):
Mr. Ellis...

Rodney Crouther (01:33):
Nursing, ever since the start of the pandemic, that was really a headline everywhere that nurses were on the front lines, nurses were taking care of people who were sick and trying to stay healthy themselves. What's it been like in the three years since the pandemic? Just broad picture, what's the state of nursing today?

Stacey Cropley (01:55):
So 76% of nurses experienced burnout, and the pandemic just highlighted that with increased stress levels, anxiety, depression, suicidal ideation, and I think nurses are at this point in recovery mode. We're trying to find new ways of coping with some of the stressors that we have in the environment with the increased patient workload, acuities and decreased resources.

Rodney Crouther (02:23):
And just a footnote, patient acuity is just how medical providers refer to how severely ill a person is, how much acute care they need.

Stacey Cropley (02:31):
Nurses right now are struggling, and this impacts nursing education as well in terms of being able to find preceptors that are positive and willing to share their knowledge and expertise.

Rodney Crouther (02:47):
Actually, let's step back a bit. Yeah. What's your nursing story? How did you get into nursing?

Stacey Cropley (02:52):
Oh gosh. Nursing is my second career.

Rodney Crouther (02:56):
Really?

Stacey Cropley (02:57):
Yes. I started off in psychology. I went as far as a master's program in counseling psychology, and then I had my very first rotation on a psych unit, and I was watching the nurses and felt like, wow, the nurses really have more of a holistic approach. They're really able to not only address the patients' physical needs, but also their mental health needs, their spiritual needs, just the overall picture. And so I dropped out of that program and enrolled in a nursing program.

Rodney Crouther (03:33):
Wow. I really feel that. I've actually said for a while, I love my doctor, but I really love my nurses. That's who actually does a lot of the hands-on patient care, right?

Stacey Cropley (03:42):
Yes. Yes, they absolutely do. The nurse is the face that you see the majority of the time, whether you are in a hospital or in a clinic. And yeah, nurses really have a special role in healthcare.

Rodney Crouther (03:54):
We talk a lot about community-based healthcare is nationally when we talk about how we deliver healthcare to people. Now with that many nurses experiencing burnout, how's that affected community health?

Stacey Cropley (04:08):
So that's a real problem. We're seeing shortages across the continuum as far as the nursing staff that's available. So we have a shortage of nurses. The United States Bureau of Statistics is projecting that year over year for the next decade, we're going to have a shortage of 203,000 nurses.

Eddie Sanchez (04:31):
That is a huge number. Rodney, did she explain what that meant for our healthcare system in our society?

Rodney Crouther (04:35):
Yeah, it shook me too. That's scary. And yes, she did have some thoughts on what that implies for us going forward.

Stacey Cropley (04:42):
Which is significant and that impacts patient care and the ability to provide care in any setting.

Rodney Crouther (04:50):
Well, so if you're a young person who thinks you might be interested in healthcare, that's a career field that's going to grow or have opportunities.

Stacey Cropley (04:57):
That is definitely a career field that's going to have openings and opportunities for nurses that have energy and enthusiasm to step in and really make a difference.

Rodney Crouther (05:08):
Could you tell me a little bit about your research background?

Stacey Cropley (05:10):
Sure. I have done research related to patient advocacy, resiliency, and burnout, how it impacts students in terms of their ability to navigate their education, especially in the post-COVID and pre-COVID world. Yeah.

Rodney Crouther (05:29):
How do you address burnout with nurses?

Stacey Cropley (05:33):
That's a very complex question. We have to think systems-wise in terms of the resources that are available for that individual to not only be supported in their workload, but also be supported with their emotional coping strategies. So we have to take a systems approach when we look at supporting students and nurses in the workplace with providing opportunities for resilience building.

Rodney Crouther (06:01):
OK. What's resilience building?

Stacey Cropley (06:03):
So it would be providing strategies and education and resources for nurses to be able to emotionally grow and develop and handle stress in positive ways. We talk about so many times where nurses or health professionals suffer with stress and may choose negative coping strategies such as substance use, which then can lead to substance abuse and cause further problems. And so we really want to be able to provide nurses and nursing students and healthcare workers with skills and strategies to help them grow their resilience.

Eddie Sanchez (06:43):
Did she talk about these strategies that students and nurses can benefit from?

Rodney Crouther (06:47):
Yeah, she had several she elaborated on.

Stacey Cropley (06:48):
So that might include mindfulness. It might include more self-care opportunities such as engaging in physical activities that promote that sense of well-being and enhancing support structures.

Rodney Crouther (07:04):
Has that changed the way that you talk to even prospective students coming in?

Stacey Cropley (07:08):
Absolutely. The students that are coming in need to be prepared to address some of the stressors that come with working in the healthcare field. So large patient assignments, increased patient acuities, doing more with less, and so students need to be equipped early with positive healthy strategies for managing stress.

Eddie Sanchez (07:32):
Did Dr. Cropley talk about what drew her into researching nurse resiliency?

Rodney Crouther (07:36):
Yeah, and you'll see this is a running theme through the episode. Nurses tend to have very personal stories of how they got into their field.

Stacey Cropley (07:44):
I think over my career, I've seen nurses do so much and incorporate so much stress into, I mean, I just remember myself on the floor and not having time to take a lunch break, not having time to just sit down for a moment and—

Rodney Crouther (08:04):
Just going from patient to patient like that.

Stacey Cropley (08:06):
Yes, it was just a constant rotation, patient to patient. And I remember how I felt as a young person not being able to have just a moment to collect myself. And I think that as we've seen an increase in patient acuities and complexity, our nurses more and more need that time to sit and reflect so that they can critically think, so that they can address their own burnout and stress.

Rodney Crouther (08:35):
Take us into a little bit of what it is day-to-day for nurses, even in just like a family doctor's office, let alone something like an ER.

Stacey Cropley (08:43):
Sure. So let's look at the inpatient setting first because I think most of our nurses that are graduating will be going into that acute care setting first. Normally when a nurse hits the floor, they hit the floor running, they get their patient assignment, they get report on that patient, and they may have anywhere from four to six or seven patients depending on their unit and the type of patients' complexity that they have. They'll get that report and then they'll start their assessments and their medication administration, and it's just continual rounding and communication, communicating with the healthcare team and the physician and monitoring that patient and providing interventions for that patient. So the nurse in the acute care setting really has very few opportunities to sit down.

Rodney Crouther (09:43):
What are really the pressures there for nurses to deliver care under those circumstances?

Stacey Cropley (09:47):
So the pressures are you have so many patients that are assigned to you in just a little bit of time, and you have to meet all of the quality benchmarks. So every facility, every organization is trying to capture quality outcomes because it's connected to reimbursement dollars. And with most hospital organizations only having a 3% margin—

Rodney Crouther (10:11):
Just a 3% margin?

Stacey Cropley (10:12):
Just a 3% margin, it makes it extremely critical, crucial for that organization to capture reimbursement wherever they can. And so nurses are having to document hourly rounding. They're having to document the patient's full skin condition. They're having to document all of these particulars that hit those quality indicators, and it's very difficult.

Rodney Crouther (10:39):
Well, let's talk about some of the good stuff. What was your best day as a nurse?

Stacey Cropley (10:42):
My best days as a nurse were when I felt like I could really help that patient, when I could connect, had the time to connect with that patient and deliver patient-centered care and meet their unique needs as an individual. Because patients aren't widgets. Every patient is different. They have different needs, and it's really important for nurses to have the time to be able to connect in that way.

Eddie Sanchez (11:06):
So it seems like there's opportunity to improve the healthcare system.

Rodney Crouther (11:10):
Yeah, absolutely. As challenging as it was the nursing leaders came up with some good ideas for making the system better and more resilient.

Eddie Sanchez (11:18):
Did Dr. Cropley talk about how the system could be improved?

Rodney Crouther (11:21):
Yeah, she had some good ideas. I'll let her elaborate.

Stacey Cropley (11:24):
I would love to see management implement programming that really does help to support their staff. So that could be counseling resources, more counseling resources, more peer support programming where nurses and staff can take advantage of having someone who understands the shoes they're walking in and be able to connect with that person. The ability to take a moment to have a break where they can meditate or just collect their thoughts and feelings. That's a start.

Rodney Crouther (11:58):
Yeah. And what does that hour-to-hour day look like? I think when I grew up, there were always stories of people in healthcare starting out, having to work insanely long rotation shifts where they're on their feet for 18 hours at a stretch or longer. Is that something that really happens in healthcare today still?

Stacey Cropley (12:15):
Well, it sure did. Back in the day, in the ’90s and the early 2000s, that was a real thing with 12-hour shifts and then potential mandatory overtime. But in Texas, we now have protections against mandatory overtime and certain conditions need to be met for a nurse to be mandated to stay an additional shift or over their scheduled time. But nurses do have a presence in policymaking and policy advocacy to make changes. It's just a matter of putting your voice out there and making yourself heard.

Rodney Crouther (12:50):
So what do you say to nursing students to get them fired up about the job now?

Stacey Cropley (12:55):
I think connecting them with their passion, so everybody brings a passion or something that they really want to see in healthcare. Every single student that comes into the program is fired up about something. My mom got really great care when she was going through her chemotherapy.

Rodney Crouther (13:11):
I was about to ask that. How many students come in because they've had a great interaction with a nurse?

Stacey Cropley (13:16):
Most of them do. Most of them talk about, oh, this person was life-changing for me. This person really transformed how I think about healthcare and my own health, and I want to make a difference too. And they bring that passion. They're all fired up about it.

Rodney Crouther (13:32):
Well, you can relate to that. Like you said, you came to nursing after seeing what nurses do firsthand.

Stacey Cropley (13:37):
Exactly. And I think we need to keep that spark alive in our students. We need to really help them to focus on their passion and be able to actualize that through their education and their training.

Eddie Sanchez (13:51):
How is caring for our caregivers something that's new? It seems like a concept that should have been implemented a long time ago.

Rodney Crouther (13:58):
It seems obvious, but that just hasn't been the way the system evolved.

Stacey Cropley (14:02):
I think for a long time, employees have always had, or most employees have had access to employee assistance programs in their employment settings, but they weren't utilized specifically to address resiliency and burnout. And I think that by connecting employee assistance programs to offer additional services specifically related to the impacts of working in a very stressful environment and the impact that has can benefit employees. So it's really kind of taking that concept and branching that out a little bit.

Rodney Crouther (14:39):
What can we all do to help our nurses?

Stacey Cropley (14:42):
Send them lots of love, be the voice of change. If you are a patient in a facility, you see your nurse running and running and give them a positive word and give them a compliment. Talk to their manager and say, "Hey, my nurse was really great. I would really like to see more of this in this facility."

Rodney Crouther (15:06):
Now, I guess if there was a silver lining from the pandemic, it was that people publicly started coming out and showing a lot of love and support to our nurses.

Stacey Cropley (15:13):
It definitely brought to light the issue that was just boiling under the surface, and it brought it out in a very public way where consumers could see, wow, our nurses are doing so much working long shifts with difficulties in accessing just the basic supplies they needed to do their everyday jobs.

Rodney Crouther (15:31):
And I do remember the times that people were lining up outside of hospitals at shift changes just to hold up signs and cheer.

Stacey Cropley (15:38):
And that is very special for nurses to have that recognition that, yes, you're doing an important job and you are making a difference and we see you. We see you.

Eddie Sanchez (15:53):
So thanks for having that conversation. Rodney, like you mentioned during the interview, during the height of the pandemic, we really banded around our healthcare workers and our nurses. Unfortunately, it seems like we've kind of moved away from that,

Rodney Crouther (16:08):
But talking to Dr. Cropley, it got me thinking when she talks about community care and providing healthcare for a community that's more than just nurses or doctors or hospitals, that there's a lot of other ways and a lot of other specialists that people contact when they're taking care of their health and a lot of other things than COVID or respiratory things to take care of.

Eddie Sanchez (16:31):
And oftentimes we really don't think about all the background players in healthcare work. So did you talk to anybody that kind of serves that purpose?

Rodney Crouther (16:39):
Yes, actually I went to our Department of Physical Therapy and I talked to Dr. Damian Rodriguez and Dr. Angela Rich.

Angela Rich (16:48):
My name is Dr. Angela Rich and I am an associate clinical professor here at Texas State University, and I'm also the clinic director for the Physical Therapy Clinic.

Damian Rodriguez (16:58):
And I'm Damian Rodriguez. I'm a clinical assistant professor. I teach in the neuroscience sequence here, but I am a clinical instructor for the clinic as well.

Rodney Crouther (17:06):
Tell us about the physical therapy clinics at our Texas State Round Rock Campus.

Angela Rich (17:11):
Yeah, it's a really cool thing because number one, most physical therapy programs do not have a fully functional clinic. Only about 10% of the programs in the nation have that.

Rodney Crouther (17:20):
Oh, wow.

Angela Rich (17:21):
Yeah, so we have what we call our low-fee clinic, and that is actually a class for the students when they're in their second year, they see patients with the clinical faculty. Our community access clinic is actually our pro bono clinic.

Damian Rodriguez (17:36):
What was happening was we have that low-fee clinic where patients are able to come in and work with students for a very reduced fee compared to what insurance coverage would be.

Rodney Crouther (17:45):
Just another note, when they refer to students, they're talking about doctoral students. So these are pretty advanced students that are serving patients.

Damian Rodriguez (17:51):
But we were noticing that we had a lot of people who just couldn't even afford to come to that kind of clinic, whether they be underinsured, uninsured, or just didn't have the funds to pay for that. So about five years ago, I believe we started the community access clinic, which was where individuals who are uninsured or just don't have the funds to pay for our cash-based clinic can get free physical therapy. Students still treat them, but they're supervised by us.

Eddie Sanchez (18:16):
I'm curious, how did the clinic operate during the pandemic considering its focus primarily on physical therapy?

Rodney Crouther (18:22):
Yeah, that's what I wanted to hear from them. Because you think physical therapy, that's very hands-on and everything in those first few months of the pandemic was about being hands-off.

Angela Rich (18:30):
Yeah, absolutely. It changed for us. I mean obviously, we closed the clinic for four months, four months. We had to have the PT program up and running first, and once we got that up and running, we were like, OK, and we ready to open the clinic again. We had initially talked about, or had just started doing some telehealth visits with our patients, individuals who maybe could not make it in the clinic or the type of care they needed, they could just have, we could address their home program through telehealth. Once everything shut down, the telehealth program, Damian brought it forward to full force. I'll let him talk about that.

Damian Rodriguez (19:05):
Our telehealth clinic started mainly because we have a lot of patients who come to our clinic who rely on this as their only form of — some of them their only form of physical activity. And so and our students weren't having access to these patients, and so it is invaluable experience for our students to have that. So we created a telehealth program where a faculty member and a student could zoom with a patient in their home and their family member and they could take them through what we perceive to be safe exercises for them to do. We have a very different population than I think what most people think of physical therapy really. So I'm a neuro-therapist and so I work in a hospital setting. I work in the ICU and I work in the hospital and I work with people with stroke and brain injury and spinal cord injury. Those are my specialties. And so a big portion of our clinic being low-fee and not taking insurance is those individuals who have been kicked out by insurance, they say, "You've reached the end of your benefits. You can't have physical therapy anymore." And so we see a lot of those patients who would be unable to get physical therapy and some of them, even any physical activity anywhere else because of the severity of their stroke or their spinal cord injury.

Rodney Crouther (20:16):
And yet it's a good point that our clinics there at the Round Rock Campus are providing a service and really filling a gap in the healthcare network in the community.

Angela Rich (20:23):
I'd say that we are a huge community-based clinic providing services that these individuals would not have if we weren't here. Obviously industries have to make money. Of course they have to pay for their therapists, and when your benefits are up, your benefits are up. And especially individuals who have these long-term strokes, traumatic brain injury, they really don't have the resources to pay cash either. So I do feel that we provide an excellent community service for the area and beyond really.

Damian Rodriguez (20:55):
Yeah, we have a lot of our patients coming from South Austin. I have an individual now who comes all the way from I think Circle C to come up and get their therapy because we are affordable and we are what they can afford, and they would be otherwise unable to get therapy anywhere else. And so it's become a really good resource for even further, not even just the Round Rock area, kind of this whole Austin metroplex area.

Eddie Sanchez (21:18):
So realistically, how viable is telehealth when it comes to physical therapy?

Angela Rich (21:22):
Telehealth really I think was primarily made for individuals who have orthopedic type of issues, which is part of our clinic, part of the clients that we see. But as Damian has just talked about, our greatest percentage is those who are neurologically involved. So it was interesting as far as trying to morph sessions to be able to fit with that type of clientele as well. The other thing about the pandemic is that, as I spoke about previously, is this is a class for our students, so all of a sudden the ability to grade them seeing patients was taken away from us. We had to be creative on how they would be able to finish their class and receive a grade in credit as opposed to taking incomplete and trying to figure out how we would do that later.

Rodney Crouther (22:06):
Tell me a little bit about your clients. Who comes to the clinic? Is it just older people? Is it people who've been in accidents? Is it workers' comp cases?

Angela Rich (22:14):
We see all types of clients from just, we talked about the actual area where neurological versus orthopedic, but we also have, we see pediatrics, we have a pediatric, obviously faculty who specialize in pediatrics. I specialize in sports medicine, so I see athletes, I have Olympians that I see in here. Really we see pretty much anything that you would think of that you would see in physical therapy clinic we see in this clinic. So it's all ages, all types of conditions. We have some wound care patients that we see in here. So pretty much it works like any physical therapy clinic would work, and we like that because it's great for the students to have that type of experience prior to going out. One thing about Texas State that we're known from is the fact because we have this clinic, our students have a leg up, as we would say, when they're going out for their year rotation, they've been here with us and this is a safe place for them. This is a great place for them to make mistakes and have successes under our supervision so we can do these little things that we need to do to have them prepared.

Rodney Crouther (23:15):
Just a little bit about the two of you. How did each of you come to the profession of physical therapy? What are your backgrounds?

Damian Rodriguez (23:22):
So I was, it's pretty stereotypical, I was a football player in high school and then I injured my back. I herniated a few discs and had a lot of pain. And so I actually went to physical therapy. That's how I got introduced to it. And I actually was going to quit physical therapy. I didn't, no offense to Angela, I didn't enjoy orthopedics. It wasn't for me. And I actually had an uncle who said, you know what? You seem like a hospital guy. I feel like you're a different kind of physical therapist. And so I worked in a hospital before I actually went to physical therapy school and that's where I met people who had had strokes and brain injuries and spinal cord injuries, and I was doing wound care. And then that's where I was like, oh, this is what I like. I still liked physical therapy. I liked the idea of helping someone. I just didn't enjoy the same things that Angela does.

Angela Rich (24:09):
So originally I was an athletic trainer. So my initial, what brought me to Texas is I took a job with the University of Texas, is I traveled with volleyball and track and field, and then I continued on outside and loved rehab. So I stepped out of the University of Texas setting and stepped into a sports medicine clinic. I worked right next to physical therapists. And what happened at that time, there was no differentiating factor between athletic trainers and physical therapists. And all of a sudden there was. A physical therapy board stepped up and basically changed how athletic trainers could practice. And we actually were degraded to the fact that we were techs. So at that point I said, OK, so I went to physical therapy school, and Damian and I are both graduates from this program.

Rodney Crouther (24:57):
Oh, awesome. And I think that's the way a lot of people who haven't been through it, their understanding of physical therapy I think is through, if it's not through a family member, it's through sports fandom and my favorite player's out. How long are they going to be on the injured reserve? When are they going to be back on the field? How big of a percentage of your clientele is from sports injuries? I know we have a ton of youth sports here in Central Texas.

Angela Rich (25:20):
I would say that probably maybe about a quarter of our patients are from sports types of injuries. But you have to remember, there's not just athletes who are school athletes or whatever, we're all recreational athletes. And so as much of our population are individuals who just love being active, whether it's running, playing tennis, playing pickleball, or doing those types of things, it keeps us busy. As far as, the thing that's interesting about orthopedics is that with Dr. Damian, we can see those patients for a year, two years, five years with orthopedics. They're in and out, which is what our goal is to do. So we usually have a turnover constantly of orthopedic patients, which is great for our students because they see a large variety of orthopedic-type situations.

Eddie Sanchez (26:04):
Considering that we've moved past the pandemic a bit, is there anything that they're continuing to do or that they do differently now?

Rodney Crouther (26:11):
Yeah, I think they took a lot of the changes they made to cope with the pandemic and saw how they could make their care more efficient going forward.

Damian Rodriguez (26:19):
Even when we returned, we kept up our telehealth program, and this is, I work in a hospital and I work with oncology patients a lot. So people who have cancer, and we had a lot of people going through active cancer treatment during the pandemic, and with an immunocompromised state as you're getting chemotherapy, anything is dangerous to you. So those people did not feel comfortable coming in for, I think we kept the telehealth, it was kind of being utilized robustly for a year after we even came back into 2022. Some of that has laxed up a little bit, so we don't use it as much, but we had it there for patients who felt uncomfortable. And again, I work with people with spinal cord injury, so the higher your spinal cord injury, the less breathing capability you have just because the muscles become paralyzed. And so we had people who with spinal cord who said, I just can't come.

(27:05):
If I get COVID, I will be significantly affected. And really I think the main thing that's changed now is — not that we weren't so keen — but if someone is sniffles or anything, mask. Obviously the world is different, than it was before, but I think we're a little bit more aware of those things now, and we tended to be kind of strict about "you need to come to therapy, therapy's good for you." Now it's like, "You should stay home. We don't need you here actually." Or I've had people who have gotten COVID and then subsequently developed a rare autoimmune disease. And so we can't say that COVID caused it, but they got COVID and three weeks later they had this autoimmune disease. And so that person came to our clinic and said, "what do you do for this?" And I said, "I've never heard of your disease, so we need to figure it out together." So we're going on this journey together. So it's been one, a good teaching opportunity for the students, but a great learning opportunity for all of us to say these are things that are coming up to these new viruses.

Rodney Crouther (28:02):
Because physical therapy is so hands-on, and I know we talk a lot about being post-pandemic, but it's obviously still out there. Has that affected recruitment for students or the type of students that you have coming into the program?

Damian Rodriguez (28:17):
I don't think it's the aspect of not wanting to be close to a person. I think it's just how everything changed, the way education changed, the way we got used to doing things, and going and people like flexibility now. We went into this Zoom world and everything, and so they got used to doing education on Zoom, and it's a rigorous program to go into physical therapy school, and people, I think what we're seeing is potentially people just want more flexibility in the idea of what we're doing, and that has actually created, or not created, it's increased a lot the number of hybrid programs we have where you have a lot of on-camera like Zoom classes and you only come in to do some of the hands-on stuff every now and then. And so we've seen the creation a lot more of those. That's what I've noticed at least.

Rodney Crouther (29:00):
OK, so you handle what you can handle on remotely and save your in-person face-to-face time for things that have to be done that way.

Angela Rich (29:13):
It creates a big controversy in our profession because what we do when we handle people, that's through repetition. Obviously you're not going to get the repetition if you're not face-to-face with your students every single day. If you do majority of your education didactically and you only spend eight hours three days a month with them, then they're not going to have the repetition or the supervision. They need to really refine those skills.

Eddie Sanchez (29:42):
We will be right back after this message. So what I found was really interesting was the fact that they provided services to so many of our under-serviced community members. And that's kind of an aspect that we really don't consider, all these healthcare workers in the different fields and different areas that provide care to populations we really don't consider.

Rodney Crouther (30:13):
And that got me thinking too, who else we could talk to? And I tapped into our nursing alumni network and found out that school nurses are actually critical to providing care to a lot of underserved people as well as just anybody that's got a kid in school or if you are a kid in school.

Eddie Sanchez (30:31):
Yeah, I can tell you that my daughters went to the school nurses so many times, and again, that's a healthcare worker that we really don't consider often because of how quiet their role is almost.

Rodney Crouther (30:43):
You just kind of assume they're always there. But I found out there's a whole world of issues going on with school nurses, positive and challenges there that they face on a day-to-day basis. And I think that was kind of under the radar back in 2020 when we were talking about ERs and intensive care units more.

Eddie Sanchez (31:02):
So who did you end up talking to?

Rodney Crouther (31:04):
I talked to one of our Bobcat master's degree graduates.

Mindy Petty (31:07):
My name is Mindy Petty. I'm the director of health services for Georgetown ISD.

Rodney Crouther (31:11):
She got her master's in nursing leadership from our Round Rock Campus. OK. What does the director of health services do?

Mindy Petty (31:25):
Well, that encompasses a lot. So we have 10 elementaries, we have four middle schools, two high schools, an alternative school, and those all have campus nurses. So I'm kind of in over the campus nurses, we implement policy procedure, they come to me for anything they need to talk about or have thought partners with.

Rodney Crouther (31:49):
We all know schools in Texas and everywhere else shut down during the pandemic, but what's it been like after the pandemic as students started coming back to campus? What was that experience like for school nurses? How did their jobs change?

Mindy Petty (32:02):
Well, during the pandemic they worked two clinics at a well clinic and a sick clinic. So they had to be in two different places at the same time. So they were running back and forth post-pandemic. We went back to I guess the new normal is what we'd call it. They have just one clinic now and everyone comes to that clinic. So if you have daily medications, you come in, and then if you're sick you come in. So we just kind of went back to what we did before the pandemic. I think for a while it was kind of kids were a little afraid to come to the clinic because of the pandemic had happened and now they're definitely coming back. Nurses are seeing a huge increase in visits. Some of our clinics average 50 visits a day.

Rodney Crouther (32:44):
Wow.

Mindy Petty (32:45):
One nurse, 50 visits a day.

Rodney Crouther (32:47):
That's a lot of weight on a single nurse.

Mindy Petty (32:49):
It is a lot of weight. They manage it very well though I'm very proud of them. Sometimes the nurses are the only medical care that some students get. That's their primary care person.

Rodney Crouther (33:01):
How did you get into nursing?

Mindy Petty (33:02):
I have been a nurse going on 24 years. I got really sick when I was a kid, not a kid. I was a teenager and the nurses took super good care of me, and that kind of made me want to go into nursing. I've always taken care of people. That's just kind of how I am. And so I went to nursing school at the University of New Mexico, and I graduated with my bachelor's degree and then I went straight into the ICU.

Rodney Crouther (33:29):
Wow. So that's like the front lines of healthcare.

Mindy Petty (33:32):
So I worked in a trauma unit, I worked in a burn unit, medical ICU, and then I started doing emergency department.

Eddie Sanchez (33:40):
How did she make the jump from ER nursing into school nursing?

Rodney Crouther (33:44):
It's like all of our nursing stories, man. I tell you, it's a very personal story. She can explain, it fit her lifestyle.

Mindy Petty (33:52):
So I decided it would be a great idea to have my kids all two years apart.

Rodney Crouther (33:58):
So

Mindy Petty (34:00):
I had my son and my two daughters and I worked shift work. So if shift work, we worked 12 hours. So there was four days sometimes when my kids wouldn't see me. And one of the nurses in the ER was a school nurse here in Georgetown ISD. And she was like, "Mindy, you really should think about doing this." And I was like, that's just not for me. I'm an ER nurse. I'm an ICU nurse. I don't know if I can go to school nurse. And she's like, come on, just try it out. I was like, be better for my kids. And so I went ahead and applied, and I got hired, and I started working in a middle school, and I've been here ever since. And it is probably the most rewarding nursing I've ever done in my life.

Rodney Crouther (34:44):
Really?

Mindy Petty (34:45):
Yes. I still have kids come up to me at the grocery store and they'll be like, Nurse Petty, how are you? And you have no idea how much school nurses impact kids' lives. It's amazing. And so this is definitely the best part of nursing I've ever done.

Rodney Crouther (35:00):
That brings up another point. Community care is really talking about the points where people come in contact with healthcare. So for our whole community school nurses are really providing a resource, not just day-to-day in the school.

Mindy Petty (35:14):
Correct. So a lot of our students, they don't have healthcare providers. They're underserved, they don't have anyone to go to. And so the nurses are their main person that they go and see. We work really well with our pediatricians in Georgetown and clinics, and so we really try to make sure that kids are taken care of. We refer out, we call, help them get appointments if they need it. I mean, we try to do everything we can to make sure that students are getting the best medical care there is.

Rodney Crouther (35:42):
How many nurses work for the Georgetown ISD?

Mindy Petty (35:44):
We have 22 total nurses.

Rodney Crouther (35:48):
Across how many campuses?

Mindy Petty (35:50):
10, 14, 17.

Rodney Crouther (35:55):
And just to note, the Georgetown ISD has about 13,000 students, and that's 22 nurses on 17 campuses servicing 13,000 students. Has it been problematic keeping those staffing levels up since the pandemic?

Mindy Petty (36:15):
I definitely have seen a decrease in applications. I'm sure you guys know and you've seen it everywhere. We're in a nursing shortage. The pandemic really made people leave healthcare. It made them afraid. They were burnt out, they were exhausted. And I'm not going to say that we were not in the hospital. The hospital workers I have the utmost respect for, but our nurses in schools, they worked so hard, they were exhausted and burnt out. So we've had a little bit of turnover, but I honestly think we have a great department and people love it here. And so I still have applications, so I'm happy.

Rodney Crouther (36:56):
Does it help having a nursing school just down the road in Round Rock?

Mindy Petty (37:00):
Actually, yes. We love Texas State. We partner with them. They have their students come and do clinicals through here. It's really beneficial for us because, I mean, I don't know what you thought a school nurse does, but lots of people just think school nurses give out Band-Aids and we don't, we manage chronic healthcare conditions. Like I said, we can average 50 visits a day. We are doing, I mean, they don't just come in for Band-Aids, we manage their care. They're like nurses. They're case managers. They collaborate with counselors and administration. And so there's a lot that goes into that. And so when the students from Texas State come, they're like, I had no idea what you guys did. And I said I didn't either before I became a school nurse. So it's been a great partnership.

Eddie Sanchez (37:46):
I didn't realize that public school nurses provided so many different services and levels of care for students.

Rodney Crouther (37:52):
Yeah, it's really evolved, and they do a lot more than I think I ever really understood. I guess if you haven't had the experience of having a chronic condition while you were in elementary or middle or high school, you might not know that.

Mindy Petty (38:07):
No, I mean, I'm going to be honest, I don't think I ever went to a school nurse growing up, but I can tell you that sometimes the nurse is the one person on campus that a student trusts, and connections and relationships are everything. So I think that it's important that they develop that trust with students and make sure that they are a safe person to go to. Like we said, we have diabetics, we have seizure kids, we have anaphylactic kids, we have kids with chronic migraines. We have kids with cerebral palsy. I mean it's from A to Z. We see everything, and we manage everything in the clinic that we can. And if there's an emergency, we need to call 911. We call them. We have a great relationship with our Georgetown Fire Department as well and our PD.

Rodney Crouther (38:54):
So were there any major changes in just basic protocols for interactions post-pandemic beyond the wearing of masks or hand washing?

Mindy Petty (39:05):
I mean, I think before it was really encouraged during the pandemic that if you didn't need to send a kid to the clinic, don't send the kid to the clinic because we had so many sick kids. I mean, our numbers were crazy. We had tons of COVID positive. And so now I think it's encouraged that you go to the nurse if you're feeling sick. They don't have to stay outside anymore of the clinic. They don't have to wear a mask in the clinic. They don't have to do any of that.

Rodney Crouther (39:30):
So things are getting more back to normal.

Mindy Petty (39:32):
Yes, yes, I think they are. They'll come in a couple kids at a time now, before they couldn't do that.

Rodney Crouther (39:39):
Has the communication changed when you're speaking to the public about what you do here?

Mindy Petty (39:44):
I think I'm getting more comfortable with talking about what I do here, and I am definitely becoming more of an advocate. I really think that school nurses, they're not highlighted enough as they should be. And so I've really tried to reach out and I've tried to advocate for how important school nurses are. If you're a parent, can you imagine your diabetic kid going to school? And there's no campus nurse. And in Texas they're not mandated to have nurses on campus. We don't have to, they're no, we don't have to have nurses on campuses. And so as a parent and as a nurse, I advocate for every campus having a nurse, school nurse. I think it's really important for the healthcare of our students.

Eddie Sanchez (40:26):
I'm super surprised that every school does not have a nurse. I just made the assumption that there was always somebody on campus.

Mindy Petty (40:32):
No, in fact, many schools don't have a school nurse, and they have admin assistants or principals or campus people giving medications.

Rodney Crouther (40:44):
Wow.

Mindy Petty (40:46):
So again, I think that we just don't see that there is a huge need for schools to have nurses.

Rodney Crouther (40:53):
Yeah, that's a critical, as you said, a critical part of the just network for people to get care, especially in underserved communities.

Mindy Petty (41:01):
So I think we're lucky in the sense that the Austin area, we have nurses pretty much on most campuses, but in rural areas there's nobody, and those kids deserve the same type of healthcare in the school setting that we have here. I'm very proud of Georgetown ISD. They value nurses. They think that it's important to have a nurse on every campus. And so we do.

Eddie Sanchez (41:24):
Rodney, my daughter actually wants to get into nursing, so I'm curious, did she have any recommendations or suggestions for Bobcats who might be interested in going into that field?

Rodney Crouther (41:33):
Yes. She's a big advocate and a big cheerleader for getting people involved in the nursing program there. So she does have a pitch to kids who think they might want to pursue nursing as a career.

Mindy Petty (41:45):
I'll tell you, the partnership with Texas State has really helped. I think that we just have to show people what we really do. It's not about giving out and that's not what it is. And so we reach out, we do a lot of community outreach. We advertise on our social media, like come and be a school nurse. We have substitute nurses that will cover clinics when our nurses are out. That's a lot of times that's how we get nurses to be campus nurses. It really is eye-opening for the nursing students to come and see what we actually do.

Rodney Crouther (42:17):
Do kids ever just stop by with just general questions about health?

Mindy Petty (42:21):
Yes. They'll come in and they'll ask all kinds of questions. You would be very surprised at the type of questions we get and the nurses—

Rodney Crouther (42:27):
At all levels or is that more of the older kids?

Mindy Petty (42:30):
I would say more of the older kids. The younger kids really come in when they're not feeling good. We see a lot of mental health as well in the clinics.

Rodney Crouther (42:39):
Is that something that's gone up over the last four years?

Mindy Petty (42:42):
Yes. We have seen a huge increase in mental health needs in our kiddos. The pandemic did not do them any favors, and so we have an amazing counseling department here in Georgetown ISD as well. And so the nurses and the counselors collaborate to meet the mental health kids. But lots of times mental health manifests in physical symptoms. So they will be having a mental health issue, but they come in because they have a headache or their stomach hurts or they're vomiting. And then when the nurses kind of work through, they don't just say, "Oh, this is what you're doing, let's take some Tums." That's not how it is. They get down to why is the kid really here? They start talking to them, they kind of figure out what's going on with them and then they'll collaborate with counselors when they find out. Yeah, it's not really a medical issue, it's a mental health issue.

Rodney Crouther (43:36):
Is that something different from when you went to nursing school that you're doing that level of counseling and investigation, or is that something that's always been part of what good nurses do?

Mindy Petty (43:47):
I think that's something that is part of what good nurses do. It's not just putting a Band-Aid on it. You want to get down to what's really going on with any type of patient, whether it's a patient in the hospital, a student in the classroom, student in the clinic. You want to find out what is really making them come to you and take care of the true problem. I think that's how you reach kids and you keep 'em healthy.

Eddie Sanchez (44:12):
I'm glad that she mentioned that there are other options for our Bobcats to get into nursing. Aside from just somebody might think like ER for instance, or family medicine, there's a lot of different opportunities it seems.

Rodney Crouther (44:26):
Yeah, it's a really diverse feel with a lot of different career paths you can take. In the collaboration with school counselors, is that something that's grown more intentional post-pandemic?

Mindy Petty (44:54):
Oh, absolutely. So I think that sometimes we feel like as professionals we have to kind of stay in our lane per se, and that's not what it is. We want to take care of kids as a whole kid. Their mental health needs, their medical needs, their learning needs. And so teachers, counselors, nurses, administrators, they all collaborate to take care of these kids.

Rodney Crouther (45:17):
Is there anything else you want to say about school nurses?

Mindy Petty (45:20):
I would love for parents to actually get to know their school nurses and really find out what they do. Have a little bit of grace with them sometimes because it is a really tough job, but they love what they do. And like I said, our nurses here, especially in Georgetown ISD, are absolutely amazing. I would let any one of them take care of my kid, and they work their tails off. And our students, I really do think benefit from it.

Eddie Sanchez (46:01):
Rodney, so I was very interested in this particular episode because my daughter is trying to get into nursing like I had mentioned before. And so this is something that I definitely want her to listen to just so that way she gets a better understanding hopefully of what she's getting into.

Rodney Crouther (46:15):
I really hope to see her enrolled here soon. Then we definitely need new nurses. That message I think came home to me clear as day with every person we interviewed. It's just such a crucial part of our healthcare network. And I mean, just from my own experience, I've really gotten great care from nurses with different doctors and specialists I've seen over the years and my family too. And I think that's like you heard in their stories when I talked to them about how they got into nursing, nearly all of them had a story about either seeing what nurses do day-to-day or having a great experience with them or a family member in the healthcare system that inspired them to pursue that as a field. So no, this was a really fun episode to do.

Eddie Sanchez (47:00):
This is usually the time when I tell you what I'm going to talk about next.

Rodney Crouther (47:04):
But we're getting close to December now.

Eddie Sanchez (47:06):
Yes, exactly. So instead of doing a full episode in December, we're going to be doing a little special mini-episode for our listeners.

Rodney Crouther (47:13):
So we're going to try to come up with a couple of fun topics just to give you something—

Eddie Sanchez (47:17):
To hold them over until—

Rodney Crouther (47:19):
Something fun to listen to going into the holidays, maybe on the road.

Eddie Sanchez (47:22):
Exactly. Yes. But we are working on some new material for January and February, correct?

Rodney Crouther (47:25):
Oh yeah. We're going to have some great new episodes in 2024, so stay tuned. Thanks for listening to Enlighten Me. We'll see you next time on the Texas State Podcast Network. This podcast is a production of the Division of Marketing and Communications at Texas State University. Podcasts appearing on the Texas State Podcast Network represent the views of the host and guests not of Texas State University.