The Salina Solution
The School of Nursing’s new Salina campus aims to curb nursing shortage in rural areas
NUMBERING MORE THAN 3 MILLION, nurses constitute 80 percent of the American health care workforce. Nursing is the fifth most common profession in the United States and one of the fastest-growing, according to the Bureau of Labor Statistics (BLS). Yet in many parts of the country, there aren’t nearly enough nurses, and the shortages have been forecast to get much worse.
The reason is a double whammy: Americans are living longer and requiring more care, while the prevalence of chronic diseases is escalating. At the same time, the largest portion of the nursing workforce – the baby-boomer nurses – is retiring or getting close to it. The BLS projects that 1.1 million new nurses will be needed by 2022 to avoid a greater shortage.
But the problem is more complex than simply needing more nurses. According to the U.S. Department of Health and Human Services, the issue is not so much the number of nurses nationally, but the inequitable distribution of nurses across the country and even within states. Whether you will have access to good nursing care in five or 20 years could depend largely on where you live.
That’s definitely the case within Kansas. Rural and sparsely populated parts of the state rarely have had enough health care providers for even basic care.
“The need for nurses in rural and western Kansas is huge and has been for a long time,” said Sally Maliski, Ph.D., RN, FAAN, dean of the University of Kansas School of Nursing. “It can be tough to attract nurses to rural areas and keep them there.”
Larger cities can offer more lifestyle amenities, job opportunities for spouses and partners and often higher pay. What’s true for Kansas City is not necessarily true for Dodge City.
But what if potential nursing students from rural parts of the state did not have to relocate to a big city to order to attend nursing school? Suppose they could get their nursing education – or even a bachelor’s degree – in the same kind of community in which they live and already have ties? Now, more of them can. In 2017, the inaugural class of students entered the University of Kansas School of Nursing’s newly opened campus in Salina, a town of nearly 50,000 people close to the bullseye of the state in one of the largest wheat-producing areas of the world. Salina is the location of the Salina Regional Health Center, a 223-bed comprehensive acute care hospital with affiliated hospitals and clinics that serves a wide surrounding rural area.
It is also home to the University of Kansas School of Medicine–Salina, which, with eight incoming students a year, became the smallest medical school in the country in 2011. The School of Medicine’s Salina campus opened with the same ambition: that its graduates would choose to practice in rural communities. At the time, five counties in Kansas had no doctors at all.
THE MOTHER OF INVENTION
The KU School of Nursing had long dreamed of adding another branch of the school further west in the state, not just to train more nurses, but to train more nurses with a bachelor’s degree. Nurses can be licensed with a two-year degree, but research indicates that hospitals employing nurses with a bachelor’s degree or higher have better patient outcomes, including lower mortality rates.
In 2010, the Institute of Medicine called for 80 percent of registered nurses to hold bachelor’s degrees by 2020. Today, somewhere between 55 and 60 percent of nurses have bachelor’s degrees, but the gap is greater in Kansas and rural areas. In 2016, the number of students entering associate’s degree programs in Kansas was twice the number of those entering bachelor’s programs, according to the Kansas State Board of Nursing.
There’s another facet to the nursing shortage. You can’t train more nurses without qualified instructors, and many nursing instructors are also gearing up to retire without enough aspiring faculty in the pipeline to replace them. The American Association of Colleges of Nursing reports that nursing schools rejected more than 64,000 qualified applicants from programs at the bachelor’s level or higher in 2016 because they didn’t have enough resources, including instructors. Having more nurses with bachelor’s degrees would put them one step closer to the master’s-level or higher degrees required to teach.
At the beginning of 2016, there were 15 nursing programs in Kansas that offered a bachelor of science in nursing (BSN). All but two were in the eastern part of the state. But by autumn, only one west of Wichita remained. Also in 2016, the University of Kansas School of Nursing established the Community College Nursing Partnership, a program that enables students to simultaneously earn their associate’s degree in nursing from community colleges Around the state and their BSN from KU via online coursework. It’s an innovative program, but to meet the demand for nurses, Maliski said, it’s going to take multiple pathways.
Maliski and leaders in Salina decided it was time to make the dream of a KU nursing program in Salina a reality. Once that decision was made, things moved quickly.
“We started talking in the fall of 2016 and by the spring of 2017 we were planning to open for the fall semester,” said Maliski. “How did that happen? We and the Salina Regional Health Center, the Salina Regional Health Foundation and the Salina community all saw the need, and we worked together.”
First, they needed class space. The KU medical school was based out of the Braddick Building on the grounds of Salina Regional, but that was soon to change. The Salina Regional Health Foundation had purchased a 40,000 square foot former bank building in downtown Salina with plans to renovate
it into a state-of-art learning facility for the medical school. Now it made sense for the building to accommodate both schools.
“We knew we needed to educate more nurses,” said William Cathcart-Rake, M.D., dean of the KU School of Medicine in Salina. “So we said, ‘we’ll make this building work for you, too.’”
In the meantime, they arranged for the nursing school to use a room in the lower level of the Braddick Building, where students would follow the same curriculum as their counterparts in Kansas City. Students complete their first two years of prerequisites elsewhere and then enter the KU nursing program as juniors. Like their counterparts at the medical school, the nursing students would do most of their clinical work at Salina Regional. Nursing and medical students would also train together using simulation technology to learn clinical skills, as well as how to work together effectively.
Cynthia Teel, Ph.D., RN, FAAN, associate dean of academic affairs at KU School of Nursing, worked out the logistics and IT issues and hired three nursing faculty members. When one of them took another job working with her family after the first semester, Teel reached out to Becky Cram, RNC-NIC, MN, who earned a BSN and master’s in nursing from KU. Cram had retired from Salina Regional in 2016 after working there more than 40 years and was helping teach some of the credentialing courses when Teel contacted her.
“There are just not a lot of master’s-prepared nurses in this area,” said Cram. “I thought it was so exciting that we were starting a nursing program here in Salina, and I felt compelled to help KU get the program off the ground.”
Teel also hired Lisa Larson, Ph.D., RN, to head up the new campus as assistant dean of academic affairs. A Sunflower State native, Larson had spent her nursing career in hospitals and schools in rural parts of the state. She was finishing a doctorate from KU online in nursing education and health care informatics and thinking about what to do next when she learned that KU was opening a nursing campus in Salina. She said she jumped at the opportunity.
“I don’t know if it was the gods or karma, but it was unbelievable,” Larson recalled. “I knew what I could offer was having lived in Salina for 15 years, working and developing relationships with the Salina school district and various organizations and people in the community.”
Meanwhile, the Salina Regional Health Center and the Salina Regional Health Foundation raised the funding for the new school through private contributions from both individuals and organizations. Salina Regional also set up a plan to offer scholarships to students, as well as a loan forgiveness program, in exchange for students working for a time at the hospital after graduation.
THE FIRST DOZEN
In August of 2017, without a dime of state money except to pay the faculty, the new KU School of Nursing opened the doors to the lower level of the Braddick Building for 12 incoming nursing students.
Sarah Medlock was one of them. Medlock, who grew up Abilene, Kansas, had wanted to be a nurse ever since she was a little girl. She had completed her prerequisites for nursing school but didn’t know where she was going to attend when she came across an article about the new nursing school in Salina. She knew immediately that she would apply.
“I have always wanted to attend KU,” she said. “Once I found out that I was accepted, I knew that was exactly where I was supposed to be.”
The Salina faculty worked closely with the faculty in Kansas City to co-teach the courses. Instructors from each campus traveled to instruct in person, in addition to teaching from their primary campus locations. For the first year, most class sessions were broadcast via interactive TV from the Kansas City campus, and the Salina students participated by tossing a throwable microphone cube to whoever wanted to ask or answer a question. A co-instructor in the classroom then helped facilitate discussions. In the future, more class sessions are expected to be broadcast from the Salina campus.
Medlock said that participating in courses remotely was an adjustment at first, but then that changed.
“Being in the first class, we definitely worked all of the kinks out, but now it is just normal to have class set up that way,” she said. “All the teachers in Kansas City really worked hard to make us feel like we were basically there in Kansas City with the other students.”
Esmeralda Tovar-Contreras, a student from Hutchinson, decided to be a nurse after being impressed with the nurses who helped deliver her daughter. She said what made her decision to attend the Salina branch of KU over the other school she applied to was the tuition and the smaller community. Ashley Lopez, who graduated from high school in Wichita, became interested in nursing when her grandparents got sick and she and her family took them in to take care of them. She also spent time volunteering at hospitals. She applied to the KU School of Nursing in Kansas City.
“KU was the only place I wanted to go. It’s the best of the best,” she said.
When the admissions office called and told her there would be space for her in a new KU school in Salina, she immediately said yes. Lopez likes the atmosphere of the smaller class size in Salina and the clinical opportunities that she and her classmates got at Salina Regional in the first year. “I loved it. We were allowed to do a rotation in the surgery center, and we got some exposure to the cath lab and saw pacemakers being put in,” said Lopez. “We were very hands-on, and the nurses were always willing to teach us.”
Sarah Kingan was one of the nurses who worked with the KU-Salina students. She’s now thinking of becoming an instructor after attaining her master’s degree in nursing.
“I walk the students through things pretty much like I would for a new hire,” she said. “They report with me on all the patients. I have them help with medications, head to toe assessments, procedures and imaging. I enjoy the teaching, honestly. It’s kind of my thing.”
The nursing students participate in simulations with the medical students each semester, and they also teach each other.
“Most of our work is more bookwork at this point, but the nursing students bring more clinical skills to the table the first year,” said Maci Hicks, a medical student from Nebraska. “They taught us how to insert an IV, for example. That was pretty cool, to learn a skill from them.”
Larson said she believes the role-playing the students experience in many of the simulation exercises helps build mutual respect between the two professions. Emily Lenherr, a medical student from Windom, Kansas (pop. 125), put it this way: “Medicine is a team sport. We can’t do it alone.”
Cathcart-Rake, who practiced medicine in Salina for more than three decades, knows first-hand the value of nurses.
“I think of what nurses did for me, even just little things like if I was running late,” he said, shaking his head. “And sometimes, a nurse can save your butt.”
A NEW, NEW SCHOOL
In August 2018, when the second KU School of Nursing–Salina class arrived on campus, the new building, dubbed the Salina Health Education Center, was ready and waiting. Eleven of the 12 incoming students are from Kansas. The school plans to increase the number of incoming students to 24 so that by 2021, the total number of nursing students will reach 48, surpassing the number of medical students.
Located on Santa Fe Avenue in downtown Salina, about one-third of a mile south of the grain elevator, the building is in many ways a miniature of the new Health Education Building that opened a year earlier at the University of Kansas Medical Center. The light and airy building more than doubles the space that the two schools were occupying in the Braddick building.
Funded entirely by private donations from several hundred individuals and organizations, the $9.2 million renovated building has the same kinds of learning spaces, labs and cutting-edge technology found in the Health Education Building in Kansas City. The simulation lab has six lifelike manikins, controlled by tablets, that enable the future nurses to check pulses, practice resuscitation, check breathing, hear bowel sounds, draw blood and insert IVs.
Build it and they will come. It’s hard to imagine such a gorgeous facility not being a draw for students. Even the modular furniture throughout the building is sleek and modern, and there’s a basement designed for relaxing and socializing, complete with a workout room, kitchen and a lounge area with an electric piano, foosball, shuffleboard and a pool table. Six artists from across the state were selected to create works for the building. Their paintings, glasswork, sculpture and collages were inspired by the two schools’ dedication to rural health care and include a series of four oil paintings called “Seasons” and a wood, metal and glass sculpture representing the sunset over the rolling hills of central Kansas.
A DRAW FOR STUDENTS
Ultimately, the purpose of the school is to produce nurses, and the school does not require the students to be from the state or to practice in rural Kansas following graduation, unless they have a scholarship that requires it.
But the school is banking that there will be plenty who want to practice in rural areas. The results from the medical school in Salina are promising: Six of the first class of eight students just finished their residencies in 2018. Of those six, all are staying in or returning to Kansas, and five will be in towns the size of Salina or smaller.
“I’d say that’s pretty good,” said Cathcart-Rake.
“You are taking care of your own. That’s a draw for rural areas and it’s been a draw for me.”
- Lisa Larson, Ph.D., RN
Rural life has its own charms, and Larson points out that when you practice in a smaller hospital or rural area, you take care of people you know ‒ the same people you went to school and church with and have known for years.
“You are taking care of your own,” Larson said. “That’s a draw for rural areas and it’s been a draw for me.”
Lopez, who plans to continue her education to become a nurse anesthetist, said she is likely to stay in the Salina or Manhattan, Kansas, area after graduation. As a scholarship recipient, Tovar-Contreras will be working at Salina Regional for at least a year after graduation.
“I’ve already talked to HR, and it sounds like a great place to work,” she said.
Medlock can only speculate: “I have no plans yet as for where I will go,” she said. “But I am from Kansas, so I will most likely stay in the area for some time.”