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Cover Story - Posted September 22, 2017 8:49 a.m.
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Photos by Shannon Richardson

Municipal Health

Before Amarillo had a hospital, it had precisely four nurses. And had those four nurses not arrived when they did, the city might not even exist.

Around the time Typhoid Mary was being quarantined in New York City in 1907, an unrelated typhoid fever outbreak hit Amarillo. The city had less than 10,000 residents at the time – the nearest census, in 1910, would record a population of 9,957 – and the number of sick overwhelmed Amarillo’s miniscule medical community. A year earlier, in Philadelphia, a similar epidemic had infected thousands of people.

Back then, Amarillo had only one hospital: St. Anthony’s, opened in 1901 by four Catholic sisters. Originally from Europe, sisters Cleophas Hurst, Eugenius Ward, Winifred Cullen and Conrad Urnau belonged to the Sisters of Charity of the Incarnate Word in San Antonio. The organization had launched its own hospital in San Antonio in 1869. Around the turn of the century, Amarillo physician David R. Fly asked for the nuns’ help in bringing a medical facility to the Panhandle.

The women arrived and began establishing St. Anthony’s Sanitarium in a two-story building at the corner of Northwest Seventh Avenue and North Polk Street. Sister Cleophas Hurst became its first administrator. While other nuns followed, those four became the first nurses in Amarillo and oversaw the facility’s 25 beds. However, they wore strange religious attire and spoke with foreign accents. Amarillo was slow to accept them.

Then came the 1907 typhoid outbreak. St. Anthony’s filled to capacity for months. Entire families filled small rooms. Patients slept in the office, and the sisters eventually gave up their own living quarters to accommodate patients as they nursed the city back to health.

By the time Amarillo emerged from the outbreak, residents had been won over by the selfless sacrifice and medical expertise of the nurses. Almost immediately, St. Anthony’s began renovating and expanding its building, and by 1909, it had opened the area’s first nursing school. The first class of students at St. Anthony’s Training School graduated in 1913, adding four new nurses to the city’s ranks. Over the next six decades, 635 students graduated from that program as registered nurses.

Same Goal, Multiple Paths
Amarillo’s medical community has grown substantially since nuns in flowing habits visited patients at St. Anthony’s, of course. But a strong tradition of nursing continues to be the backbone of the city’s health.

As with the rest of the United States, the first nurses to care for patients and serve alongside local doctors were trained in hospital-based diploma programs like St. Anthony’s. Initially, these were not standardized or licensed programs. They existed primarily to help hospitals train their own employees. “In the old days, the overwhelming majority of registered nurses who were educated in the Texas Panhandle were from Northwest Texas and St. Anthony’s hospitals,” says Dr. Richard Pullen, a professor of nursing at Texas Tech University Health Sciences Center and the former dean of nursing at Amarillo College. “Those were two highly regarded schools of nursing.”

The two hospitals trained nurses well into the 1960s and 1970s. But slowly, on-the-job hospital training gave way to programs that divided time between clinical and collegiate settings. Today, Amarillo College and West Texas A&M University offer very strong nursing programs. “WT is the only institution located in the top 26 counties [of the Texas Panhandle] that educates baccalaureate- and masters-trained nurses,” says J. Dirk Nelson, Ph.D., Dean of WT’s College of Nursing and Health Sciences. The university’s Department of Nursing currently enrolls around 750 total students, offering a Bachelor of Science in Nursing (BSN) degree plan that equips students to become licensed registered nurses.

Meanwhile, Amarillo College offers two nursing programs. Its oldest is a two-semester vocational nursing program that prepares students to become licensed vocational nurses (LVN), an entry-level designation. Its largest program, however, is a five-semester Associate Degree in Nursing (ADN) program that prepares grads for RN licensing. “Our associate’s degree program is one of the larger programs in Texas,” says Lyndi Shadbolt, the director of AC’s ADN program, which boasts 413 students for the fall semester.
In fact, the majority of registered nurses working today in the Texas Panhandle began their careers at Amarillo College. “Our stats say that over 70 percent of RNs in the Amarillo area were educated by AC,” says Shadbolt. “We are extremely proud of that.”

For students seeking to become licensed as a registered nurse, both institutions – AC and WT – offer different pathways to the same destination. “In terms of capabilities and the clinical experiences and the nursing skills, there would be very little difference” between nurses who graduated with an associate’s degree and a bachelor’s degree, Nelson explains. “Someone with an associate’s degree in nursing can be a registered nurse just like an individual with a baccalaureate degree can be a registered nurse.”

In fact, the two local nursing schools collaborate more than they compete. “Locally, we are very unique in that we have WT and AC plus different programs at Texas Tech,” says Valerie Kiper, a Texas Tech University Health Sciences Center (TTUHSC) nursing professor who spent more than two decades as Chief Nursing Officer at Northwest Texas Healthcare System. “We’re a very close group in working together to identify what we think the community needs and what the nursing profession needs to help advance nursing education.”

A large number of Amarillo’s nurses graduated from both programs. WT offers a special RN-to-BSN online degree plan to help existing registered nurses complete a bachelor’s degree. In other words, a student might graduate from AC, receive his or her registered nurse certification, and then go on to complete a four-year degree in Canyon. (TTUHSC offers similar, smaller BSN and RN-to-BSN tracks.)

“My first degree was an associate’s degree in nursing, and then I got a bachelor’s degree in nursing,” says Helen Reyes, Ph.D., the head of the Department of Nursing at WT. She says many nurses are choosing to extend their education simply because patients’ illnesses are becoming so complex – and because those extra semesters of training and education have a tangible impact on patient care (see sidebar).

Currently, around 50 percent of registered nurses in Texas have graduated with bachelor’s degree. An influential 2010 Institute of Medicine Report recommended that 80 percent of the nursing workforce have at least a bachelor’s degree by the year 2020 – which means more and more hospitals and medical facilities have begun prioritizing RNs with a four-year degree.

More Patients, More Complexity
The primary reason health care providers are seeking nurses with a broader education is because today’s patients have broader health problems. People are living longer, medicine is advancing, and technology is increasing. These are beneficial things, but they have significant health care consequences.

In 1910, for example, the average life expectancy for a man in the United States was around 48 years old. If he had heart disease, he might barely live past 40. He definitely wouldn’t live long enough to suffer from heart disease and dementia at the same time.

Western medicine has made great strides in reducing the mortality rate. So a man who suffered from congestive heart failure in his 40s may today live into his 70s, at which time he could face other diseases that compound his heart problems.

“We have an aging baby boomer population with chronic illnesses,” says Pullen. “Chronic illnesses are vast and can be anything from diabetes to heart disease to neurological problems.”

This means hospital patients are sicker than ever. “When nurses graduate from any program, they are put in situations where people are older and have more than one disease process,” says Reyes at WT. The complex interaction of multiple diseases requires a high degree of critical thinking for a nurse.

Amarillo College Nursing Director Lyndi Shadbolt became an RN in 1982, and says the evolution she has seen across the profession is staggering. “In my last semester of school, the patients we took care of in the intensive care [unit] are now the patients our students are taking care of in the regular medical unit,” she says. “Today, [patients] are much more acutely ill. The intensive care areas are so much more critical.”

The National Council on Aging estimates that 4 in 5 older adults have a chronic condition. Sixty-eight percent have at least two chronic conditions. And right now, there are more Americans older than age 65 than ever before in our nation’s history.

The patients aren’t the only factor becoming more complicated. “I’ve been in nursing 35 years and my nursing pharmacology book was very small compared to what our students have now,” says Shadbolt. “The myriad of drugs that patients could be on and procedures that are available have changed drastically.”

Nurses are on the front lines of this war against complex medical situations. “Nurses spend more time with the patient than anyone,” says Reyes. “That’s not to put down any other health providers, but they do. They have to navigate a really complex health care system. What they’re able to accomplish is pretty amazing.”

Those accomplishments are clear, as nurses regularly top lists of America’s most trusted professions (see sidebar).

High-Intensity Training
“Care and compassion for the community is the foundation of what nursing is about,” says Pullen. “It’s an honor and a privilege to care for people when they can’t care for themselves. It takes a very special person to do that.”

But bedside manner is only one aspect of the profession.

“There’s caring and concern,” says WT’s Nelson, “but combine that with the ability to think in an instant what to do and not to do, how to solve problems, how to understand a life-and-death situation and stay calm, how to take instructions from other health care providers, how to comfort the patient and provide a sense of ease to family members. It is a dynamic profession and a tremendous breadth of skills, traits and characteristics are required.”

To ensure nursing graduates bring these skills to their careers, local programs combine classroom and clinical education. The clinical aspect involves seeing live patients under supervision in a hospital setting. But it also relies heavily on technology, including high-fidelity patient simulations (HPS). These HPS labs use computerized mannequins to simulate real-life hospital scenarios, from treating postpartum hemorrhaging after an infant delivery to working with a patient whose heart has stopped in surgery, or who is having an opioid overdose. AC and WT have shared these expensive simulators in the past, and recently collaborated with TTUHSC to open SiMCentral, a multidisciplinary training center to help students develop clinical and diagnostic skills in a controlled environment.

Critically, the high-fidelity mannequins “allow students to practice and train to get used to the whole set of medical scenarios before they actually see real patients,” Nelson explains. During simulations, students speak to the mannequins just like they would talk through a procedure with a human. These are a long way from the legless, plastic CPR dummies in health class. The simulations hew as close to real-life as possible and the impact on students is tangible. “When you look at some of the stress hormone levels [among students during simulations], they’re higher than when they’re working on actual humans,” Nelson says. “Having that kind of experience while they’re being educated – even before their clinical experiences – has been a tremendous benefit, not only from the education standpoint but from the quality of nursing education as a whole.”

Students in Amarillo College’s RN program graduate with nearly 400 hours of these simulations on their resume. “Simulation is very important in our program,” says Shadbolt. It allows students to make mistakes without threat to patient safety. It also allows them to participate in procedures for which they would rarely have responsibilities before entering the workforce. “They get to learn how they would handle [these scenarios] in simulation, whereas in a true clinical setting they would stand back and watch the health care professionals take care of things.”

Thanks to these simulators, today’s nurses enter the workforce with experience nursing students didn’t have in the 1980s or ’90s. “[Simulation] is a safe place for them,” says Reyes. “It lets them gain critical thinking skills. We do classroom teaching, but those critical thinking skills don’t come in lecture.”

They come with clinical, hands-on experience.

A Perfect Storm
While nurses are entering the workforce with more education and skill than ever before, the number of nurses isn’t enough. Around three million nurses are working nationwide. It’s one of the fastest-growing occupations in the U.S., but experts still see a crisis in nursing’s future.

When Valerie Kiper became a registered nurse nearly four decades ago, career options were limited for young women. “It was either nursing or being a teacher,” she says. Far more options are available today, but there’s no denying that a smaller percentage of of career-minded women are choosing the profession. (While the number of men choosing nursing as a profession continues to rise, only 10 percent of local nursing students are male.) With a third of the nation’s current registered nurses older than 50, the American Nurses Association estimates that 700,000 nurses will retire or leave the labor force by 2024.

“You have a population of nurses that are aging out,” says Kiper. They’re not being replaced at the same rate.

Nursing educators are aging out as well. “The average age for nursing faculty is in the upper 50s,” says Pullen. “Those individuals are getting older and approaching retirement.” Even if the number of nursing students increased, they would encounter an academic bottleneck. Nationally and locally, there simply aren’t enough educators to teach them.

In recent years, Amarillo College has responded to the increased demand by expanding the number of nursing students it accepted, but the faculty has struggled to keep pace. Going into the fall semester, Shadbolt was short two full-time faculty members. “If we don’t have enough nursing educators, we can’t increase the number of RNs in Texas,” she says.

Those two factors – a declining number of nurses and the lack of graduate-degreed nursing faculty to teach them – are colliding with another statistic to create the health care industry’s version of a perfect storm. By 2030, 1 in 5 Americans will be a senior citizen. The aging baby boomer generation means more patients with more complex diseases, and not enough nurses to treat them. The nursing shortage has been bad for decades. Experts worry it’s about to get much, much worse.

Outlook and Options
That scarcity – now and in the future – means today’s students at AC and WT have excellent job prospects regardless of their degree plan. Over the past seven years, more than 95 percent of WT’s graduates have passed their licensing exam on the first try. When they do, they enter a job market desperate for RNs. “More or less, 100 percent of our graduates have jobs,” says Nelson.

In some cases, not just one job. “Most of them have many jobs from which to choose,” adds Reyes.

Amarillo College is no different. “Our benchmark is that over 80 percent [of students] would have jobs when completed,” says Shadbolt. “We’re always above that.” The licensing pass-rate for AC nursing students has been above 90 percent for the past three years, and the majority of new nurses remain here in the Amarillo community. “Our hospitals in town are fabulous to recruit our graduates and to give them clinical space. I’m very proud that they stay here.”

But today’s workforce offers far more career options for RNs than work at Northwest, BSA, or the Veteran’s Administration. “Before, it was mainly hospitals and maybe a clinic or doctor’s office” that would employ nurses, says Kiper. “Now you can work for a corporation that is making cardiac monitors. You can be in research, be in sales promoting different products for health care. There’s so much.”

“There are flight nurses,” Reyes says. “There are travel nurses that travel all over the country and work in different hospitals. They hire them for three months at a time because they might have a nursing shortage. One of our graduates worked at Bell Helicopter as their Global Health Coordinator.” In addition to various medical specialties like pediatric or geriatric care, nurses can fill treatment and preventative roles in public schools, nursing homes, home health, community health, correctional facilities, and beyond.

“When I used to teach beginning nursing students, I would always tell them ‘Don’t ever get bored with nursing,’” Shadbolt says. “I’m one of those examples.” Before getting into education, Shadbolt worked in obstetrics. Then she took a position as a surgical nurse. Then she went to work in pharmaceutical sales. “My nursing knowledge translated beautifully to being able to educate nurses and physicians about new pharmaceutical products.”

White Hats
Amarillo’s first nurses wore religious habits. Today they may wear scrubs … or business attire.

“People have a perception of what a nurse is,” says Reyes. “Even children, when they draw a nurse, they put a cap on their head with a cross on it,” despite the fact that western nurses haven’t worn caps and white uniforms since the 1970s. Upon graduating, Amarillo’s nurses are more educated, more skilled, and even more experienced than ever before. Their patients are sicker than ever before, too.

Those things have changed.

But if the nursing educators in the Texas Panhandle have their way, one thing will never change. “Nurses get into nursing because they want to care for someone,” says Kiper.

The nursing profession may have helped save Amarillo when typhoid hit in 1907. As more and more Panhandle residents age, retire and rely on local medical services to stay active, Amarillo’s nurses will become even more crucial to the city’s health.

The Value of More Highly Educated Nurses

Promoting higher education among nurses isn’t just an idea that serves the four-year nursing school at West Texas A&M. A number of recent studies have found a well-researched connection between the overall education level of nurses and positive patient outcomes:

• One 2013 study showed that, between 1999 and 2006, hospitals that hired more nurses with BSN degrees saw a more noticeable decline in mortality rates than hospitals that did not add nurses with bachelor’s degrees.
• Another 2013 study found that hospitals with a higher percentage of registered nurses with BSN degrees resulted in shorter lengths of stay for patients.
• A 2014 study showed that increasing by 10 percent the number of nurses with BSN degrees would decrease patient deaths by seven percent.
“Knowing that nurses need to advance their education to improve the health of the population they serve has very much been proven through research,” says Dr. Valerie Kiper, the former Chief Nursing Officer at Northwest. “The higher degree you have, the better outcome patients have.”

Nursing Definitions

LVN: Licensed Vocational Nurse. This requires completion of an approved one-year program and passing of a licensure exam. LVNs provide only the most basic levels of care, as the designation is considered an entry point into nursing.

RN: Registered Nurse. This requires the completion of an Associate Degree in Nursing (ADN) or a hospital-based nursing diploma program, plus the passing of a licensure exam. These are two-to-three-year programs.

BSN: Bachelor of Science in Nursing. This is earned at the conclusion of a four-year program from an accredited college or university, after which a student must pass a licensure exam. Both ADNs and BSNs are pathways to becoming a registered nurse, but research links BSN-prepared nurses to improved patient outcomes.

NP: Nurse Practitioner. An advanced, masters-level nursing degree providing more specialized education and clinical training. Often working in private practice, NPs can provide higher levels of care than RNs are licensed to provide. They can prescribe medications and often perform roles similar to a physician. (In some states – but not Texas – a nurse practitioner can operate independently from a private physician.)

The Most Trusted Profession

Since Gallup began including nursing in 1999, nurses have topped the pollster’s annual list of most trusted American professions every year but 2001. That year’s poll was taken soon after the 9/11 terrorist attacks, and firefighters topped the survey for the first time. (Nurses placed a close second.) In the most recent 2016 poll, 84 percent of respondents rated the honesty and ethics of nurses as “Very High” or “High.”

Recognizing Panhandle Nurses

Amarillo's Medical History

by Jason Boyett

Jason has written more than a dozen books and is the host and creator of “Hey Amarillo”, a local interview podcast. Visit heyamarillo.com and jasonboyett.com.
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