Finding solutions to a national crisis
After graduating with a nursing degree, Carmen Drentlaw D’24 jumped right into her new field at Abbott Northwestern Hospital in Minneapolis. After a few years of working in the intensive care unit (ICU), Drentlaw knew she was ready for a change.
“While I was in the ICU, I worked alongside a lot of nurse anesthetists, and I was impressed by the amount of autonomy that was given to them,” she said.
Drentlaw decided to enroll in Saint Mary’s Doctor of Nursing Practice in Nurse Anesthesia program.
A Saint Rosa, Minn., native, Drentlaw knew she wanted to practice in a rural setting and was drawn by Saint Mary’s focus on placing students at rural hospitals for their clinicals. With students needing to complete 12 different clinical rotations in the program, Drentlaw did five of her 12 at rural hospitals.
“Rural practice is a bit different,” Drentlaw said. “And with autonomy in my job being something I wanted, I wanted to experience rural clinics.”
Rural health care in crisis
Drentlaw is like many studying students from small towns in the field of health care who look to return to their home communities after the completion of their degrees. And at the moment, well-educated health care professionals entering rural hospitals and clinics are desperately needed.
According to a 2023 report from Becker’s Hospital Review, since 2005, 40 rural hospitals in the state of Minnesota have lost certain services and six have closed. A recent report from Axios showed that 45 percent of rural hospitals in Minnesota no longer offer maternity care.
The concern goes well beyond maternal care, with the Minnesota Department of Health reporting in 2022 that rural parts of the state face a “severe shortage” of health care practitioners of all types.
“Simply put, rural health care in crisis,” said Dr. Julie Gauderman, DNAP, the associate director of the Doctor of Nursing Practice in Nurse Anesthesia program at Saint Mary’s. Along with educating the next generation of nurse anesthesia providers, Gauderman has served as the federal political director for the Minnesota Association of Nurse Anesthetists.
Gauderman says the cause of the crisis in rural health care is multifaceted; however, a major driving force is the fact that many rural areas in the U.S. are underserved communities. Many in rural areas rely on Medicaid and Medicare for health care. While those on Medicaid and Medicare are covered, the payments going to hospitals aren’t covering the cost of caring for a patient, which puts strain on rural hospitals. Many rural hospitals and clinics have also lost federal COVID-19 funding that was provided to prop them up during the pandemic.
The closure of medical services and hospitals adds a burden to already underserved communities.
“Headlines about rural hospitals closing an obstetrical unit will grab everyone’s attention because everyone is going to have empathy for a baby or a mother who might be struggling or at risk. But rural health care has so many other services that get overlooked. Think about pain management. An hour car ride to the closest hospital offering pain management services for someone who is experiencing back pain can be excruciating,” Gauderman said. “When someone is in crisis and they’re driving to the hospital and they see that blue sign with an “H” on it, it offers a little bit of relief. When specialized care units or hospitals close in rural areas, it removes that sense of relief.”
Not only do the closures of hospitals and medical services impact members of rural communities, it impacts practitioners in rural communities.
“For a lot of these professionals, when they go to nurse anesthesia school, usually it is with the goal of returning to their home community or a community they’re connected to, and that’s why they end up in these rural towns,” Gauderman said. “And so another big piece of that is these are usually people who love doing everything that they’ve been educated to do for their patients, providing the absolute best service they can. And from a job satisfaction standpoint, being able to do all of the different facets of anesthesia is a big part of that. So to lose an obstetrical department, they have to think about whether or not that is where they still want to be. Do they want to give up that skill set? And I think that’s the first place that my heart goes.”
Where Saint Mary’s steps in
Within the Saint Mary’s Doctor of Nursing Practice in Nurse Anesthesia program, Gauderman and the program faculty are focused on doing what they can to help alleviate the crisis in rural health care.
One major step the program has taken is focusing on accepting students from across the state, not just inside the Twin Cities metro.
“We have to be very mindful that we’re accepting students from these communities that are in need and need these providers, and also have a harder time recruiting people,” she said. Typically somebody is more likely to stay in these communities if it’s basically returning back home for them.”
The program also focuses on setting students in clinical settings in rural hospitals. With the program offering 40 clinical sites for its students, over a quarter of those clinical sites are in rural settings.
For Saint Mary’s nurse anesthetist students like Drentlaw and Tenzin Lobsang D’24, this is a major win.
While Lobsang did a majority of her rotations in the Twin Cities, she said her experience at Saint Croix Regional in Saint Croix Falls, Wis., was extremely eye-opening — so much so that she hopes to work one shift a week at the rural hospital.
“Going to St. Croix really opened up a new environment of practicing anesthesia for me as it was a CRNA-only practice. There we got to do a full scope of our practice, which included spinal anesthesia, epidurals, and doing regional nerve blocks for pain management during orthopedic surgeries,” she said. “During my clinical there I got to see all the things nurse anesthetists could do without the support of an anesthesiologist.”
With the need for competent, trained health care professionals in rural settings, both Drentlaw and Lobsang said they are pleased that Saint Mary’s has made rural health care a part of its focus.
“Saint Mary’s has been doing such a great job with rural hospitals,” Drentlaw said. “And these hospitals want to keep their partnerships with the university, so it just shows how well Saint Mary’s is training its students.”