By Jessica Stump, Appalachian Today

BOONE, N.C. — Every Wednesday during February–April — save for university breaks — a group of nursing students donned in black and gold scrubs have traveled to Ashe Memorial Hospital to provide care to patients in the facility’s medical–surgical care unit.

These undergraduate nursing students at Appalachian State University have gained hands-on, clinical experience in rural health care thanks to a partnership developed between Appalachian’s Department of Nursing and Ashe Memorial Hospital in Jefferson.

Dr. Jean Bernard, assistant professor and director of undergraduate programs in Appalachian’s Department of Nursing, received $10,000 in funding from the North Carolina Area Health Education Center (NC AHEC) program to develop a nursing clinical site at Ashe Memorial. The clinic became operational in September 2018.

Shaina Barnes, of Winston-Salem, left, and Amber Pratt, of Yadkinville, juniors in Appalachian’s nursing program, look for various nursing equipment in a supply room at Ashe Memorial Hospital in Ashe County. Photo by Marie Freeman

Bernard said the clinic is a great experience for students to see how care is provided in a critical access hospital (CAH), or a rural health care setting, compared to that of a major medical center.

“Students gain a broad nursing experience by serving on multiple units within the hospital; they learn to be flexible and gain multiple skill levels that can be applied to the various specialties they may pursue once they graduate,” Bernard explained.

The clinic is led by Clinical Instructor Rebekah Almond ’18, who earned her Master of Science in nursing with a concentration in nursing education from Appalachian in 2018. She holds a Bachelor of Science in nursing from the University of North Carolina at Charlotte.

“Many aspects of patient care are unique in rural hospitals, giving students the opportunity to gain a new perceptive of nursing care and the community,” Almond said.

She added, “Observing the adaptability of rural health nurses as they care for patients with diverse medical conditions has been a great learning experience for Appalachian students who have previously participated in clinicals at facilities with specialty care units.”

As a CAH in an underserved area, Ashe Memorial provides access to needed medical care for patients who might otherwise have difficulty in reaching a medical care facility located farther from home. The CAH designation is given to eligible rural hospitals by the Centers for Medicare and Medicaid Services.

Students in Appalachian’s undergraduate nursing program and their instructor, Rebekah Almond, second from right, during the clinical experience at Ashe Memorial Hospital in Jefferson. The students, pictured from left to right, are junior nursing majors Kelsey McKinney, of Reedsville; Taylor Sabia, of Zebulon; Amber Pratt, of Yadkinville; and Shania Barnes, of Winston-Salem. Photo by Marie Freeman

In order to obtain the designation, eligible hospitals must meet the following criteria:

  • Have 25 or fewer acute care inpatient beds.
  • Be located more than 35 miles from another hospital.
  • Maintain an annual average length of stay of 96 hours or less for acute care patients.
  • Provide 24/7 emergency care services.

According to the American Hospital Association (AHA), CAHs represent a quarter of all U.S. hospitals and more than two-thirds of all rural community hospitals in the nation. “Critical access hospitals (CAHs) are vital for maintaining access to high-quality health care services in rural communities,” the AHA website states.

Clinical instructor Rebekah Almond, left, assists junior nursing major Kelsey McKinney with locating patient medication at Ashe Memorial Hospital. Photo by Marie Freeman

Kelsey McKinney, a junior nursing major from Reedsville who has participated in the spring 2019 clinic, said “working in a hospital the size of Ashe Memorial is a unique experience” — one that has “opened her eyes” to both what it’s like to work within a rural health care setting and the lives of patients she interacts with.

“When completing a clinical at a smaller hospital, there is more focus on the skills, gaining the basic skills, whereas that might not happen in a larger setting,” said Shania Barnes, a junior in Appalachian’s nursing program from Winston-Salem.

Barnes, who took part in a nursing clinic in fall 2018 at Frye Regional Medical Center in Hickory, said the different teaching styles she has been exposed to via Almond and her previous clinic instructors have been helpful as she navigates the work environments in various hospital units.

Taylor Sabia, a junior nursing major from Zebulon, said she has enjoyed working with the Ashe Memorial staff, and the experience has allowed her to practice and improve skills she’s learned in the classroom — especially communication skills.

“Talking in person with hospital patients rather than practicing with my peers (inside the classroom) is quite a different experience,” she shared.

Almond spoke of the Appalachian pride the hospital’s patients tend to have and how they become excited when they see Appalachian students there to care for them. “It seems to raise their spirits,” she said.

Bernard is in the process of applying for additional grant funding from NC AHEC, which will support a second year of the program in the 2019–20 academic year.