On a chilly morning in November, a group of student nurses in white smocks gather around an eerily lifelike mannequin in a hospital bed at Heritage University in Toppenish. He’s hooked up to a heart rate monitor, a blood pressure monitor, an IV drip and a machine that measures the oxygen in his blood. The teacher tells the students, “He’s a middle-aged man who suffered a bad bee sting earlier in the day. He feels breathless, dizzy and groggy.” He blinks his eyes but his breathing is shallow. As the students quiz the teacher about signs of shock, he becomes unresponsive and his heart rate flatlines. They leap into action, starting CPR and intubating him. Still no pulse. “What do you do now?” asks the teacher, as a team of students continues CPR. “How about some epi?” asks one student. The teacher nods and they administer some epinephrine in his IV. Another teacher is in a room behind a mirror, controlling the dummy’s reactions. A faint pulse comes back, and suddenly the dummy moves and groans. The students, startled, jump and laugh.They saved a dummy’s life on this day, but the hope is these undergraduate nursing students will help alleviate the dire shortage of primary health care providers our rural area.
According to Dr. Michael Lawler, the president of Pacific Northwest University, 20 percent of this country’s population lives in a rural setting, yet only 10 percent of our health care providers live in those areas. “There is an enormous need for nurses in the Lower Valley, and all over the east side of Washington. There is a terrible nursing shortage,” said Christina Nyirati, the director of the BSN program at Heritage.
When she did a needs assessment in 2014 as she was designing the nursing program, she spoke to the chief nursing officers at local hospitals and clinics. She says every one of them told her it’s extremely difficult to keep a stable workforce in this rural area. “A lot of nurses who come here, come here because they have a difficult time getting a job as a nurse in the place where they really want to work, and can easily get a job here. But they get experience, and then they leave. That’s why we are trying very hard to recruit nursing students from this Valley, so they’ll stay here,” Nyirati said.
Heritage’s first class of undergraduate nursing students graduated in May. A check of Astria Health’s job site in mid-January showed 27 RN positions available, while Virginia Mason Memorial had 17. “There is a shortage of RNs in the Yakima area, as evidenced by the consistently sizeable number of open positions,” said Kelliann Ergeson, the talent acquisition specialist at VMM. But the situation isn’t hopeless, she said. “Heritage’s plan is an important part of the solution, especially with the anticipated increase in RN openings as the baby boomers retire,” Ergeson said. According to the Bureau of Labor Statistics, the need for registered nurses is expected to grow by 15 percent from 2016 to 2026, compared to 7 percent growth across all occupations.
Nyirati has a Ph.D. in nursing from Ohio State University and was one of the first few hundred nurse practitioners in the nation, pioneering that role in the Appalachian underbelly of Ohio. Nurse practitioners are one step below doctors, with advanced education and clinical training that allows them to diagnose illnesses, treat conditions, prescribe medications and provide health education for their patients.
She was running the family nurse practitioner program at OSU, doing research on pregnant teens in Appalachia and nearing retirement when former PNWU president Dr. Keith Watson called to recruit her to Heritage University. Heritage had an LPN program at the time, which was struggling, and Watson wanted Nyirati to start a bachelor’s of science program that would recruit nursing students from the Yakima Valley and keep those students working in their own communities after they graduated. Watson and former Heritage President John Bassett lobbied her for a month until she agreed.
She is passionate about nursing and the role nurses play in rural communities like ours. She said the health challenges facing some populations in the Lower Valley are worse than what she saw in Appalachia. “We have the highest rates of obesity, childhood death from asthma, teen girl suicide, and the highest rate of post-neonatal mortality,” Nyirati said.
She said nurses are excellent at giving preventive care that can address some of these problems, and she designed the Heritage program so that its nurses would look not only at patients in their moments of crisis at the hospital, but the patient’s family as well.
“We have created a very strong community health-focused program,” Nyirati said. “Because it is not sufficient anymore just to have skills at the bedside. As they begin preparing this family for caring for their loved one out in the community when they leave the hospital — this is what will transform the health of this community.” The program encourages the enrollment of students who are bicultural and bilingual and helps them get scholarships. All nine in the first graduating class got scholarships, including Sandra Sanchez.
After she graduated in May and became an RN, the 25-year-old started as a floor nurse at Fieldstone OrchardWest Assisted Living in Yakima. She is now director of nursing there, with 17 people under her supervision. She grew up in Mattawa and has firsthand experience with the lack of health care providers in Yakima. “My primary care physician is still in Mattawa. I’m on a waiting list for a doctor here, so I know there is a medical shortage,” Sanchez said.
She knew she wanted to become a nurse since she was a little girl. She started in the LPN program at Heritage, then transitioned into the BSN program, doing work study during the school year and going home to work in the fields to save money during the summer. It took her seven years. She considers the day she graduated as the best day of her life.
She said at first, she and some of her fellow students dreamed of working at hospitals in big cities, but “after you hit your junior or senior year, your mind shifts and you start to think ‘I want to impact my community. I want to impact the Lower Valley or the West Valley.’ Heritage teaches you to stay in your own community without you even noticing that’s what they’re doing.”
As far as advice she’d offer those considering going into nursing, she said, “You have to have the passion and the discipline. You have to love it, because it’s going to be hard.” But the payoff is worth it, with the median annual wage for RNs at $70,000, according to the Bureau of Labor statistics. There are 11 seniors now in the Heritage BSN program who plan to graduate in May. Ten of them are planning to stay here and serve the Yakima Valley community.