Indiana State Shows Way in Rural Health Care

Features, Top Stories — By on February 25, 2011 3:27 pm

A nursing student takes a blood sample.

As a nursing student in 1967, Esther Acree was nervous the first time she had to give a shot. Painless injections were the stuff of science fiction’s Dr. “Bones” McCoy on TV’s Star Trek. 

“Being in the hospital for the first time, right out of nursing fundamentals class, I had to draw up 3cc’s of penicillin in a glass syringe, the kind where we used to sterilize the needles and draw up the medication,” Acree said. “Miss (Helen) Dean, our fundamentals teacher, said, ‘You know you have to keep pushing it because it clogs up in the end.’ Well, I didn’t know that.” 

The shot went off without a hitch. Acree pushed, the penicillin didn’t clog and the patient had no ill effects. 

Acree completed her nursing degree in 1969, a member of the third class of ISU nursing program graduates. After a year working at Clay County Hospital, she returned to Indiana State as a faculty member and has experienced the evolution of nursing and allied health education from an era of playing catch-up – ISU was the last of Indiana’s major state universities to launch a nursing program – to its current status as a leader in developing new programs and partnerships to address the shortage of health care professionals. 

As in most areas, it is in technology that nursing education has changed the most at ISU since her student days, said Acree, associate professor and chair of the baccalaureate nursing completion program. Acree is also a former dean of the College of Nursing and former co-interim dean of the College of Nursing, Health, and Human Services. 

Students now benefit from pre-packaged injections with disposable needles and can practice on life-like human patient simulators so sophisticated they can even give birth. 

“Practicing immunizations and intravenous injections using the simulators, with skin that is so realistic, gets students comfortable in doing a skill so they can go beyond that skill and focus on interpersonal involvement, critical thinking and clinical judgment,” she said. 

Technology also allows Indiana State to offer nursing programs online, enabling practicing nurses and other health care providers to complete a bachelor’s degree or pursue advanced degrees while working around their current jobs. 

Esther Acree

Amid all the changes, one thing has remained constant. ISU nursing students still come largely from the small towns of Indiana and Illinois, said Acree, who hails from Harmony, Ind. 

Those students are attracted to Indiana State because of the individual attention they receive, Acree said. 

“In our clinical courses it’s a one-to-10 ratio; in pediatrics and medical surgical-intensive care, it’s one to six,” she said. “Students have very individualized learning experiences with their instructors, with each other and with their patients.”  

Students also benefit from the 2007 creation of the College of Nursing, Health and Human Services, which combined programs from the former colleges of Nursing and Health and Human Performance, Acree said. 

“We’re working together from all the different disciplines. It is so wonderful. The sharing from the merger is what is outstanding.  You get their perspective, they get our perspective and find out what each other have to offer,” she said. 

Working not only with other nursing students and medical students from the Indiana University School of Medicine, but also with students from such areas as athletic training, physical therapy, health administration and social work, prepares ISU students for the realities of practicing in rural areas, where specialists are in limited supply and preventative health is especially important, Acree said. 

New programs 

Doctorate in nursing practice 

The college has launched two new advanced degree programs this academic year and has a third set to begin classes in August. Four additional new programs are in the works, pending state approval. 

Susan Eley

The first such program, a doctorate in nursing practice launched in fall 2010, is still a fairly new program nationally and “exemplifies the professional terminal degree” for nurse practitioners, said Susan Eley, assistant professor of nursing and director of the DNP program.    

Accrediting and certifying bodies have indicated that by 2015 “doctoral preparation will be the expected degree for anyone seeking certification as a nurse practitioner or wanting to go into advanced practice,” she said. Nurse practitioners are licensed and nationally certified to deliver primary care. In many rural areas, they can be the only local primary care provider. 

ISU’s program is online, which provides flexibility for working professionals, Eley said. 

“An online program attracts students nationally, which adds a lot of diversity, and it also adds a lot of robust student collaboration,” she said. “Most of our applicants have significant years of provider experience. They are able to use those years of experience and knowledge to offer effective health promotion strategies and disease prevention care. 

Students in the program are required to develop projects that target rural or under-served populations. Kathy Miley, a nurse practitioner, is working on a community-based program to provide medical education to adolescents in partnership with Decatur County Schools. 

But Miley has another goal, one she set after her family of seven moved to Greensburg, Ind., and she found herself “like 278th on a waiting list for a primary care provider,” she said. She wants to open her own rural family clinic – possibly in Greensburg, after discovering how underserved the community is. 

Student nurses administer a test to a patient.

Miley works for a company that assists hospitals in 42 states with emergency room providers. A Chicago native who has followed her military husband around the country to communities large and small, she said she loves “the small-town feel” and that “nurse practitioners can educate and be an integral part of a small town community.” 

The DNP program currently serves 19 students – nine who enrolled in August and 10 who began part-time studies in January. While it is currently open only to those who have completed a master’s degree and are nationally certified as family nurse practitioners, in 2013 it will be converted to serve students with a Bachelor of Science degree in nursing, Eley said. 

Nurse practitioner Felicia Stewart, a Sullivan native who now lives in Indianapolis, is pursuing the DNP degree to enable her to teach nursing students and manage a student-run community clinic. 

 “I want to empower students to pursue their own educational goals and also want to facilitate communities becoming healthier,” she said.  

 Stewart’s student project is to integrate a health ministry into her church, Southport United Methodist. The idea for that project took root after both her parents were diagnosed with stage 4 cancer in 2008. 

 “The mental strain, confusion and feelings of purely being overwhelmed during a time like that is unbelievable,” she said. 

 Having a system established for treatments, doctor appointments, tests and medications helped relieve some of the stress for her parents and other family members. 

 “It allowed my parents to truly be able to refocus their mindset on living, not dying – even in the face of such dismal, late-stage diagnoses,” she said. “It kept cancer from completely taking over their lives.” 

Master’s in physician assistant studies 

A master’s degree program in physician assistant studies began in January with Dr. Randy Stevens, a practicing physician who was one of the nation’s early physician assistants, serving as its medical director. 

Randy Stevens

With physicians in short supply, many small towns are served largely by nurse practitioners and physician assistants and new federal health care legislation will only increase the demand for services, said Stevens, former director of family medicine at Union Hospital and currently director of the hospital’s Center for Occupational Health. 

“By 2014, 30 million more people are going to access health care that previously did not,” said Stevens. “That’s going to pose a real dilemma for the medical community because the providers, particularly physicians, are in short supply.” 

Physician assistants are licensed to practice medicine independently, under the supervision of a physician. 

Heather Mata, program director for physician assistant studies, said most students in the first class “seem quite interested in rural health care. That’s where we will focus our rotations and shadowing to make sure that’s where the students stay when they complete their degrees.” 

The program will expose students early to real-world experiences and focus on inter-professional education and practice, said Mata, associate professor of applied medicine and rehabilitation. 

“Get your hands dirty from day one,” she said, noting that students will begin shadowing providers in a variety of specialties beginning in February, “so that when they order a cardiac catheterization or colonoscopy, for example, they will understand what they are ordering and what sort of preparations are required.” 

Beginning in the second semester of the seven-semester program, students will be mentored by current health care providers in preparation for clinical experience in the second year. 

Heather Mata

The program stresses inter-professional education, in which students from a variety of health-related fields learn together.  “[It’s]something not a lot of schools are doing right now,” Mata said, “but the approach should serve ISU graduates well, especially those who will be working in rural areas where specialists are few and further between.”  

As a 1977graduate of the first physician assistant program in the country at Duke University, Dr. Stevens said it is a natural evolution for him to serve as the new ISU program’s first medical director. 

“It’s an exciting moment in time. My vision for the Indiana State program is that it will be a program of excellence for the area,” he said. 

Stevens served as a medic during the Vietnam War. Upon his release from the military, he enrolled at Indiana State, but transferred to Duke when it launched its physician assistant studies program. 

“They were looking for well-trained medics to come back and have something to fit into in the civilian world,” Stevens said. 

After working as a physician assistant for 10 years, he entered the Indiana University School of Medicine to become a doctor. He served his residency in Union Hospital’s family medicine program and was involved for many years with the Clay City Center for Family Medicine.  

Matt Becker of Evansville is a member of the first physician assistant studies class. He holds a bachelor’s degree in business administration from Washington University in St. Louis, but “after a couple of years in corporate business, I decided sitting behind a desk is not what I wanted to do,” he said. 

Becker was in the pre-medicine program at Washington and has worked as a firefighter and EMT. Patient care is his true calling, he said. 

The program’s approach, focusing on rural health and inter-disciplinary practice, together with the proximity of the ISU campus to his hometown and in-state tuition, attracted Becker to ISU. 

“It’s a good fit. I really like the faculty and staff and feel the program is headed in the right direction,” he said. “I thought it would be a great chance to have a personal stake in the new program.” 

Doctor of physical therapy 

The college’s third new program, the doctor of physical therapy, which will start in 2012, comes not only in response to the rural health care shortage but to changes in demographics. 

“[T]he need for physical therapy continues to rise because of the baby boomer generation,” said Lori Khan, program director and associate professor in the department of applied medicine and rehabilitation. 

Like other ISU nursing and allied-health programs, the doctor of physical therapy program will emphasize inter-professional education, Khan said. It is expected to serve about 30 students during its first year. 

“Having an interdisciplinary approach is very futuristic, both academically and professionally. Few programs are doing that,” she said. “ISU is in a very good place to be a leader in physical therapy across the nation. It’s centrally located to a lot of larger cities and yet in a rural population area that is not being served.”    

Planned programs 

The new programs include an accelerated nursing degree for persons who already have a baccalaureate in another degree, a master’s of social work, a master’s degree in occupational therapy and a Ph.D. in health sciences. Development of these programs recognizes not only the need for more nurses but also for more social workers, physical therapists, health educators and researchers – particularly in rural areas. 

In addition to the new programs, existing programs formerly housed in the College of Arts and Sciences, including dietetics and social work, have been moved to the College of Nursing, Health, and Human Services in a further effort to provide the most effective inter-professional education. 

“Indiana State and Terre Haute are rapidly becoming a one-stop shop for health-care education,” said ISU President Dan Bradley. “In the very near future, we expect that virtually all health-care programs will be available here. ISU is excited to be able to offer an increasing number of these important programs.” 

Richard "Biff" Williams

Richard “Biff” Williams, dean of the College of Nursing, Health, and Human Services, praised the college’s faculty and staff for quickly developing and launching new programs. 

“The college has made great progress since its creation in 2007. Our faculty are committed to student-centered education and to meaningful research. They’re also working to strengthen our long-running partnerships with the Indiana University School of Medicine, Ivy Tech Community College, Union Hospital and other health care providers to ensure the health care needs of rural America and other medically-underserved areas are met,” Williams said. 

McKee Nursing Center 

In addition to the new advanced degree programs, the college and the university’s Division of Student Affairs are stepping up efforts to ensure the success of undergraduate students. 

Sandison residence hall reopened last fall following an $11 million renovation with five floors devoted to themed housing for nursing and allied health students. It is also home to the McKee Nursing Center, thanks to a gift from Nancy McKee, professor emeritus of nursing, and her husband, Dale. 

The McKee Center includes offices for faculty advising, conference and classroom space and will feature the latest technology to allow students to get hands-on experience without having to leave their residence hall. 

“The first two years of college can be especially stressful academically for nursing majors. Faculty will now have more opportunities to go where students live and be available to them outside the classroom,” said Deb Barnhart, associate professor of nursing and academic advisor to first-year nursing students.       

“To live in a building where everyone is in the same major is very helpful,” said Katelyn Petrovich, a sophomore nursing student from New Carlisle. “Professor Barnhart has regular office hours. To have someone right downstairs to talk to makes a tremendous difference. It’s also a good, quiet place for students to get out of their rooms and study with people in the same major.” 

Rural Health Scholars 

Kelly Loman, a Rural Health Scholar, works with her father Dr. Chris Loman.

A Rural Health Scholars program, which awards scholarships to Indiana State and the Indiana University School of Medicine to selected students planning to practice in medically underserved areas, has been around since 1997. The first of its graduates have made it through the lengthy training required to become a physician and are now serving patients. 

Two newly minted small town doctors praise the program for helping them achieve their goals. 

“I knew I wanted to go into medicine. I didn’t know the road to take to get there,” said Dr. Jennifer Mollencupp, a native of Kewanna, Ind., who joined a nurse practitioner in an office in Austin, Ind., and also practices at nearby Rochester. “I had a very good advisor who helped me decide what the best path was for me.” 

Dustin Ellis of Dugger, Ind., who joined two veteran physicians at Sullivan Family Practice last summer, said the exposure to rural medicine that the program provided was invaluable. 

“Not too many undergraduate students get to spend time shadowing physicians and in rural critical access hospitals. Those experiences let you see what it’s really about to be a rural physician,” he said. 

Rural Health Innovation Collaborative    

Building on the success of the Rural Health Scholars Program, Indiana State and the Indiana University School of Medicine are partners in the two-year-old Rural Health Innovation Collaborative. The collaborative has two major goals: to further develop Terre Haute as a center for leadership in creating and implementing health care programs to meet the challenges of rural areas, and to redevelop the neighborhood between the ISU campus and Union Hospital. 

“In a rural community, education and health care are keys to success of these communities. If you don’t have a good school system, if you don’t have access to health care, that rural community is going to wither,” said Dr. Jim Buechler, director emeritus of Union Hospital’s Richard G. Lugar Center for Rural Health. 

“This collaboration has allowed us to look at all the shortages of healthcare providers so that we’ve got the right providers at the right location at the right time,” said Scott Teffeteller, Union Hospital president and CEO. 

In addition to ISU, the IU School of Medicine and the hospital, collaborative partners include Ivy Tech Community College-Wabash Valley, the city of Terre Haute, Terre Haute Economic Development Corp. and the Vermillion-Parke Community Health Center. 

“I’ve been involved in economic development in our community for over 20 years and I can’t recall another instance where we’ve had this many major players all pulling together for a common goal,” said Steve Witt, Terre Haute Economic Development president. “We think it will be a driver for new job creation, for attracting new students to Indiana State and Ivy Tech and for redevelopment of a 200-acre area between the ISU and Union Hospital campuses.” 

Witt said the area is ripe for attracting retail businesses, professional office buildings, research and development and single-family and multi-family housing. 

Attracting statewide attention 

From new programs in healthcare to its partnership in the Rural Health Innovation Collaborative, Indiana State is being noticed as a statewide leader in education and community involvement. 

“What Indiana State University has done makes so much sense and the university is going to see a great return on its investment because more and more students will be seeking out ISU for education to further their careers in health care,” said Dr. Richard Kiovsky, executive director of the Indiana Area Health Education Network and a professor of clinical family education at IUPUI. 

Among the top 50 growth jobs in Indiana, 26 are in health care and 54 of the state’s 92 counties are medically underserved, Kiovsky noted. 

“There are many students who grow up in underserved counties and many students from those communities go to ISU. Students trained in a rural setting have a far greater chance of returning to a rural setting to practice. It makes imminent sense for ISU to be involved in this,” Kiovsky said. “The Rural Health Collaborative is quite innovative and can become a national model.”


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