Welcome to the Becker's Healthcare Podcast. I'm Chris Sosa, the copy chief here at Becker's, and I'm thrilled to be joined by Denise Harmon, director of medical surgical pediatrics at Olympic Medical Center in Washington. Denise, thank you for joining us today. You're welcome. Denise, for those in the audience who are maybe not familiar with you and the work you've done, would you mind introducing yourself and telling us a bit about your background? Sure. As you mentioned, I am the director of the medical surgical pediatrics department here at Olympic Medical Center. We are a small rural community hospital serving the very, very far Northwest of Washington state. My background is mostly med surg. I have had this position. It'll be three years in April 0. Before that, I worked as a bedside nurse in this department. I've done a variety of things, some pediatric home health, long term care, some clinic work. But I love the the med surg department, so I like the the pace and the exposure to different things. Our house, as I mentioned, our hospital is a rural hospital. My department happens to be the largest 1, for what it's worth. It it has 40 beds, so that gives you an idea of of what our hospital looks like as a whole. Yeah. I think that kinda covers my background. It's pretty straightforward. Well, terrific, Denise. If you wouldn't mind for our audience, could you lay out some of the top priorities today from the the angle, the example that that you push forward? Your background, that is, is from a rural community hospital. So our our top priorities are making sure that our hospital stays up to date with the with the latest and greatest, being that we are kind of remote ish. It it does take a little bit of time for kind of the newer stuff to to hit our our hospital. 1 of the unique things about our department in particular, it we do have pediatric patients, but we, also take care of adults. So it's kind of a combination adult medical surgical pediatrics. So that means that our our nursing staff has to be able to care for that very, very diverse population. So our our main priorities are making sure their education is up to date, making sure that they know what is going on in the world of peds, as the majority of our patients are not peds. So that is I am in constant contact with our local pediatric clinic who has a relationship with some, pediatric hospitals in the Seattle area. They do a really good job of making sure that we are, you know, updated on any changes in processes or, hey, you know, now we're treating this condition differently. This is what we're doing now. And our main priority is making sure that our nursing staff is familiar with those changes and comfortable with those changes so that they can provide the care that our patients need. Thank you for laying all that out for our audience, Denise. Speaking of changes, looking at the next eighteen months or so, how do you anticipate your role is gonna change and the role of your team? So, I am not sure how my role is going to change. I know that we, are coming out of the post COVID, slump, as I like to call it. We had a huge amount of turnover. You know, our organization as a whole is kind of bouncing back from from that where we were just kind of rolling minute by minute, figuring things out. Now we've got time to breathe and we're we're refocusing. So my role is will remain the same. But I know that it's going to shift into a different direction with different responsibilities as as things arise. As far as my my team goes, we had a large turnover of more experienced nurses, so our team is relatively young. We also are finally coming out of the, heavy traveler nurse, population. We had quite a few open positions, that we had filled with travelers and now we are getting nurses in. Some of those are fresh graduates, some of them are experienced nurses from other other areas. So as we build our team back up to permanent staff, there are a lot of changes that come with that. So we have to build a lot more familiarity with our pediatric population. How how we do things because they're they're, you know, during COVID, I think people just kind of did the best they could with what they had at the moment. And so there was a lot of, spur of the moment decisions like, hey, this is what we're going to do right now. Not a lot of time to really think through and develop a solid processes. So we are working on improving our pediatric orientation and education process for our nursing staff. So that is more clear, more in line of what the other facilities in our area are doing, where we know that if we end up having to transfer a pediatric patient out, that our care is gonna line up with what their next step in care will be at those higher acuity facilities. Making sure that our staff is comfortable caring for pediatric patients. You know, we have we have brand new nurses out of nursing school who are in their early twenties, no experience with children in any way, shape, or form. They tend to get that deer in the headlights look and panic when you say, hey, here's a kid. Let's, orient and train with them today. So, getting them more familiar with that population. We have been working really hard on building better relationships with our pediatricians. We have a great team of pediatricians here that are very good at making sure that our staff knows what the plan is, knows that they're a resource at any time they can reach out. So over the next eighteen months, we're gonna focus on that education and building up those stronger relationships and getting those policies and processes solidified so that our staff is comfortable, and we know that we are providing the best possible care to our patients while they're here. Chase, I'm glad you mentioned, the younger nurses and the amount of turnover you had. Certainly, your organization is not the only 1. But I'm curious as to what you find are the most important resources when you have a younger crop of, nurses and other staff coming in. So our our most important resources are our more experienced staff. They they do a great job while we have less than we had before. They do a great job of kind of calming that panic down. You know, you're you're a new nurse. You feel like you don't know anything. Everything is, you know, appears to be a huge deal when in fact it isn't. So we utilize a lot from our experienced nurses. They're they're great, kind of keeping people in check and helping people out. We have our education department has actually, in the past few years, started a residency program and it has progressed over the years. It's it's a year long program for them. The residents, they meet weekly with their cohort. They get to bounce ideas off of each other. They get to work together with all of the residents in the different departments to kind of give each other a bigger view of the of the hospital as a whole and what everyone's different roles look like. So there's that good interdepartmental communication. Whereas, you know, we're not kind of siloed out together. You know, med surg does their thing. The ED does their thing. ICU tele does their thing. So we have really worked to build those relationships between departments so that we all get a better idea of what's going on. So, you know, people are a little bit more, you know, we're we're giving each other a lot more grace. And those those things, the, more experienced nurses and the the continued education, the residency program have really really helped our new grads feel more comfortable. They're you know more comfortable asking questions that they're they have really really done particularly well. We've noticed a significant improvement in their ability to to, you know, kind of flex on the fly and handle things as they come up over the past couple of years as they as the Education Department has tweaked that residency program, it has been a big help, in getting those new nurses, you know, comfortable and and ready to go. Well, it certainly sounds like they're benefiting from all the communication and infrastructure that you have out at your organization. Denise, the next and last question I would ask, it's a 2 part question. And 1 is, you know, what's getting you really excited right now, I should say, about the health care industry in general, and what is making you a little nervous? I think that what I'm what I'm most excited about is that there's really an a lot of collaboration between organizations, and I'm sure that it's not just specific to to our hospital. I'm I'm I have, you know, read white papers and done some research and it and it seems as if hospital systems are communicating better with each other and kind of providing tips and resources, because we all essentially have the same issues going on. And, being able to reach out to to another facility and and ask them, hey. How did you handle this? You know, what worked for you? What didn't? That that collaboration, is really, really exciting to me. Particularly, I've been in this role. It'll be three years in April 0. So I'm I'm wouldn't say I'm, like, you know, know all the things. So being able to have that collaborative relationship with other organizations, I know I can reach out to other hospitals in the Seattle area or other places in Washington and kind of say, hey, you know, your your facility looks about like ours. What are you doing to help solve this problem? And it it really helps. First of all, it helps reassure, you know, me that, hey, it's not just us. And it helps provide better continuity of care for our patients. If, you know, we're all kind of on the same page, we're all working things out. We don't have to start from scratch developing some kind of process if someone else has kind of, you know, worked through that and, you know, lets us know what their hiccups were. It is a real big turn, I think, for health care, which it benefits everyone. Along the lines of what makes me nervous, as I mentioned previously, we have adult and pediatric patients. We don't have a lot of pediatric patients, and the majority of our pediatric patients are, respiratory patients. So we get them during, you know, the flu season with RSV and that sort of thing. We are seeing more kind of post surgical patients, you know, here for appendectomies or, you know, a cellulitis patient. But what makes me the most nervous is the amount of time that it does take to orient and train our nurses just based on the low number of of pediatric patients. Even a lot of our more experienced pediatric nurses are kind of like, hey, you know, it's been a long time since we've had a peds patient, you know, because maybe they didn't work the week that the the patient was here. And so what makes me the most nervous is making sure that that my nursing staff stays comfortable. They keep their skills up, which I working on that with our pediatricians, you know, hey, what can we do? What other resources do you offer, in the kind of downtime between pediatric patients? But that is kind of where the the nervousness comes in for for me in our organization. Denise, you have been incredibly generous with your time and your insights today, and I want to thank you for that. We absolutely cannot wait to share them with everyone in our audience, and we look forward to connecting with you again soon. Great. It was a good time. Thanks so much for the opportunity.