Training Resilient Healthcare Workers – Dr. Lisa Urban, Southern New Hampshire University

Dr. Rishi Desai: Hi, I'm Dr. Rishi Desai. Today on Raise the Line, I'm happy to welcome Dr. Lisa Urban, Associate Chief Nursing Administrator at Southern New Hampshire University. Lisa brings a wealth of experience in higher education, research, and clinical practice to that role, and I'm looking forward to getting her perspective on the current challenges and opportunities in nursing education, and specifically how COVID has impacted nursing education at SNHU. Thanks so much for being with us today.

Dr. Lisa Urban: Thanks.

Dr. Rishi Desai: So I'd love to, first, back up a little bit in time and learn more about what got you first interested in healthcare, particularly in nursing.

Dr. Lisa Urban: Yes, so everyone has a story right? I think what really drew me to nursing was my love for the sciences. I probably could have gone in a few different directions. I also loved animals. I love people too. But I was thinking about a veterinary career. And I think what sealed it for me was the life experience. I was fortunate enough to be in a high school that offered a nurse's aide program while you were in high school. It provided some academic background of what a nurse's aide would do, but also exposed us to other healthcare providers. We went and took care of patients. I think that kind of sealed it for me. I just fell in love with it, and I knew I wanted to do more. It was a natural career choice for me to start in an undergrad nursing program.

Dr. Rishi Desai: Did you have any friends, family, that coaxed you into it or out of it, as the case may be, at the time?

Dr. Lisa Urban: Yeah, I think I did have some influence. One of the families that I babysat for—we all babysat back then—was a physician, and he really encouraged me to seek that path, and also provided some additional experiences. Once I was in nursing school, he let me work, to my ability and skill level, in his office. I got real exposure to primary health care. So yeah, I did have that influence. But I think for me, still, it was the love of sciences and knowing that that would be the strong basis for nursing and nursing practice.

Dr. Rishi Desai: Got it. That's fantastic. What then drew you into teaching and administrative roles in education?

Dr. Lisa Urban: As you know, one of the cornerstones for nurses is to teach. We teach patients about their disease, about how to manage their disease, about the treatment plans that will help them regain their health and as a practicing nurse, I was able to mentor new staff. I think that, again, was a life experience that helped me develop that love for, "Hey, maybe I want to do this more." 

When you teach a nursing program, you still take your students to the hospital. You're still taking care of patients, but you're interacting with and creating the new nurses for the future. I think that was a passion. I started nursing in the late 70s, and there was a nursing shortage— go figure, right? The nursing shortage gets a lot of press, and we're making some progress, but it's always been there. I just felt like it would be a skill that I had. People told me I was doing a good job as a mentor. I went on and got my master's, and then later my doctoral degree, because I really wanted to educate that next generation of healthcare providers.

Dr. Rishi Desai: That's a good segue because, obviously, in terms of educating the next generation specifically of nursing providers, SNHU has an amazing program. Do you mind giving me and our listeners an overview of the program, as well as what you think differentiates it from other programs that are out there?

Dr. Lisa Urban: Sure. We offer an RN-to-BSN program. We don't have a pre-licensure program at this point. So all our students come to us as a registered nurses. They're across the country. They're in associate degree nursing programs, and are already looking to further their education in a BSN. So we have some pathways that we have designed with specific community colleges to make sure that transition is easy for students, so that they don't have to repeat coursework. They're ready to go and then they can do a two-plus-two program.

We also offer our registered nurses an opportunity to select, if they're successful, to be on the pathway to the MSN too. They can do that after their bachelor's, or they could do it along with their bachelor work. We have a program designed where they can select to take a couple of graduate courses while they're working with us on their BSN. 

In that way, they can speed up their progress toward their master's work. Because we know time is valuable. We're very conscious of the fact that our students are working adults, and they're concerned about the cost of education. Anything that we can do in design to help move our RN's along that educational pathway, we're always open to doing that.

So, again, still maintaining quality, but trying to move them at a faster pace to their end goal. We offer five tracks in our master's program. We just redesigned our portfolio based on a market analysis, and really we listened to our students. Which I think sets us apart a little bit. Everyone says they do but we really do. And we heard that students wanted more opportunities to advance their careers, so we now have a nurse executive leadership program. We have a nursing education program, which was redesigned and updated. We have our first advanced practice registered nurse program, which is a family nurse practitioner, which will launch in October. 

And we have population health care, and we're really happy about that with the pandemic. It's a great field for addressing populations, which has always been part of nursing but not as much a specialty. We saw it more as a specialty in public health. But now we're launching that program, so we hope that fills a need out there. And last but not least, we continue to have our health care quality and safety program.

Dr. Rishi Desai: So it sounds like... if I'm trying to digest everything you just shared, there's a lot more flexibility in terms of how it's offered, and meeting people where they're at in terms of the logistics and their time and things like that. And then there's also a lot more content offering in terms of different interests that people may have. Given that you've been involved in nursing and nursing education for many decades, do you see this as a major change from how nursing educators viewed what they ought to be offering, maybe 20-30 years ago?

Dr. Lisa Urban: I do. I think with the information overload that we see, we really have had to step back and say, "What are the skills sets that people need?" And we design that by really listening to our stakeholders. When we just did our redesign for the MSN program, we had a lot of meetings with people who are out there, hiring nurses, saying “here's some skill gaps: If you're redesigning your programs, you should really start looking at those softer skills, so that they're transferable to whatever role that a person is in the field of nursing.”

As you know, people think of acute care for nurses, but nurses work in lots of different organizations, across lots of different types of health care. We've designed our new courses and programs to really reflect that we want nurses to share their practice experiences in the courses—to look at the challenges they're facing and try to solve real-world problems. A lot of our assignments are, "You tell us what you're struggling with. Here's the concept that we want to address. But we want to use a real-world example that you can go back and improve your practice or improve the care and outcomes of the patients." We're really trying to do a lot more of what I would call more general type concepts and competencies that are transferable across multiple organizations, and will really help provide a high-quality practicing nurse.

Dr. Rishi Desai: That's a really interesting frameshift. You're trying to create the foundational skills with the understanding that the realities are going to shift day to day or week to week. And so, you want to make them as adaptable as possible. With that theme of adaptability in mind, one of the things that have been very clear is that there's this nursing shortage, and part of the shortage even before the pandemic is that a lot of folks are feeling stressed, burnt out, unappreciated, overworked. What is your take on how to best deal with this both for active nurses in the field as well as trainees that are about to go out there?

Dr. Lisa Urban: Yeah, I mean, there's certainly a documented increase of stress and burnout. We have close advisors that we work with our students. Every student has their advisor, and it's usually the same advisor unless the advisor leaves for some reason. But they get attached to their advisor and the nursing students go to their advisor for advice. We recognize the stress of our students. We did extend deadlines routinely because we knew that that would help with making our students successful.

We did some customization, I call it. Deadlines—the university extended that across the university too and supported that. We also had some self-care activities for students. We have a counseling department, so they were able to help students with thinking about quick meditation, just ways to disengage, to leave the stress behind. And then when they're refreshed to come back to whatever it is: The care of their family, the care of their patients, or their studies.

We did as much as possible, and we continue to do that through quick videos. We also offer some one-credit type continuing-Ed offerings that are self-care oriented, because as we know, the pandemic has continued. And with the upsurge, students really just need to be listened to and supported. As a university, we provide some mental health resources. We've always had some support like that. But now, we have worked with the advisors to really try to, at least, raise that question: "How are you feeling?" And as you know, nurses are very honest, and if you can connect a student with a resource, it could make a difference, not only in their life but in their progression and education.

So anything we can do to help relieve some of the stress. We don't want education to seem like a huge stressor. We've also allowed students to say, "Maybe I need to step back and take one course versus two courses." Even though they were so committed to doing that, it just allows them to step back for one 10-week term and say, "I can continue. I can be successful, but I just can't do those two courses right now." We're trying to be as flexible as possible. I call it customized requests. We really do try to listen to individual needs.

Dr. Rishi Desai: That makes sense. And obviously this year, those individual needs are probably adding up with COVID and Delta, causing a lot of stress in people's personal lives, and taking care of their own health in some ways. Have there been a lot of educational shifts or changes that you've had to make to accommodate that?

Dr. Lisa Urban: Yes. Just like everyone else, our students have to do some direct care experiences. So, we have been faced with trying to craft experiences that will meet their needs, but using other formats like simulation and telehealth opportunities. We've always had a nursing education track, and our nursing faculty have stepped up big time to welcome more students and manage more students to help them with online teaching experiences that they might not have had an opportunity for, but again allows them to apply concepts that they were learning in the classroom. They probably were going to a community college to do things, but then the doors were closed. So, we're really just trying to be as creative as possible to make sure that the students get quality experiences. 

The world has changed, and those opportunities are reopening, but we know that we have current students and future students, and we need to be creative to figure out how to provide those direct care experiences in multiple formats.

Dr. Rishi Desai: Zooming out a bit beyond education. Given how you sit in different spaces—education, healthcare—what are some of your thoughts in terms of what the COVID crisis has revealed about our healthcare system in the US, and ways that you think that we might improve it or strengthen it in the future?

Dr. Lisa Urban: We all know that health care is a very complex system. We have students across the country and there are differences even in the same region of how one organization works versus another. As far as what I think could help the organizations that are dealing with the pandemic or future crisis, they should really look at their organization, themselves, and say, "What did we do well, and how can we get ready for the next round of whatever?" 

I think for health care workers, cross-training would be really helpful for organizations to think about. They've always done that but almost like an aside. And I think that, especially for nurses, just because I'm targeted to be an emergency room nurse doesn't mean that I could not do other functions in the hospital with some additional training. Get that readiness in place now, so that people can be more flexible. And I think that would help address the shortage areas in the hospital a little bit more.

Dr. Rishi Desai: As you know, we're a teaching company and we love to fill knowledge gaps. So I'll open it up to any topic that you feel our learners might benefit from filling in one of those knowledge gaps—something you can educate us on. What do you think everyone ought to know? And it can be from any field that you think is relevant.

Dr. Lisa Urban: I think, it might be a buzzword, but inter-professional teaming. For sure, nurses have worked on teams, but what I see, especially in the MSN program, is they need to lead those teams. How to be a leader on a team? How do I select the team? How do I get everybody's lens and input to get the best product at the end of whatever we're working on?

I do think that inter-professional education is super important. And we do have courses designed to do that. But what we hear from our healthcare partners is that not everyone's on board with that yet. That even though we've talked about interprofessional care and interprofessional teams, somebody still has to lead that in the organization. 

Not just the nurses, but teaching everybody how to collaborate more efficiently across units, across virtual environments too, because we know how many healthcare organizations are complex conglomerations. There are 10 different sites, right, and they're all supposed to work and help each other. So, I just think that that whole idea of "how do we collaborate well? How do we learn from each other? How do we get ready for those next challenges that we face?” By looking at resources, and then creating teams that can be flexible so that we can call on our teammates when that next pandemic arises.

Dr. Rishi Desai: One quick follow up on that is, one key member of these teams is, of course, the patient themselves. And one of the big challenges that has been in the news is how patients oftentimes don't believe in... you can fill in X.  Don't believe in this. Don't believe in that. And sometimes it's about masks or the value of masks. Sometimes it's the vaccine. Sometimes it's even in COVID itself. And sometimes it's even more broad than that. They just don't even believe their nurses or their doctors or don't believe what they have to say. How do you deal with that? What's your sense of how your trainees are being trained to deal with these issues?

Dr. Lisa Urban: I think we talk a lot about trust and how to build trusting relationships. It's not unusual that there's some mistrust, I think, with medicine. And some of that is due to possibly a past experience that the patient has experienced or seen in their family members experience. So, I think a lot of what I do when I work with students is to really say to them, "What can you do to gain trust?" If you say you're going to do something, do it and follow up and get back to the patient. If there's a delay, get back to the patient, so that there's a trusting relationship and then they'll be possibly more accepting.

The other thing that I think we need to do a better job in: We work a lot on diversity and that is one of the goals of our university to really become more diverse, equitable, and inclusive. We do that in the courses, too. But I always think that that's an area where we continually need to attract and mentor students who might not choose healthcare as their first profession, because we know that if patients are being taken care of by somebody that they recognize as inclusive of what they represent, they might be more accepting of the information we're providing. 

So really, to increase diversity of students should be a mission of all universities, especially in healthcare, because we know that can build trust. If patients see people that look like them, that represent them, they may be more accepting of the information we're providing.

Dr. Rishi Desai: That makes a lot of sense, and I think that's a really great point: It's not just the message but it's the messenger. And making sure that our messengers are speaking in the language that people feel comfortable with makes a lot of sense. 

One final question I'd love to ask—and this is really, in a way a personal question—is that people see you, they see that you have a career that's very, very remarkable, one that people would aspire to. How does one get there? If you're a student, and you're sitting there with an amazing background and professional story, how do they put the pieces in place today to try to get themselves to where you're at now?

Dr. Lisa Urban: I would say, keep all options open. Look for opportunities wherever you're working, if they're out working as a professional. I know that I was given opportunities that I probably needed to stretch to do well, but I always had a mentor who encouraged me to raise the bar, create those next career goals. And there's plenty of people to help you. 

I would say one of the best things that I learned was to write things down. I was a writer. I would write down a career plan, and have some goals and say, "Okay how long will this take? Maybe three to five years. Maybe it'll be five to 10 years." But really structure your life around some goals. And it's okay if you have to delay them a little bit because other life events happen. both positive and negative. We always have those kinds of things that happen in our life. 

Do some self-reflection and self-assessment. Follow your passions. What do you like doing? What's the best part of your job? And maybe that'll be what triggers you for that next opportunity, and may trigger what you decide to do for the next degree too—whether you want to be a nurse practitioner, an advanced practice nurse, or you want to be an educator, or you just say, "I just fell in love with administration. I have great communication skills. I have great organizational skills. So, I'm going to look for a program and mentor that can help me do that." Again, look for opportunities wherever you are, whether it's in your personal life or your professional life, that will help you get those skills that you really want to use every day, and that you're passionate about. I hope that explains it.

Dr. Rishi Desai: It does. It's a very inspiring answer and a very humble one, given all that you have done. It's a really powerful and inspirational message. So, I want to thank you very much for joining us today, Lisa. That was fantastic.

Dr. Lisa Urban: Great, and I appreciate it. I appreciate all the work you're doing to help educate all health professionals. It's an interesting and challenging job that we have.

Dr. Rishi Desai: Yes, indeed. I'm Rishi Desai, thank you for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together.