 and welcome to the latest edition of Tell Health in Hawaii. I'm your host, Vikram Acharya. I'm the Chief Executive Officer of Cloudwell Health and all virtual telemedicine platform based in Hawaii. We have a very cool show for you today. We have two nurse practitioners, educators and leaders. Becky Yosa and Pamela Smith, Becky and Pam, how are you today? Good, nice to see you. Thank you for having us today. Always a pleasure to talk to both of you. The topic today is Shamnaud University in healthcare. Becky and Pam, it looks like you're taking care of patients right now. We're always prepared for that. Exactly, exactly. To get things started, tell me a little bit about yourselves. We'll start with Pam, where you're from, what got you into healthcare and we'll go from there. Well, sure. I'm originally from Baltimore, Maryland, but I've been here in Hawaii for 20 years and I've always had a passion for healthcare, for helping others and really being a part of the solution. And my career evolved from being a registered nurse to becoming a nurse practitioner and through my experiences in clinical practice, then desiring to become a educator and administrator so that I can help others be part of the healthcare system. That's excellent. Becky, tell me a little bit about yourself. Hi, thank you for having me. So I'm from Benton Harbor, Michigan originally. I started out in survey research, more of social sciences, I have a sociology background and I sort of fell into data management for clinical trials research and the clinical area was becoming more interesting to me. So I decided to become a nurse and I was a registered nurse for a few years in Colorado and the providers that I was working with really encouraged me to become a nurse practitioner and have more autonomy and decision-making and independent practice. And it was actually Pam that recruited me to become an educator, to be a mentor, preceptor and clinical instructor for her family nurse practitioner students and then it evolved from there. That's very interesting. So you guys have known each other for quite some time. Now you both made the jump from registered nurses to nurse practitioners. We'll start with you, Becky. What made you wanna make that advancement to becoming a nurse practitioner? That's a great question. So as I was working as a registered nurse, I just wanted to learn more and expand my practice so I could take better care of my patients and the providers that I was working with, I was an inpatient registered nurse in Colorado and the providers I was working with, it was physicians, but it was also physician assistants and nurse practitioners in the hospital as service really encouraged me because I would always ask questions about the patients, about their care, about the path of physiology, the pharmacology. So they really encouraged me to continue my education and become a nurse practitioner. And I really wanted to have that independent practice which thankfully in Hawaii, we have independent practice as nurse practitioners. So it's a real advantage. Emma, what brought you to make the decision on advancement? Yeah, great question. For me, I found that I wanted to have more autonomy to care for patients in a more comprehensive manner. I found that oftentimes there were, or sometimes there could be pieces missing from a patient's care, not connecting all of the dots and looking at the patient as a whole. And I found that advancing my education as a nurse practitioner so that I can help patients really be treated with from all angles in terms of looking at what are their social determinants of health? What are their health care, what are their risk factors as far as their lifestyle? And all the way to, okay, well, what disease processes do they have? What medications are they on? Is every angle being looked at and really being able to offer that systematic, sorry, systematic process for each patient as well as the healthcare system. And to be able to say, look, the healthcare system could use effects here, let's look for solutions towards that. Yeah. Both of you mentioned the level of autonomy for nurse practitioners in Hawaii, which is great, especially I would think when it comes to addressing the significant shortage of providers there are in the state of Hawaii. Is that a fair assumption? Absolutely, yes. And that's one thing that we prepare our students to do. We have a family nurse practitioner program track and also a psych mental health track. And we are training our students to really step in and fill that void. There's a huge shortage of primary care providers. So our family nurse practitioner students when they graduate are able to step right into that role and take care of patients, either own panel of patients for primary care. And there's also a huge shortage of psych mental health providers. So our psych mental health nurse practitioners with also with independent practice are able to step in and fill that void and take care of patients in Hawaii. Yeah. Now, go ahead, Pam. In fact, that's why we chose to focus first on these areas, both family practice and psychiatric mental health because those are really the areas of need that we see at the forefront currently in our healthcare system here in Hawaii. And we wanted to make sure that we're meeting the needs of the community. Yeah. That's wonderful. I mean, to have the availability of nurse practitioners to provide care for many in need. So you've become nurse practitioners, but now you're also educators and leaders, professors at Shamanad University. We'll start with Pam. What's your role at Shamanad in terms of education and leadership? Yes. I'm the associate dean here at Shamanad University. And so my role is to help everything go smoothly and advance our education for all of our students here. And in that role, I'm also the DNP or Doctor of Nursing Practice Director. We started our program a year ago and my role here is to lead that program with my colleagues. We have a FNP track coordinator who you're meeting here, Dr. Bakioza, a psychiatric mental health nurse practitioner, track coordinator, Dr. Dana Munday, as well as an executive leader coordinator. And so together as a team we make, we're here to prepare the students for what they're going to see when they graduate so that they're best prepared. Bakioza, what's your role at Shamanad? So I'm an assistant professor and also the family nurse practitioner track coordinator for the Doctor of Nursing Practice program. So we have three tracks, the executive leader. So those students have a master's degree in nursing already. They're typically leaders in the community already within healthcare organizations. And so we're just taking them that step forward to the Doctor of Nursing Practice degree where they can look at the healthcare system from a population health standpoint, systems organizational vantage point, which all of our tracks will do. And then as the FNP track coordinator, I'm guiding and mentoring our students through the program, specifically that the FNP track students teaching them their didactics, but also coordinating with their preceptors, who they're working with out in the community. I'm placing them in those clinical sites. So matching them with a preceptor that's gonna meet their needs and the student strengths to bring to that organization. So I'm a matchmaker, if you will, and then a mentor and then assisting the students as they go through their program and providing that mentorship and guidance as they prepare to take their board examination, get their license, and then start working out in the community. These are very big roles, both of you have. That's wonderful. Now, when it comes to healthcare, we have the, let's call it the traditional model of taking care of patients in person. But now, especially throughout the pandemic and then post COVID-19 pandemic, we have Tell Health. Both of you are active providers in the Tell Health space, but you're now you're also playing a role in teaching the future generations of nursing practitioners about Tell Health at Shyamalan. Can you walk us through a little bit about the great work you're doing? We'll start with Pam. Yes, absolutely. Tell Health was a part of the healthcare landscape before COVID, as you know. And with COVID, it's just increased exponentially. Tell Health has been part of NP education or nurse practitioner education prior to COVID, but what the past few years have changed with the COVID-19 pandemic is that the amount of Tell Health, as you know, has increased in the healthcare delivery model from primary care to urgent care and specialty settings. Our students will be graduating and we're in a few years and we're preparing them to work in the environment, the current healthcare environment and the future healthcare environment. And so what we've noticed is that we need to increase, well, we've implemented quite a bit of Tell Health education in the curriculum so that they're prepared when they graduate to work in their setting, both at our FNP track and our psych mental health track. The students will have experience doing Tell Health in a simulated environment with simulated equipment, as well as in the direct patient care environment where they're working with a preceptor, delivering care to patients and so that they're getting that real life experience and preparing them for what the future holds. That's very exciting. Now, Becky, for nurse practitioner education, there's already so much that they need to be taught and how do you incorporate the critical component of Tell Health into an already very busy, very extensive curriculum? How do you carve out the time but make sure they still focus on other aspects that are equally important? Well, that's where the challenge comes in as educators to be creative and learn to incorporate these technologies and these modalities into their education. So what I like to do is incorporate other learning objectives at the same time that we're teaching them the Tell Health modalities. So just as we're teaching them how to assess patients' hands-on, so whether they're seeing the patient in person, we're also teaching them, okay, how do you assess that patient over a Tell Health visit? So we can incorporate that right into their coursework. For example, we're teaching the Advanced Health Assessment course this summer that is for both of our NP-track students. And so we're just incorporating that right into the course. This is how we assess our patient, both in-person and virtual. We've learned as providers over the last few years with the pandemic, we have had to adjust our own practice of how do we learn how to take care of patients in this modality because we were forced into it with the pandemic. So that is why it's very important that our faculty is very experienced providers in the community already that we've learned from our own experience of how we've had to adapt our own practice. And so then we're able to bring that to our students and incorporating a lot of the newer technologies that exist and continue to grow as a result of the new push towards Tell Health. There's all these products available that we can use right in our program and right in our coursework to bring that to our students so that they already have that experience when they are ready to graduate. And now Pam, when you design the curriculum, is it first you need to learn really the in-person, hands-on care and then we go to Tell Health? Or is that the progression or is it more parallel or how does it work from a chronological standpoint in education? Sure, absolutely. Well, first the students, they're coming in already as nurses as registered nurses with bachelor degrees and some have master's degrees. Some even have additional NP certification. But the first year of the course for our DNP students of courses are core courses that they need to build upon such as advanced health assessment, advanced pharmacology, advanced pathophysiology. These, this framework of or a base and a foundation that they can then learn their work, the clinical skills and management components is the very first step. So once they've learned some foundational framework, they then move forward into their track specific courses where they're learning how to diagnose and manage patient care in acute set, mostly in the primary care setting for the FNPs and in all practice settings for the psychiatric mental health. Both programs span the lifespan, so children through geriatrics, children, adolescents, adults and geriatrics. Through this didactic coursework as well as laboratory experiential coursework, they are then concurrently at their second year placed with clinical preceptors. Those are one-on-one encounters with preceptors, a variety of preceptors through that year, typically about three. It could be a little bit more, but what they do, what the students will learn in that process is really to provide that patient care, direct patient care, both physically one-on-one in the real in-person environment, if you will. And then some students will gain that telehealth experience. So it's not necessarily, the foundation is prior, and then their clinical experience will depend on what their needs are, what their gaps in knowledge are, and what their aims are, but all students will have in-person experience with patients hours, and then that telehealth component will also be added. What we found is through those many hours of experience, at least 500 hours, but really closer to by the time that they're done with our program and their project, it'll be many more hours than that, a total of 1,000 or more hours for their DNP. And that is that having that breadth of experience, both telehealth and in-person, will provide them with that solid clinical knowledge base to provide care when they graduate. That's really interesting. Now, Becky, with the generation and cohorts that you're educating now, who probably use a fair share of social media and think, is there more of a proactive interest in saying, oh, I wanna do telehealth? I really like it, and that's my focus. Do you have more of that now, or is it more towards, let's just call it, the traditional form of nursing? Are you seeing more of what I wanna do, virtual? Definitely, the younger generations are more tech savvy, I'll say. So I think it's easier for them to learn some of these technologies that we're learning. We do have a wide range of experience levels with our DNP students. So we do have some students that aren't necessarily in that millennial generation. So, and we have different ability levels as far as their technology knowledge. The nice thing is that we have a lot of partner organizations that assist us with some of these products, and they love to come in and do demos and teach the faculty as well as the students. And a lot of these products are very easy to use. And we're finding that the telehealth, it really assists with expanding access for patients. And I'm finding that a lot of my older patients actually love the telehealth because they don't have to leave the house. And they're learning the technology, their children and their grandchildren are helping them with the technology, and they're loving it. So it definitely goes both ways. And most of our students, they just wanna absorb everything, all of the knowledge. And one thing I wanted to add to what Pam was saying is out in the community, when we match our students with the preceptors, and then the students go and perform that direct patient care with their preceptor, the preceptors are already providing that telehealth as part of their practice. So the students are getting that experience in clinical where they're already seeing patients virtually and patients in person. So it's pretty seamless for the students. And the nice thing about our program since it's new and we're building it from the ground up is that we get to build it the way that we want it and be on the cutting edge, as opposed to having to go and rework to try to incorporate the telehealth into something that is already existing. The faculty are very experienced and have taught nurse practitioner students for many years, but we're also experienced providers. So we have that ability to seamlessly incorporate it into our curriculum. Yeah, you know, how do you teach students to approach a telehealth mental health visit versus a telehealth urgent care visit? Obviously you're breaking down the clinical diagnoses, but how do you go about doing that from a virtual standpoint because you probably have students that wanna pursue mental health as well, I would think. Absolutely. And the need for mental health care providers is increasing. And so we're starting to see an increase in demand for that education as well. Nurses are realizing that that's where a lot of the need is and they want to prepare to provide care in that setting, and also they have passion to provide care in that setting. Telehealth and mental health, the mental health discipline has been here for a very long time. It started there, right? Before we started to do exams and assessments on patients outside of mental health, we were, for many, many years, healthcare has been doing psychiatric mental health care via telehealth. So that transition has been more gradual over time and it's something that's been done in education, not just NP education, but also for MDs and medical education for a while. So preparing preceptors and providers for that is not as much necessary because many of them are already doing it, right? Because they've been providing that care and that capacity. So what we always like to do is ask the patients if they are comfortable with having a student. And the student, of course, is dedicated to this education. They're going to be providers. They're professional and licensed already as RNs. And that's explained to any patient that might be in this opportunity, also in the FNP world as well, not just like mental health. But with the patient's consent, and if they're comfortable with it, then we can proceed with that dual, providing of care where there's the provider, as well as the student interacting with the patient to really see what that patient needs and help make a plan for their care and management of their care. So it's something that's been going on. And what we've seen is there's also a lot of tools out there. There's toolkits for educators and preceptors who might be new to it so that they can prepare and become accustomed to it. Also having mentors that have done this in the past, linking them with any new provider that might be doing this is also a way to kind of train and provide resources for that next step. That's very exciting. Now, on a personal level, how do you toggle between these various roles that you have when you're seeing patients, when you're educating, you're providing leadership for the future of your profession and for Shalmanad. How do you balance both? We'll start with Becky. How do you wear so many hats? I think we're used to that as nurses. Yeah, that's good. When we're taking care of patients as nurses, you have to be maintenance. You have to be housekeeping. You have to be pharmacy. You already have to do all of that anyway. I teach my undergrad students that as the RN, we're the gatekeeper and we're kind of doing that care coordination. So it's similar when we're wearing these different hats. It just comes with nursing. But what I love about being a professor and being a provider is they feed off of each other. So always when I'm in the classroom, I'm always relating to my students. So definitely being a practicing provider definitely helps me in the classroom and the other way around too, that being up on the latest evidence-based practice as a professor, it helps me in the exam room too. So, and then just with coming with that experience, then I'm able to share that with students and mentoring, it just, it comes naturally. That when you're experienced, you want to help out less experienced providers and students that mentoring and educating, it's part of the nursing role where advocates were teachers just in our nursing role. And so it all, it all feeds on each other. Yeah, Pam, Becky just gave a great analogy. You can quickly pivot from what you're seeing clinically to providing the high quality education because you're in it every day. That's right. Yep, having that experience without a doubt, it's easy to lend that experience forward because we're currently in practice, we're currently leading in an environment and we're able to seamlessly transition that content to our students for their benefit. It's just incredible, the both of you, everything that you do on a daily basis, you're providing care, you're protecting people, especially during the height of the COVID pandemic, you were there on the front lines providing care, but you're also looking at the future of your profession and making sure that the future of being a nurse practitioner is well designed to now accommodate and integrate telehealth. And I can't thank you enough for being on the show. And both of you just do such a great job, not only taking care of the patient, but also shaping the future. And it's just an honor and we're all very grateful for what you're doing in the community every day and the great work you're doing at Shyamana. Well, thank you so much for having us and we are so happy to be a part of this. Thank you very much. You're most welcome. Mahalo, thank you. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. You can also follow us on Facebook, Instagram, Twitter and LinkedIn and donate to us at thinktechhawaii.com. Mahalo.