Q&A: Chief nursing officers discuss challenges facing rural hospitals during COVID-19


Ethan Kispert


Terra Palomarez is the chief nursing officer at Astria Toppenish Hospital, a rural medical center located in Toppenish, WA. Amber Hunsaker is the chief nursing officer at Astria Sunnyside Hospital, Astria’s second rural hospital located in Sunnyside, WA.

In this Q&A, both Palomarez and Hunsaker update State of Reform on the challenges rural hospitals are facing — such as staffing and bed shortages — amidst the recent surge in COVID-19 cases.

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Ethan Kispert: How has COVID-19 impacted your hospitals? 


Terra Palomarez: “What we’re seeing now is that … beds are very limited. So how do we maximize our resources, and pair patient acuity with the skills and abilities at rural hospitals? We have been able to take in transfers as a hospital which is not something you normally do in a rural setting … Very recently we were able to take six patients from four different hospitals into our facility to manage that care. That really gave us a sense of pride and an ability to say that we’re caring for the community at a greater reach.”

“From a global perspective, we’re facing a lot of the same challenges as health care across the nation. But as a rural hospital, we have to really pay attention to the specific needs of our community. 

As an organization, we’ve really had to step up our game and evolve. In doing so, we’ve had to prepare our staff and make sure that they have the skills necessary to respond as we have all learned.

What has been really great is that we’ve also had this really wonderful collaboration — not just within our hospital setting and in our hospital system, but across our valley and even across our state.”

EK: Governor Jay Inslee announced vaccine and mask mandates for all health care workers in Washington State on August 9. What’s your response to that? 

TP: “What we have to do as leaders is really transition and make sure that what we’re doing is supporting our staff with continued access and vaccine information so that they can make informed decisions. From a personal standpoint, I’m a huge advocate [of the COVID-19 vaccine]. I was so relieved when we were able to provide vaccines to our staff. “

Amber Hunsaker: “I think what’s really important is that if people are considering declining the vaccine, before they decline, that they get informed.”

EK: How is the Delta variant of COVID-19 impacting things in your hospitals? 

AH: “It’s a younger patient population that we’re seeing that are coming in very sick.”

TP: “I know for Toppenish over half of our acute care patients right now are here because of COVID…

It’s kind of like this convergence of a need for care. It’s not just the Delta variant and this new surge of COVID, it’s that people are out and about in the community again. They’re getting sick with other things. It’s not just COVID… they’re getting injured, and they need care.

Then you have the population of people who have not been able to get the kind of preventative care they needed … That is creating a strain for the limited resources in our health care system.”

EK: Shane McGuire, CEO of the Columbia County Health System, said that due to limited staff, his facilities are unable to provide services like surgical intervention and cardiac intervention, and that he must rely on telehealth and contract nurses. Are you in the same boat? 

TP: “From the perspective of travel nurses, obviously it comes at an expense which is hard. We’re bringing in nurses from around the country who have had experiences at other hospitals and can bring that to our rural setting.”

AH: “The only thing I’d like to add to that is that even though traveling nurses are expensive, the benefit is that we can continue to care for our community to the best capacity as we can.”

EK: According to the Washington State Department of Health’s COVID-19 dashboard, COVID-19 patients are taking up roughly 30% of all available ICU beds. What’s the situation like at your facilities right now? 

AH: “The COVID patients we have in house have transitioned from the ICU to medical surgical units… That’s the snapshot as of this hour right now, and that could change in an hour and the ICU could be filled with COVID [patients].”

TP: “At Toppenish we have less ICU beds than Sunnyside does, but all of our ICU beds are currently COVID patients. We have between two to four ICU beds on a given day depending on staffing, and they have all been for ICU and COVID-19 as of late.”

This interview was edited for length and clarity.