THE HEART OF HEALTH CARE
By Anthony Lane | Photography by Jerod Young | June 6, 2024
Growing up in the Philippines, Marilyn Doster got an early introduction to rural medicine. She lived with her grandmother, a certified midwife, and a knock at the door, day or night, served as a call that her grandmother’s services were needed. After walking to a laboring woman’s home, sometimes for miles in darkness, Doster assisted in a baby’s delivery, keeping forceps, towels, and other necessities at the ready.
Payment for her grandmother’s services sometimes came in the form of a chicken, eggs, or vegetables delivered fresh after harvest.
Now, Doster is a doctoral student in the CSU Pueblo School of Nursing, where she earlier earned a master’s degree. She is already continuing her grandmother’s custom of providing rural health care by working as a nurse practitioner in Walsenburg, an isolated town of 3,000 south of Pueblo. During a recent shift at the Spanish Peaks Regional Health Center, Doster described her childhood experiences.
She had been reminded of them a day earlier, when an older patient brought her a carton of 18 freshly laid eggs as a gift. Doster, who serves as a primary care provider in the rural community, had seen the woman for a heart condition and a mental health check.
“I was really emotional because it reminded me of my grandma, and it told me I did the right thing for her care,” Doster said of the patient’s gift. “It took me back. It feels like history repeating itself.”
About 200 undergraduates and 100 graduate students are enrolled in degree and certificate programs at the CSU Pueblo School of Nursing. The school focuses on preparing nurses to fill shortages, especially in rural communities.
Doster feels driven to relieve suffering and promote healing. “The most rewarding part of my job is seeing the progress of my patients – to see them get better,” she said.
It is a sense of purpose shared by many students enrolled in the CSU Pueblo School of Nursing, said Susan Belport, a nurse practitioner, professor, and school director. Many of her students feel, “I need to be a nurse to help others,” she said.
The School of Nursing, a standout program at CSU Pueblo and across the state, is annually training hundreds of students who share this sense of purpose. The school is growing in the quality of its teaching resources, in its community partnerships, and in its programmatic reach – all to help address significant health care needs, especially in rural Colorado.
The work is urgent: Colorado is projected to have a shortage of more than 7,000 registered nurses this year; that number is expected to grow to more than 10,000 by 2026, according to the most recent Mercer U.S. Healthcare Labor Market report. In fact, Colorado is among the states with the most pronounced nursing shortages, though demand for well-trained nurses is prevalent in many states across the country, the analysis showed.
Several dynamics are driving demand for nurses in Colorado and elsewhere, other reports have shown. Among them are population growth, an aging population, and a wave of retirements among health care professionals, some because of burnout during the COVID-19 pandemic. Moreover, physician assistants and nurse practitioners, such as Doster, increasingly are functioning as primary care providers for patients, another trend accelerating the need for nurses, according to the Mercer report.
The nursing shortage is acute in some rural communities, Belport said. For this reason, training nurses for rural practice has been a strategic focus for the School of Nursing at CSU Pueblo.
To help fulfill that goal, the nursing school is seeking final approvals to establish a rural bachelor’s degree track and to offer its training at a new satellite campus in Walsenburg, about 50 miles outside Pueblo. With this track, the nursing school aims to advance community, university, and state-level goals to recruit and retain nurses in rural areas.
“We’re trying to put education where people live to improve access to health care services in rural and underserved communities,” Belport explained.
Regina Griego, a nurse practitioner at Spanish Peaks Regional Health Center, is a graduate of the CSU Pueblo School of Nursing who delivers family health care in the rural community of Walsenburg.
In fact, CSU Pueblo has been awarded a $1.4 million “Opportunity Now” grant from the Colorado Office of Economic Development and International Trade to support would-be nurses interested in serving in rural areas. An additional $500,000 from the Colorado Health Foundation will promote nursing careers among high school students from rural areas and underserved groups by providing scholarships, child care, and work stipends to support students.
The state Legislature likewise is boosting the production of nurses in rural communities: In 2022, it passed the Colorado Rural Health-care Workforce Initiative, which provided $65,000 a year to support expansion of the CSU Pueblo nursing program to Walsenburg; 40 percent of that funding is going toward scholarships.
Talea Logan, a registered nurse working at Spanish Peaks Regional Health Center in Walsenburg, received one of the recently funded scholarships to gain additional training through the CSU Pueblo nursing school. She is closing in on a master’s degree in nursing education and hopes to teach nursing at the new satellite campus, to be called CSU Pueblo at Spanish Peaks.
“She’ll be a great teacher,” said 83-year-old Lone Ewing, a patient who received care from Logan in the health center’s extended care unit.
Talea Logan is a registered nurse who works with patients at Spanish Peaks Regional Health Center. She is completing her master’s degree in nursing education at CSU Pueblo’s School of Nursing and hopes to teach nursing at the school’s new satellite campus in Walsenburg.
Logan hopes so. She once saw herself becoming a high school English teacher. Instead, she went into health care, first working as a scrub technician, then as a licensed practical nurse, and later as a registered nurse. She looks forward to teaching future nurses the skills they will need, while also coaching them in developing the outlook and attitude to stay positive and attentive to patients.
Working as a nurse in a rural area has unique rewards, she explained. “I’m taking care of my friend’s dad and my neighbor’s co-worker. I’m taking care of my community,” Logan said. “I can’t imagine doing anything else.”
Even as it works to stand up a satellite program in Walsenburg, the nursing school is running strong on the CSU Pueblo campus. Established in 1964, the program has been ranked highly statewide and nationwide by several nursing and health care organizations.
About 200 undergraduates and 100 graduate students are enrolled in nine academic degree programs and three certificate programs in the School of Nursing; that number will grow when the Walsenburg program launches.
Andrea Pacheco is a licensed practical nurse at the health center in Walsenburg and is a potential student at CSU Pueblo’s new satellite campus in the Southern Colorado town.
The school has grown in other ways: In 2018, it began offering a Doctor of Nursing Practice, CSU Pueblo’s first doctoral program. Now, it is collaborating with Colorado State University in Fort Collins to propose a five-year training program that would allow students to graduate with both a bachelor’s degree in nursing and a master’s degree in nurse leadership; it would be the first degree program of its kind in Colorado.
On the Pueblo campus, students learn in updated facilities, including a state-of-the-art nursing simulator lab that opened in 2020 as part of the university’s new Center for Integrated Health and Human Inquiry. Developed in partnership with Pueblo’s Parkview Medical Center, the lab enables students to practice skills and rehearse scenarios in spaces simulating medical care settings ranging from exam rooms to an intensive care unit.
Patients in the simulation lab are human actors or robotic mannequins, yet even scripted situations can evoke strong emotions among students, said Reynaldo Vazquez Gonzalez, an undergraduate in the nursing program. Recently, he observed a scenario in which classmates provided care for a patient in active decline. “I was surprised how stressed I felt at that situation,” he recalled.
During an earlier scenario in the simulation lab, he was the student providing care and did not pick up on signs that he needed to step back and call the patient’s health care provider to request a new medication. When a similar scenario came up recently, Vazquez Gonzalez knew to make the call. “I was surprised how ready I felt to do that,” he said, referring to the lab as a judgment-free zone. “Whatever mistake you make, you will absolutely learn from.”
School of Nursing students learn in classrooms and a state-of-the-art nursing simulator lab at CSU Pueblo’s new Center for Integrated Health and Human Inquiry.
Vazquez Gonzalez is the most recent of several family members to pursue a health care career. His mother, aunt, and grandmother all have worked as certified nursing assistants – and he gained CNA certification while completing an associate degree at Pikes Peak State College before transferring to CSU Pueblo.
“They say that nursing pays really well, but I’ve never thought of that because I’ve had the approach that I want this career I can be proud of and something I can feel honored to do,” said Vazquez Gonzalez, who is on track to become the first member of his family to complete a bachelor’s degree. “I’ll be fulfilled in my work, and my family will be taken care of, and that’s really all I’m dreaming of.”
One of his goals is helping young people facing behavioral and psychiatric challenges. While discussing his plans, Vazquez Gonzalez described the Japanese concept of ikigai, which translates roughly as “life purpose” or “reason for being.”
His clinical experiences in the School of Nursing have helped Vazquez Gonzalez develop his philosophy about nursing. During a course in the dynamics of behavioral health, he went to the Colorado Mental Health Hospital in Pueblo for weekly shifts interacting with patients undergoing treatment. For pediatrics, he spent time with providers in clinical settings, including an outpatient therapeutic center. His experiences in class, clinical settings, and the nursing simulator have led to a steady progression in his knowledge and confidence, Vazquez Gonzalez said.
Marilyn Doster, conferring with a colleague, is earning a doctorate that will prepare her for research and higher levels of leadership.
Doster, the School of Nursing alumna now pursuing her Doctor of Nursing Practice, had a job offer to work as a nurse practitioner at Spanish Peaks Regional Health Center in Walsenburg even before she completed clinical training for her master’s degree. She has been motivated to advance her nursing knowledge in part by life experiences, such as working alongside her grandmother in the Philippines and witnessing the effects when a cousin was refused care because she lacked money. Her doctorate will allow her to take another step in her career – into research, business, policy, and higher levels of leadership.
Doster, the mother of three, came to the United States with her husband, whom she met when he was in the U.S. Marine Corps. She has diligently advanced by earning an associate degree from Pikes Peak State College, a bachelor’s degree in nursing at Colorado Christian University, then her master’s degree in nursing at CSU Pueblo in 2022.
In late March, she had a unique opportunity when she accompanied Belport on a trip to Washington, D.C., for a student policy summit held alongside an annual meeting of the American Association of Colleges of Nursing. She also serves as president-elect of the Philippine Nursing Association of Colorado. Doster doesn’t see herself slowing down.
“I’m still fresh,” she said. “I’m still inspired, and I want to make change.”
Photo at top: Marilyn Doster is an alumna of CSU Pueblo’s School of Nursing and is now pursuing her Doctor of Nursing Practice while working as a nurse practitioner at Spanish Peaks Regional Health Center in Walsenburg, Colorado.
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