In the wake of local concerns and a staffing shortage, BBRMC says it is strategizing

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The Big Bend Regional Medical Center in Alpine. Photo by Stephen Paulsen.

FAR WEST TEXAS — On Thursday of last week, the Big Bend Regional Hospital District Board of Directors met at the Marfa Public Library and discussed, among other things, reporting in The Big Bend Sentinel that raised concerns about internal operations at the tri-counties’ only hospital — Big Bend Regional Medical Center in Alpine. 

The Big Bend Sentinel had published two stories on the hospital in recent weeks — one covering the administration’s decision to move the med-surg unit for general patient care into the emergency department, which prompted health and safety concerns from locals, and one on the concerns of former staffers, who say lack of sufficient pay and appreciation, safety concerns, and low morale were prompting an exodus. One former employee who spoke to The Big Bend Sentinel said the consolidation of med-surg with the ER had been the final straw for them.

J.D. Newsom, the hospital district’s executive director, met with hospital CEO Rick Flores earlier in the week, along with Chairman Buddy Cavness, to discuss ongoing problems with staffing at BBRMC. “There’s been a lot of press lately about the hospital and their operations, and I wanted us to be informed of what’s going on and see what the hospital district can do,” said Newsom at Thursday’s meeting.

Newsom said that while Flores presented “great long-term strategies” to address the ongoing staffing crisis, “I feel like when asked about their short-term solutions, they didn’t have a whole lot, and I think they’re still trying to figure that out and it’s really hard.”

On Monday, Flores met with The Big Bend Sentinel for an approximately 45-minute interview, with Marketing Director Ruth Hucke present, to discuss those strategies along with the hospital’s outlook in the shorter term. 

Most immediately, the hospital on that day was beginning the process of separating the med-surg unit from the ER, said Flores, with the target date for officially re-opening med-surg slated for April 25. “That’s official,” said Flores. “There are no ifs, ands or buts.” 

The two departments have been combined since the end of January, cutting down available space for emergency patients and relegating some to gurneys in the hallway, with non-emergency patients downgraded to smaller rooms with fewer amenities.

The department’s re-opening will be facilitated by a spate of new nurses who are beginning work at the hospital, said Flores — a combination of permanent employees, travel nurses, and independent contractors. Several of the nurses had finished orientation, and the last of the new nurses would be starting the week before the med-surg reopening, said Flores. Altogether, eight new nurses are starting at the hospital prior to April 25, said Hucke — of those, four are permanent employees.

Then there is the hospital’s labor and delivery room, which has been intermittently on “diversion” — meaning closed, with staff directing obstetrics patients to other hospitals — since July of 2021 due to a nursing shortage. When asked about the status of the diversions, Flores said the hospital is averaging two to three days a week with L&D on diversion and is “going to have challenges for another month.” OB nurses are “tough to come by,” he said.

As for the hospital’s outlook in the longer term, Flores explained it was working to establish job pipelines with local universities, and would be participating in a government-funded apprenticeship program with the Texas Workforce Commission — the goal, essentially, is to build a healthcare workforce from the ground up.

According to Flores, the hospital has established a relationship with Southwest University at El Paso, which is providing groups of students that will undergo training at the hospital for various roles. Students currently at the hospital are training to be operating room scrub techs, said Flores. In the future, groups of prospective medical lab technicians, stenographers and radiographers (or operators of CT scanning devices) will train at the hospital, he said. The hospital is in the process of trying to figure out how the pipeline could be used to bring in nurses, said Flores.

The hospital has also established a relationship with Sul Ross State University, which has funneled six nursing students into the hospital to participate in what Flores called the “patient care tech” program — the students will learn clinical skills that can be put to work in the hospital while in training, and the hope is that they will come on as nurses upon graduating. 

Lastly, the hospital is in the process of securing a nursing apprenticeship project through Texas Workforce Solutions, a joint effort between the Texas Workforce Commission and regional boards across the state which partner with schools and other entities to help connect workers with jobs in a variety of industries. The apprenticeship project would be subsidized by Texas Workforce Solutions, said Flores, and would entail a mixture of academia and hands-on training within the hospital itself to cultivate a new workforce. The program will allow the hospital to bring in LVNs (licensed vocational nurses) and “get them to an RN [registered nurse] level,” said Flores, “So it’s a recruitment tool and a retention tool.”

The curriculum for the program will be finalized in the first week of June, he said, with the goal of implementing it by the fall. Ultimately, said Flores, this kind of pipeline will “replace contract labor.”

Of course, that is only the case if incoming students choose to stay at the hospital following their training and education. The hospital has struggled to retain staff — a chronic issue that led to the dearth of employees, ER restructuring and L&D diversions in the first place. 

“We’re looking at a variety of things,” said Flores, when asked by The Big Bend Sentinel what he will do to retain staff moving forward. “We do have referral programs.” He presented the educational components of his strategies as a retention tool. “One of the biggest things we see is, can we get additional education? I don’t know how much more education I can get with this component.” 

Ultimately, said Flores, the hospital will work to better show employees they are valued.

“We are putting a lot of stuff together to say, ‘Hey, look, we value you.’ It’s pretty simple,” said Flores. “We do things now, but obviously we’ve not done a good enough job. I think we probably can do better.”

When asked how the hospital will tackle the disparity in pay between full-time employees and travel nurses, he said the hospital is “developing strategies.”

“It’s a challenge, that I will say,” he said. “We’re not there yet. We’re developing strategies, we really are.”