Thomas Gastineau ’23 — My summer internship at Shaping Our Appalachian Region, Inc. (SOAR) has been a great experience. Our main project is to find a solution to the nursing shortage in rural eastern Kentucky. Before the pandemic, hospitals have struggled to find enough nurses to be fully staffed and offer the best quality care to patients, and the pandemic only made the problem worse. The main hospital in Pikeville, Pikeville Medical Center, was offering massive sign-on bonuses and benefits to nurses to come to Pikeville, but that still could not fill the shortage. The hospital had to spend around $40 million hiring travel nurses to cover what the local workforce could not provide. That is just one example of the many hospitals in the area that struggle to find nurses. There are many reasons for the shortage, including a large elderly population with a higher proportion of chronic illnesses, a solid push to leave Appalachia due to decreased perceived economic opportunity, a brain drain, and socioeconomic issues influencing postsecondary education. As I noticed very quickly within this internship, the problems within rural eastern Kentucky are very complex.

At the beginning of the internship, I was excited to travel to Pikeville, KY, and visit SOAR’s main office for about two and a half weeks. While I was in Pikeville, it was all about learning from the community and making connections. We met with nurses, the health department, high school counselors, nursing colleges, and possible financial stakeholders to discover information on the nursing community and struggles in the region. When we were in Pikeville, we also visited many businesses and museums to understand the history and culture of the area, which the many Appalachians take great pride in. This helped us connect our program with the community and make more significant connections when speaking with locals. While in Pikeville, we tried to learn as much about the community we could. It was partially a culture shock, but it was one of the prettiest places I have ever been.

For the last two weeks, I have been working from home, and I miss the connections I made in Pikeville. It is way different working from home, and I wish I was still in the office. We are also now working on writing and putting everything we learned on paper. We are taking all that information and deciding on what type of program would best impact the nursing shortage. We are considering cost/benefit analyses, amount of job creation, and most impactful for the community’s health. As of now, we are thinking an interactive health care career/college fair and a summer mentorship program would be the best programs. The healthcare college/career fair would be a simple and inexpensive way to expose students to what careers in healthcare are like, and the area has not had a career fair in a very long time. The mentorship program would be more expensive but equip students with guidance, growth in necessary soft skills, and shadowing experiences to interest them and prepare them for a career in nursing. We are now planning and writing a business plan to show hospitals and stakeholders what we think is the best long-term solution to the nursing shortage. I have lately had to channel my inner businessman and learn about budgeting and writing a business plan. It was initially a struggle, but I am slowly getting the hang of it. Overall, I have learned a lot from this experience. I have learned a lot about rural healthcare and its struggles. I have learned about a unique community that has many internal struggles. Finally, I have learned to expand my business horizons. I look forward to learning even more, these next four weeks.