Other Side of the Door

A winter immersion program shows students how nurses help build healthy communities in rural places
By Jenny Price

Ephraim, Door County, Wisconsin in winter
Ephraim, Door County Winter Immersion Program, All photos by Alex André

In January, Door County, Wisconsin, is the polar opposite of its summer self. Picturesque lakefront towns are quiet without the crush of tourists and temporary residents, and harsh winter weather can sometimes dictate how quickly residents get medical help.

This cold hard fact hit Ashley Schoen ’19 last winter as she and Drew Farrahar ’19, classmates in the first class of the School of Nursing’s Accelerated Bachelor of Nursing (ABSN) program, prepared to board a ferry last winter to Washington Island for the inaugural offering of a Door County-focused rural health immersion course. An ambulance traveling from the scene of an accident on the island disembarked with lights flashing and sirens wailing.

“I couldn’t imagine what it would be like to have the ferry as your main source of transportation, especially during a situation like that or even getting to and from a check-up appointment,” says Schoen, one of eight students who participated last year.

“Not all experiences are identical, but the [S]chool [of Nursing] is committed to helping [students] understand what it’s like to provide care where you don’t have resources or a team of people down the hallway.” —Dr. Wendy Crary ’00, School of Nursing

A new group of eight — who signed up for the experience just as last year’s group did — took part in January. All of them arrived in Door County having completed three other clinical experiences in or around the Madison area, but the school is committed to every student participating in a clinical focused on population health, says Dr. Wendy Crary ’00, who was coordinator of the school’s accelerated bachelor’s program until last year and wrote the existing rural health course that was adapted for Door County. She now serves as coordinator for the School’s graduate nurse educator program. “Not all experiences are identical, but the school is committed to helping them understand what it’s like to provide care where you don’t have resources or a team of people down the hallway,” Crary says.

In Door County, nurses are often the ones who help residents connect to services needed to live healthy lives. There is only one pharmacy north of Sturgeon Bay, and a ride to the hospital can take upwards of ninety minutes, depending on where someone lives.

The idea to send students to Door County bloomed in conversations Peggy Zimdars ’73, a member of the School of Nursing Board of Visitors, had with UW nursing faculty and nurses who live and work in the area. Zimdars felt passionately that Door County had something to teach the students and could offer a window into what a nursing career looks like in a place where residents and providers work together to weather tough conditions.

“Door County has this veneer during the season of being very affluent,” says Zimdars, who lives in Ephraim. “And yet, in the off-season there are many people who earn their income in six months. There’s a high concentration of people over the age of 65, so that creates some unique needs.”

Community Conversations

Samuel Nash ’19, who participated in the immersion program in January 2019, greets a client at Sunshine House, a nonprofit that provides day programs and employment opportunities for disabled adults. Accelerated Bachelor of Nursing (ABSN) students work in settings around Door County.

Midway through their Door County experience last winter, the first group of students had lunch with senior citizens at the Aging and Disability Resource Center in Sturgeon Bay. They discussed their lives and challenges, including how their strong ties to their communities outweigh concerns about being too far from a hospital in an emergency.

“The providers did an amazing job of connecting them with resources. It was remarkable to me — the resilience of these people,” says Samantha Swancoat ’19, an oncology nurse at University Hospital who was part of the first group to go to Door County last year. “They understood their challenges, but dealt with them, because they wanted to live there.”

Swancoat, who grew up in bustling Orange County, California, says that before this experience, she would not have considered working in a rural setting at some point in her career. “It opened my eyes to maybe make that a possibility,” she says. “I think before I would have probably turned my head the other way.”

Students followed up the meal with a mini-health fair that offered information on diabetes, as well as blood pressure screenings and hand massages with essential oils. This year’s group also put on a health fair and conducted screenings to determine fall risk.

They also visited a children’s center that includes a significant number of children with disabilities and requires staff members to have a four-year degree in education or be actively enrolled in such a program.

“We were able to do a pretty comprehensive exposure to wellness through the life span, not just focused on aging.” Dr. Donna Scattergood, program facilitator

“We were able to do a pretty comprehensive exposure to wellness through the life span, not just focused on aging,” says Dr. Donna Scattergood, a nurse and educator involved in the Northern Door Health and Wellness Ministry, who served as facilitator for both groups when they visited the child-care center. “Because they were in more than one facility, more than one clinical, I think they got the chance to see how a community is really woven together.”

Students spent time at the surgery, recovery, and wound clinic at the Door County Medical Center and at a luncheon met School of Nursing alumni who live in Door County. A community panel discussion, including local nurses and public health officials, covered topics including affordable housing concerns, healthy aging, air and water quality initiatives, public policy impacts on health and wellness, and nontraditional roles for nurses.

Door County Winter immersion program
ABSN students Elise Clussman ‘19 (right) and Samantha Swancoat ’19 play with some tiny students at the Northern Door Children’s Center.

The students also visited Sunshine House, a nonprofit that provides day programs and employment opportunities to disabled adults, and spent the day with home health nurses in locations around the county. During those home visits, students saw how integral nurses were to people successfully living in their homes, even at advanced ages. Schoen called the experience “eye-opening.”

“[The home health nurse] had a full schedule and even with that, she made time to check in on someone she wasn’t scheduled for that day,” Schoen says. “I heard from another classmate that the home health nurse did someone’s dishes for them while they discussed health care. I did not expect to see this level of care and closeness within a community.”

Slices of Life

Students witnessed that collaboration during their visit to Washington Island, where they met with Christine Andersen, a registered nurse with the nonprofit Washington Island Community Health Program, whose work focuses on keeping older residents in their homes safely and independently. She brought the students with her on a visit to a homebound resident who was born and raised on the island. They also met with the island’s EMS crew chief to discuss emergency medicine in a rural setting and assisted with a blood pressure screening clinic.

Door County Winter Immersion program
“I did not expect to see this level of care and closeness within a community,” says Ashley Schoen ’19, shown here doing a craft project with a Sunshine House client.

“Up here in January, it’s pretty barren. It’s about as isolated as you’re going to get,” Andersen says. “We lean on each other a little more heavily in the winter months.”

When the weather cooperates, there are two ferry boats a day during the winter: One arrives on the island at 10:30 a.m. and departs at 1 p.m. When community health service providers come to the island “they have a narrow window,” she says. Andersen lived briefly on the island with her parents in the 1970s and returned in 2011 to be closer to her mother after her father died. She came from a larger clinic in the San Francisco Bay area.

“I’m not going to lie, I had a moment where I was like, ‘What did I do?’ and now I walk, talk, breathe it,” she says. “We are all in it to help everybody and work together. We never had that collaboration in the city, ever.”

On Washington Island, the students also had the opportunity to visit with a physician and a nurse practitioner to learn about working in a rural access clinic.

Students spent another day at Scandia Village in Sister Bay, which offers care options for senior citizens ranging from independent living apartments to rehabilitation services to memory and nursing home care.

“It was such an energizing thing,” says Kathy Wagner, a retired registered nurse and educator who volunteered to guide the UW group during its time at Scandia. “Those students were so bright, so sharp, so ready and willing to do and learn and ask questions.”

During each day of the immersion, the students did something they wouldn’t have the opportunity to do in their normal rotation, says Dr. Mary Francois DNP’16, current coordinator of the ABSN program, a path to a nursing degree in one year for students who already hold a bachelor’s degree. They attended a classic Door County fish boil, and this year’s group was also tasked with a lesson focused on cooking on a budget to help them better understand the nutritional options patients have available to them
in more rural areas.

“Maybe their road isn’t going to be plowed, and if they don’t show up to their clinic appointments, somebody might label them as being noncompliant when really it’s just the issue of safety.” —Peggy Zimdars ’73, member, School of Nursing Board of Visitors

They also built strong bonds with one another and found strong mentors in Zimdars, Wagner, and Scattergood — relationships forged during meals and fireside chats at the close of the day’s activities. On one particular icy morning, Zimdars reminded students how poor road conditions could affect residents’ ability to travel. “Maybe their road isn’t going to be plowed, and if they don’t show up to their clinic appointments, somebody might label them as being noncompliant when really it’s just the issue of safety.”

Schoen, who now works in the neurology intensive care unit at University Hospital — and keeps her phone screen background set to a picture from Door County’s Peninsula State Park — says her experience there showed her how important it is to consider all of the factors that influence a person’s health. She also now strives to avoid making assumptions about her patients, such as everyone having access to reliable transportation. “I found myself more empathetic and driven to understand people than to be judgmental,” she says.

Pen Par, Door County Winter Immersion Program
The view from Eagle Panorama in Peninsula State Park, with Horseshoe Island and Welker’s Point at left, shows the quiet beauty of Door County during the winter months.

The Takeaway

At the end of the course, students must write a final paper that details specifically how the experience in Door County changed them. The responses have been what the organizers had initially hoped for, Crary says.

“In those one-day experiences they already developed relationships with the patient that just went right to their hearts,” she says. “This wasn’t just a check the box, ‘OK, that’s another clinical done, I’m that much closer to graduation.’ ”

“I wanted them to see how each piece fit into making a quilt of a healthy community.” —Dr. Shawn Skurky, School of Nursing

At the end of the first group’s experience in January 2019, clinical associate professor Dr. Shawn Skurky, who leads the course, asked the students to physically draw how the sites and services they observed were linked to and supported one another. “I wanted them to see how each piece fit into making a quilt of a healthy community,” Skurky says. The exercise also showed them how nurses fit into that picture, often connecting their patients with those resources.

“What I always try to impart in anything I do with my students is that every patient you take care of, they come from somewhere and they go back to somewhere,” Skurky says. “Here they can really experience it.”