Week 1 at Sisseton
As a new guest of Sisseton, I would like to say thank you to the community first and foremost for making a great impression.  They are a welcoming group of people that opened their arms and minds to me as a student provider many times this week with humor and wisdom.  Coming to this community is a humbling experience.  I enjoyed working with many of the providers.  It is very refreshing to have an opportunity to discuss issues with the local dentist regarding dental emergencies that I have seen in the past and how to tackle these issues in the future.  I also enjoyed the interprofessional conversations we had together discussing how to partner with patients in treatment of infections and pain management.  It was nice to take advantage of opportunities with the surgeon that visits discussing evidence-based care and current guidelines and have his over 30 year expertise in the area of general surgery and GI standards of care lectures.  I almost hate to tell my classmates back at SDSU I am being a little spoiled with the one-one lectures.  Another refreshing aspect to rural care is the local surgeon delivers his colonoscopy news in person to his patients.  I have never seen this approach in big medical institutions.  In primary care this is usually my role after reviewing the report.  It was definitely a very nice personal touch to see in the rural community here. I greatly appreciated working and partnering with my newest mentor, NP I have been working with.  Sisseton has a diversity that is not common to most rural communities.  Because of this diversity, I am learning and increasing my exposure to the Native American population, their needs, and developing a working relationship with this patient demographic.  It has been a wonderful experience and truly rewarding feeling as I am completing my DNP this month and will be stepping out into practice this year.  I look forward to more experiences to come and will keep you posted in week two. 

Week 2
This week was a wonderful week.  Meeting with the 1000 days coalition was a wonderful sight to see with several different organizations partnering together to work to decrease adverse childhood experiences (ACEs).  Recent studies have been published recognizing that toxic stress at an early age will affect children’s mental and physical health into adulthood.  Seeing an at risk community partner together is a great start to seeing change and access for patients to services that had in the past had some minor hiccups with increasing communication.   I have really enjoyed my time seeing patients in many different areas of the hospital.  As a clinician it is nice to see the abilities in a critical access hospital.  I also enjoy learning the time it takes to process the labs so that in the future I can have a time frame to better assist patients with processing times.  Emergency Room rotations are always filled with interesting, diverse clinical situations that can enhance learning.  I am fortunate to be in a community where there are challenges, but many people working to create change.  My partner and I are looking forward to working on our community project.  We hope to work on some of the needs in the area of wellness thru education and low cost healthy meal solutions and tastings at the local grocery.  Looking forward to another great week and future opportunities.

Week 3
This week was a great week.  My family was able to come to visit Sisseton.  I was able to go horseback  riding with my son and project partner Dana.  I was never truly appreciative of the beauty of this area of South Dakota until I had the opportunity to live here this month.   My family took the opportunity to join the cause by volunteering with us for “Relay for Life”.  Although cancer has never touched my family, it has touched my heart in my 10 years as a nurse.  It is always difficult to see a lab, a CT, or a x-ray that makes you think as a clinician that a patient has cancer.  It is one of the scariest and hardest things to tell a patient.  Unfortunately, it is one of the things as a future NP I will have to deal with.  The Relay for Life is a wonderful organization that brings hope to people living with cancer.   Even in small towns, people can organize and bring hope to others.  Another great opportunity during this event is the chance to honor those family or community members who have lost their lives to cancer. It was a great experience and something I will always remember about my experience here. I look forward to my last week in Sisseton and the time we will have sharing with the hospital the community project we have completed.  Stay tuned for more to come.

Week 4
I would have to wrap up this experience as one of the best choices I have made in my program to pursue.  I think any person struggling with the decision if they want to practice in a rural facility should consider this a great opportunity.  Due to the community dynamics here in Sisseton, I have seen some very sick patients.   As I wrapped up my experience here, I mentioned my fondest memory will be having shared a moment with a provider that is retiring while following her with one of her patients of 30 years.  He was weeping, wondering where he would find care.  Nothing is more intimate than a man telling you that you are like a daughter to him.  As I witnessed this, I felt that this physician is such a reminder of what it means to be rural.  She stuck by this man through so many things in his life.  I consider her a role model for providers.  I hope to experience this someday in my career.  As I exited the site, I had to let her know she raises the bar very high for providers everywhere.  I look forward to looking for employment as a future NP in the near future and I do look forward to seeking a position a rural community.