Silva-Steele: Patients remain priority as SRMC adjusts to UNM merger

Sandoval Regional Medical Center has undergone several changes over the years, and the changes will keep coming. SRMC President Jamie Silva-Steele recently detailed just how much change there was and what is to come.

"I started as a nurse, so I never dreamed that I would be running a hospital one day," Silva-Steele said.

Known for her hands-on approach to running SRMC, Silva-Steele wears many "hats."

Her certifications as a RN, BSN and FACHE compliment more than 38 years of experience in an academic health care environment. After earning a Bachelor of Science in nursing from the University of New Mexico, she began her career as a pediatric nurse and worked in the general and sub-acute nursing units at the University of New Mexico Hospital (UNMH).

After serving as interim chief operating officer in 2013, she served as president and CEO from 2014-23 and as of this year remains president. The hospital has been in her care through some tough times and big changes.

Campus

The SRMC campus is much larger than people would think. The building and parking lots span about 14 acresb but the land owned by the hospital spans to almost 250 acres. Broadmoor Senior Center sits on the land as well with the city leasing from the hospital.

Silva-Steele explained that when the university was planning a campus out there, the establishment of City Center and city hall was the deciding factor.

"So the first building that came up was the Health Sciences Rio Rancho building and that was actually first known as UNM West," she said.

Initially the university wanted to bring main campus courses to the community. Silva-Steele also wears the hat of executive director of the campus.

Eventually, the UNM West campus had a primary care clinic retrofitted to the building.

"So, the clinic started and then the we broke ground for the hospital in 2010 and opened two years later in 2012. I came out about a year after the hospital was open," Silva-Steele said.

The fourth floor is purely administration right now, but she says the original plan was to convert into clinical spaces as the spaces grew and eventually move administration off site. The plan was to have 300 beds.

"All the way out to the road basically is all UNM property, and then the Center of Excellence, actually is Health Science Center building, but we run the clinic that's in there, all the clinics: orthopedic, surgical and then on the first floor we run our outpatient rehab services. We have all of our academic and research activity for orthopedics in that building as well. So the hospital opened with 72 beds and on the fifth floor, which is the top floor, that's all med surge. That's 24 beds," Silva-Steele explained.

The fourth floor is a replica of the fifth. Then, the third floor is the ICU, pharmacy and respiratory therapy. Silva-Steele says the rehab got more inpatients through and after COVID.

"Obviously during COVID, respiratory therapy was a key role that was taking care of patients because a lot of them were on breathing machines. They had to get all of the various treatments. So yes, we did see respiratory heightened and now we've had pre-COVID and post-COVID. You have kind of a seasonality to when you see respiratory things. So like in the fall kiddos going back to school, that's when they get sick. We don't get kids here, but then parents get sick, grandparents get sick. So you'll see the flu, RSV and pneumonia. All those things hit in the fall primarily and then in the winter time frame," she explained.

The second floor is all surgical, which started with a 12-bed inpatient behavioral health unit. That service was funded through the county mill levy, which was in place from 2008-16.

"It helped us with the initial funding of the hospital, plus some other bonds and things that we went out for plus HUD funding. The mill levy was supposed to be specifically for behavioral health and trauma services. In 2016, when we went back to voters to continue the tax, the voters did not continue it and we lost that funding," she said.

The behavioral health unit was on the first floor and ended up closing after that loss of funding.

"But a couple years later we went back to voters by ourselves because that mill levy was split with Presbyterian Hospital with Rust and we still felt that we wanted to do behavioral health and trauma," she added.

Now the first floor is check-in for every department.

COVID

In a lot of ways, COVID changed the health care world. SRMC was not excluded from that.

At the time of this interview, the hospital had a total of four COVID patients. Silva-Steele says that is a dramatic decrease from the amount of COVID patients during the peak of the pandemic.

"We kind of waxed and waned. We've had a pretty good period of time where we had no admissions, and now we have four right at this moment. They are all doing well," she said.

She says during COVID staff were tested in many ways.

"Everybody had to be in gowns and masks. They actually had to have a buddy to help you because either you were in a full COVID unit or you were going between a COVID and a non-COVID patient. The assignments were even tricky, trying to get staff to group together so that you were maybe only taking care of COVID or only taking care of non-COVID," she said.

The goal was making sure cross-contamination didn't occur.

"There was just so much of that happening during that time. We've always had scenarios like (tuberculosis) patients where you have to gown up to go in a room but not at the rate that we had during COVID. Almost every single patient, everyone was on a ventilator, everyone was super, super sick," she said.

Crime

Through COVID, staff also started having to deal with violent patients.

In Silva-Steele's years in health care, she says she has never had to put up signs to remind people not to become violent until recently.

"We had to put up signage throughout the organization, unfortunately, because as we were coming through kind of that second year of COVID, and masking was required at the hospital with limitations on visitation. We unfortunately dealt with a lot of aggressive behavior. It's not as bad as it was and we periodically ask our leaders whether or not we should be thinking about removing the signage, but it's not time yet," she added.

Silva-Steele says there has been an increase in criminal behavior in and around the hospital as well. Health care workers have been victims to assaults, batteries and other behavior.

"We want people to know that we take that seriously. So if an employee is physically harmed, we want the employee to know that there's an avenue to pursue charges like that. Also, for the general public to just understand that we're not going to tolerate aggression against our staff or providers," Silva-Steele stressed.

In addition to that, some victims in recent violent crimes have been taken to the hospital. For example, the man charged with murder after allegedly shooting his wife in the car brought her to SRMC after the shooting.

Learning and research

For SRMC, the future is a lot closer than people would think. The UNM Health Sciences Center of Excellence for Orthopaedic Surgery and Rehabilitation (COE) just next to the hospital focusses on reconstruction of total hip, total knee, foot and ankle, total shoulder and total wrist. Orthopedics also includes sports medicine (adults and children 8 years and older), hand/wrist, podiatry, spine and physiatry.

The building has several classroom spaces for academics, some hospital meetings and trainings.

Silva-Steele was especially proud of the School of Engineering and the department of orthopedics, announcing other departments are doing research.

"They have created lab space in which they're 3D printing of joints, 3D printing of tissues, ligaments ..." she explained.

She added the lab's machines all do something different. A 3D item is printed then taken into cadaver surgery lab.

"They'll do testing to see that what they've created is better than or equal to the joint that they've just produced or the item that they've just produced like a ligament or a tendon and so they do that microsurgery here," Silva-Steele said.

Joints are also tested for balance and how much weight they can stand.

Silva-Steele also talked about research into skiing injuries. Companies then try to design ski bindings that won't cause injuries.

The labs also allow team members to brush up on skills. Cadavers can be full body, arms, legs and other parts.

"It gives them more confidence to be able to work with it. Particularly, if they want to try some new techniques, they can try that all in the cadaver lab before they start working on humans," she explained.

What's next

As of Jan. 1, SRMC is now a subsidiary of UNM Hospital instead of a partner. But Silva-Steele said the goal was to keep the aches and pains out of patient care.

"When we started to talk about what are the pros and cons to integrating or being acquired, the main thing was to be able to standardize processes for patients," she explained.

She added that SRMC is basically what Presbyterian is to UNM Hospital.

"That was our relationship, separately licensed, separate leadership structure, private nonprofit hospital versus public," she said.

Patient transfer was very different when the two were separate. If a patient had to be flown from SRMC to UNMH, or vice versa, they were discharged and readmitted at the other hospital. Now, it is just a transfer and patients move just like they would move floors in the same hospital.

"One of the pieces that benefits patients there is now it's not multiple bills for the same experience that the patient had," Silva-Steele explained.

All policies and practices that UNMH follows will be followed by SRMC now, too. Additionally, all nursing and medical practices are overseen by one person for all campuses. Silva-Steele says this has created an efficient atmosphere.

The hospital also issues surveys to patients to ask how they like the hospital.

"For the most part, I think it's pretty seamless what we've done. But hopefully moving forward, we will be able to bring the more robust nature that UNM Hospitals had for their academic offerings that they have through the school and now through College of Nursing (and be) able to bring some of those same things here," Silva-Steele added.

"We get to take advantage of the teaching experience, background research, all the things that are being done at the main campus. We would be able to bring those to patients as well."

However, an obstacle is getting more students excited about working in health care, she said.

"Again the pandemic has kind of thrown a big whammy in everybody's mind about health care. So before you know it, we were heroes and we were all these various things. I think the pandemic really impacted people's thinking around 'Where do I want to work and what environment do I want to be in?'" she said.

She also talked about adapting health care jobs to fit a new generation of workers.

"In this other meeting I was just in, we were talking about the flexibility to be able to offer some work-from-home jobs," she explained. "We're having to accommodate for a new workforce and people now know what they don't want. They know what they will tolerate. We're being put to test as employers."

One of these adaptations is introducing licensed practical nurses back into hospitals. Silva-Steele says LPNs are really only seen in nursing homes and other out-of-hospital positions. When she started as a nurse, they were "everywhere."

"But we were having such a hard time recruiting on our end that we thought bringing back team-based nursing with LPNs would help," she said.

LPNs also have more avenues to become registered nurses. Silva-Steele had one tech that was going for their LPN during COVID became an RN recently.

"Hopefully that's what we'll be able to do is think about grabbing staff that want to pursue that career and then we can show them there's lots of different options other than a nurse or doctor. There's lots of offerings. I think it gets people excited when they see the different options, and I bet that gets people excited about staying in one place. They don't have to worry about, 'OK, where's the next time?'" Silva-Steele said.

She says SRMC is also a med-surg hospital. Med-Surg nurses are RNs who care for diverse adult patient populations and treat a wide range of medical conditions.

"We created an what's called an acorn program. It's taking a bedside regular nurse and putting them through a six-month training program to become a surgical nurse," she added.

This has been an annual program for five or six years, and Silva-Steele says they just graduated six nurses this summer. She added it helps with retention. Nurses also have the chance to try other specialties if they need to figure out what they want to do.

"One thing I always say, though, is the patient comes first," Silva-Steele said.

That is her motto for the SRMC staff.