What happens to patients in rural areas who are diagnosed with cancer? How can they get access to quality care without having to drive for hours? In the Mojave Desert of California, many living in the rural town of Ridgecrest and its surrounding areas can now go to the recently established Ridgecrest Regional Hospital (RRH) Cancer Center for diagnosis and treatment based on state-of-the-art consultations with oncologists in the University of California (UC) Davis Health Cancer Care Network.
RRH Cancer Center is an affiliate of UC Davis, and the medical oncologists at RRH can consult about difficult cases by virtual tumor boards with an extended network of cancer specialists. Using advanced technology, the RRH oncology team can transfer pathology slides and reap the benefits of support and insights from expert oncologists at UC Davis and its 5 affiliated rural-based cancer treatment centers.
The Oncology Nurse-APN/PA (TON) spoke with Shantell Utley, OCN, MSN, BSN, RN, Clinical Project Manager, Oncology Services and Outpatient Pavilion, RRH Cancer Center, Ridgecrest, CA, about this new initiative and the plans to expand access to state-of-the-art cancer care for rural patients.
TON: What was the genesis of the cancer center and its current operations?
Ms Utley: RRH is a small rural hospital designed for critical access. We have 25 inpatient beds, 10 observation beds, and 22 outpatient beds. Our hospital offers inpatient and outpatient care, including emergency care, intensive care, cardiac and pulmonary rehabilitation, case management and social services, community outreach, hospice care, maternal/child/perinatal care, senior services, transportation services, and we have a clinical pharmacy. The cancer center is a new initiative that stems from a community survey we did a few years ago.
The second highest priority, according to the community survey, was oncology care. Following up on that, James A. Suver, RRH’s chief executive officer, spoke with UC Davis, which already had 4 other affiliated cancer treatment sites in rural areas. We are part of the UC Davis initiative to reach out to rural America to areas that lack resources for patients with cancer. Approximately 1 year ago, the staff at RRH and I built an oncology team through training and recruitment, and we opened our doors in 2017.
Currently, the RRH Cancer Center only offers medical oncology using the outpatient beds in our infusion center. Our staff includes 1 medical oncologist, 1 nurse navigator, 5 oncology-certified registered nurses (who also work with patients who do not have cancer), and 1 medical assistant. We are building our cancer center slowly. Currently, we use 4 beds per day for infusions and the medical oncologists see approximately 6 to 7 patients with cancer each day.
TON: What are your responsibilities at RRH Cancer Center?
Ms Utley: I manage everything for the cancer center, which includes the physician’s practice, the office staff, the infusion center, recruiting, and hiring. I also manage all patients who need outpatient treatment, including wound care, ambulatory surgery, and any patient requiring an intravenous infusion. Any situation requiring an outpatient registered nurse comes through my department.
TON: What are the biggest challenges associated with your job?
Ms Utley: My biggest challenges are cancer-related. We are located in a rural community and we have only 1 oncologist. We need to be creative when collaborating with UC Davis. We do not offer radiation, so we often have to arrange to transport patients to receive radiation and other services. We try to provide high-level care, and that requires reaching out and networking.
TON: How does that play out with an individual patient?
Ms Utley: The patient comes in and sees the medical oncologist. If collaboration or a second opinion is needed, we call UC Davis. Our doctor and nurses can attend virtual tumor boards between 12 pm and 1 pm every day and these are connected to UC Davis and other affiliates. We discuss complicated cases. We also refer and connect patients to UC Davis, which is approximately 6.5 hours of driving time, or other accredited hospitals, which may be closer.
TON: What is your biggest reward or your most significant achievement?
Ms Utley: My biggest reward is also our biggest achievement to date—knowing that cancer care is such a high priority for our community; this has been a pressing need for many years. We were able to pull it together, establish a successful cancer center, and continue to provide high-level care. Patients with cancer do not have to travel for access to quality care. Traveling is difficult for elderly patients, patients with young children, and caregivers. We are doing a good job and that gives me great satisfaction.
TON: What are some future plans and goals for RRH Cancer Center?
Ms Utley: We hope that within 2 years we will be accredited by the Commission on Cancer and can start to participate in clinical trials. In 3 to 4 years, we hope to have a linear accelerator to provide radiation therapy to patients who need it.
TON: What are you excited about right now in cancer care?
Ms Utley: I think that biotherapy and immunotherapy will change the way we deliver cancer care. It is no longer “one size fits all,” and, in many cases, we will be able to offer personalized and individualized therapy for some patients. This is how we will make great strides in cancer care.
TON: What has been your career trajectory, and do you have a role model?
Ms Utley: I started working as a healthcare housekeeper. Then I went to school to become a licensed vocational nurse (LVN), which is the California equivalent of a licensed practical nurse. After 8 years as an LVN working in physicians’ offices, I went back to school and became a registered nurse (RN), and spent 7 years working in the emergency department as an RN. Then I went back to school again and received my Bachelor and Master of Science degrees in healthcare administration and worked for Bakersfield College, CA, for 2 years where I was a Nurse Instructor for people transitioning from LVN to RN. I was recruited as a hospital clinical educator for the nursing staff at RRH and then I was appointed to lead the cancer center. There was also a need for leadership in the outpatient pavilion and that led to my present position.
I would say that Barbara Badertscher, Chief Operating Officer at RRH, is my role model. She was recruited by our center 2 years ago, and is a dynamic and very sharp administrator with 40 years of experience as a nurse. I report to her directly, and if I could turn out like her, that would be great.
TON: What would you do if you won the lottery? Would you keep your job?
Ms Utley: I would stay involved in the cancer center, but do far less administrative work and take on more strategic planning and development.