News and Community

by Lacey Johnson, MSN, RN, Medical-Surgical Manager at Sheridan Memorial Hospital

TCU is, most often, a short-term care facility for medically complex patients who are transitioning from the hospital to home.  At Sheridan Memorial Hospital, our TCU is designed to provide rehabilitation and skilled nursing care to ensure you are meeting your goals to be successful when you go home.

The journey towards TCU typically begins with an acute inpatient stay.  Whether you are recovering from injury, illness, surgery, or disability, our TCU has a team of therapists, nurses and Case Management staff who are here to assist you in your recovery.  Focusing on a patient’s recovery to return to independence and go back home is a goal of the unit. 

The benefit of the TCU is that it provides coordination and continuity during transitions between different locations or levels of care.  The TCU bridges the gap between various providers, services and settings, ideally providing education about the next stage of recovery for the patient and their family and caregivers.

Our TCU is hospital-based, unlike community-based subacute care facilities, the team of professionals is present 24-7 to collaboratively answer questions and change your care plan as needed. 

How it works: 

Following a qualifying hospitalization, your physician may recommend that you receive additional skilled nursing care to assure a safe transition back to your home or other living arrangement.  The Case Manager speaks with you about your options for skilled nursing, where you make your choice.  Once you make that decision, the transition of care begins.  The nursing staff works to create your care plan and goals for TCU.  Once that is completed, you are moved to the TCU area, where you begin your journey to recovery and strength. 

During your stay in TCU, your care is personalized to fit your needs and goals.  On a daily basis, your goals and current state are discussed with you, your family, therapist, nursing and Case Management.  If you do not feel you are meeting your goals, your care plan is adjusted to move toward success. 

Opportunities in the TCU include rehabilitation with some of the best Physical Therapists, Occupational Therapists, Speech Therapists and Nurses.  The staff focuses on teaching skills and activities that are needed to prepare for the transition to home including: cooking and baking in the TCU kitchen, completing laundry tasks in the laundry room, exercising either in the therapy gym or outside on the beautiful SMH campus, and practicing entering and exiting a vehicle.  Prior to the patient’s discharge, home visits are scheduled.  These home visits are a perfect way for the care team to determine, with you and your family, the barriers you may have at home.  The team then adds those barriers to your care plan while in TCU for the team to work with you to overcome them for a safe transition home.

Giving back to the community in which you live can be very rewarding. For those who have done it, you know how it feels and what it means to give of your time and talents.

Dr. Kristopher Schamber says, “I want to help; and when someone asks, if I feel I am capable of doing the task, I want to make a difference.”

This kind of positive community attitude, along with his expertise as a physician at Sheridan Memorial Hospital’s Internal Medicine, has led to recognition for the doc.

The American College of Physicians (ACP) recently bestowed on Schamber the designation of Fellow, or FACP, a designation honoring the work he does with his patients as well as in his community.

“It is an honor and distinguishing to be a Fellow of the ACP,” Schamber said. “This recognizes the work we do outside of the workplace, throughout the community, as well as excellence in medicine.”

The ACP website states it this way, “ACP Fellowship is a mark of distinction representing the pinnacle of integrity, professionalism and scholarship for those who aspire to pursue careers in Internal Medicine. The most important considerations for ACP Fellowship are excellence and contributions made to both medicine and to the broader community in which the internist lives and practices.”

While Schamber knows he can’t take on every community challenge put before him, he has honed his efforts to a couple of areas.

“It is important to seek those opportunities I am passionate about and hospice care and dementia care are the two big ones for me,” he says.

That passion gave way to activities at the Senior Center (The Hub) where Schamber volunteers his time for quarterly presentations called Doc Talks and his involvement in the Dementia Friendly Program, among other activities.

“Since my days in medical school and residency, I also have a passion for helping in underserved clinics,” Schamber added. “So when the opportunity came to help at the Sheridan Health Center that was a no-brainer for me.”

To obtain this new accolade, it requires letters of recommendation from two physician colleagues. For Schamber, those two colleagues were Dr. Ian Hunter, Sheridan County Public Health Officer and physician at SMH Internal Medicine; and Dr. Robert Monger, Rheumatologist at Cheyenne Regional Medical Center, Governor of the Wyoming ACP Chapter and Clinical Dean for the Wyoming WWAMI Medical School Program.

“Dr. Schamber certainly deserves to be recognized as a Fellow of the ACP,” Hunter said. “He puts in the work, cares greatly about his patients and community to the point of action beyond his paid job. This recognition speaks to the level of competency and caring of Dr. Schamber and we are lucky to have him in our community.”

Dr. Monger also has high praise for this accomplishment, “Dr. Schamber is an outstanding physician, and being awarded FACP is a true mark of excellence because to be awarded FACP a physician is nominated by and then voted on by fellow physicians for the honor. It’s awarded to physicians who practice excellent patient care and also are involved as leaders in the physician community.”

When asked what may be on the horizon for him, Schamber humbly says he is definitely interested in leadership roles in the community in the future, but they aren’t on his immediate radar. 

“Thinking about what’s next is a tough one,” he adds. “I do these things because I’m passionate about them and to help the community. I didn’t have this end in mind. I just hope this demonstrates my dedication to the field of medicine and to the community.”

“That’s not to take anything away from the other physicians in our community who work just as hard and put is just as much time, if not more,” he adds humbly.

Environmental Services (EVS) has always been an integral part of Sheridan Memorial Hospital (SMH). With the rise of COVID-19 cases, their hours of dedicated service towards keeping everyone at our hospital safe has been all the more necessary. So in honor of EVS Week, we want to shed some light on everything the members of our housekeeping and laundry staff have done and currently doing to ensure SMH can keep providing excellent patient-centered care to our wonderful community.

March began as just another routine month for the EVS staff. Their days consisted of the usual standard daily work, and they followed the same processes and procedures. But when COVID-19 began rapidly spreading throughout the country in mid-march, EVS had to break from routine and start adopting new ways to keep the hospital as safe as possible. One of the most difficult initial problems that EVS had to work around was the lack of information on how to protect against COVID-19. Heather Yost, an environmental services aide, explained, “Since COVID-19 was such a new disease, a lot of the health organizations, like the CDC, were still trying to decipher exactly what did and didn’t work when trying to stop its spread. So a good number of the processes that we would adopt ended up being changed pretty rapidly because of new discoveries. It also didn’t help that with every new process, we had to get additional education for that process, which took even more time out of our already cramped schedules.”

But now that time has passed, and much more research has been done, the entire EVS team has finally been able to find a consistent process they use to keep us safe. However, just because they’re done doing all the guesswork, it doesn’t mean they’re done doing all the hard work.

Whenever EVS cleans an isolation room after the patient has been discharged, they must first wait outside until any air in the room which could’ve been contaminated by the patient has been filtered out. While waiting, EVS dons personal protective equipment (PPE), including gloves, gowns, and facial coverings such as MAXAIR CAPRs to protect them from any traces of disease. When the contaminated air has been filtered out, they can enter the isolation room and begin disinfecting. Once they’ve entered the isolation room, procedure dictates that they are to remain inside until all cleaning processes have been followed, and the room has been completely sterilized. So EVS goes about the room, disinfecting the entire space, including the floors, furniture, bathroom, and even the walls. Then, once the room is thoroughly cleaned, they must remain inside it to doff all of their PPE and dispose of any materials that may have been contaminated in the process of cleaning. It is only then that they are finally allowed to exit the room. The process of cleaning just one of these isolation rooms can take up to 2 hours, about twice as long as it normally takes to clean a typical MedSurg room, and that isn’t including the time it takes to don and doff any necessary PPE. With this additional time devoted to cleaning the isolation rooms and other areas vulnerable to COVID, EVS has never been busier. But they’ve kept their chin up and continue to push through these congested times, even when that has meant working overtime or helping to share someone else’s load during a hard shift

You might wonder what keeps them going, how they are able to take on such busy days, and how they are able to keep cool under this kind of pressure. Emily Cummings shared, “My family is what drives me forward.  I’ve had loved ones who once stayed in these same rooms that I cleaned today.  EVS was there to keep things clean and safe for the people I loved. If my Dad were sick in the hospital, I’d want to know that everyone there was doing everything they could to keep him safe, so that’s why I need to do everything I can to keep these patients safe.” “I’ve been afraid to get COVID, I know how serious this disease can be, but I want to contribute in any way I can to stopping it from getting to somebody else,” Heather Yost explained. “I keep going because of everyone on the EVS team.  I see how hard they work every day, and I’m so proud of all the hard work that they do. They inspire me every day to work harder than I ever thought I could,” Karen Wemple concluded.

We at Sheridan Memorial Hospital are so very grateful for our outstanding Environmental Services team. We can’t thank them enough for their perseverance throughout these difficult times and for the amazing work they do every day to ensure that our community has a clean, safe place to receive excellent patient-centered care.

When you meet Elisabeth Scalva, MD, the first thing you might notice is her height. However, that quickly fades away as her vibrant personality radiates as she engages with people. As a new Obstetrics/Gynecology physician at SMH Women’s Clinic, Scalva will bring that positivity, and her infectious laugh, to bear on her work every day.

“I have always had a genuine love for people,” Scalva says. “When I couple that with my love for science, I naturally moved towards healthcare.”

It was her grandfather, a veterinarian, who initially piqued her interest through his practice.

“He would have to dissect animals or do surgeries and that was my first exposure to any type of medicine,” she adds.

Originally from Littleton, CO, Scalva grew up in the shadow of the big city of Denver. But she knew she had a passion for rural areas and bringing quality healthcare to those who make their homes away from the big city lights, especially women.

“I trained in rural settings after medical school and have always had a commitment to rural medicine,” Scalva says. “I thought I wanted to be a general surgeon at first, but found that I am passionate about helping women throughout their entire life. I like and appreciate that continuity.”

Scalva was part of a private practice in Grand Junction, CO for the three years prior to her move to Sheridan. Her best friend from med school, Lindsay Capron (another OB/GYN physician at the SMH Women’s Clinic), was recruiting her pretty hard.

“Lindsay and I are very close and she knew how much my family and I would love it in Sheridan,” Scalva said. “And she was right. We came to interview and just loved it.”

Describing herself as “outdoorsy,” Scalva and her family like to hike, backpack and camp. She is also into trail running and yoga.

“My husband, Ryan, and I bought a home near the park and just love being able to take our kids, ages one and four, to the park,” said Scalva. “We want to be a part of the community and living in the heart of it makes sense for us.”

By Kim Gilbert, FNP-C, AGACNP-BC

Kim Gilbert is a Family Nurse Practitioner at Sheridan Memorial Hospital’s Internal Medicine practice.

I am a certified Family Nurse Practitioner, earning my master’s degree in 2012. Recently I completed a post-master’s certificate program through the University of Northern Colorado-Greeley as an Adult Gerontology Acute Care Nurse Practitioner, graduating in April 2020. I am now dual certified FNP/AGACNP. With this new certification, I am better able to care for our communities’ aging population, diagnosing and treating patients in both the clinic as well as the hospital.

            I would like to explain what a Nurse Practitioner is and what we do.  There are many types of health care providers in our current health care delivery system. Physicians, physician assistants, and nurse practitioners make up a vast majority of them. Over the last fifty years, advanced practice nurse roles have increased and evolved with the ever-changing health care system.  Nurse practitioners, also known as NPs, are one type of advanced practice nurse. NPs are nurses who obtain additional training to provide either primary care or specialty care to a specific population. NPs are trained in a specific role based on the education they obtain. Nurse practitioners can diagnose and treat acute illness and chronic disease as well as provide preventative health care to the population they serve.

            The most common type of nurse practitioner is the Family Nurse Practitioner (FNP), making up approximately 70% of advanced practice nurses. Family Nurse Practitioners provide primary care to all ages. Some Family Nurse Practitioners obtain additional training such as Emergency NP or specialty, such as oncology. In addition to FNP, there are other nurse practitioner education programs that train to a specific population, such as pediatric (ages 0-21) or adult-gerontology (age 18 and older). Within these roles, there are educational programs geared toward primary care (PC), which is the management of chronic conditions and preventative care, or programs with an emphasis on acute care (AC), or the management of acute illness (which includes patients in the hospital setting). Another specific training program includes Women’s Health Nurse Practitioners (WHNP). These NPs provide a variety of care to women of all ages. Finally, there is the Psychiatric Mental Health Nurse Practitioner (PMHNP). These NPs provide psychiatric and mental health care to all ages of patients.

            Nurse practitioners typically have either a master’s degree (MS) or a Doctorate of Nursing Practice (DNP) degree. State licensure and certification are required to practice within a state. Each state has specific requirements for practice, which includes required continuing education to maintain licensure as well as requirements to maintain the ability to prescribe medications, also known as prescriptive authority.

            As a health care consumer, there are many options and choices for receiving care. Understanding your options can be very difficult, especially as health care delivery systems change. Learning more about the training and certification your health care provider can help when you are looking for a primary care provider or if you become ill and require additional services such as hospitalization or specialty care.  Sheridan Memorial Hospital’s Internal Medicine providers include physicians, physician assistants, and family nurse practitioners who are divided into teams to ensure patients receive consistent, well-managed and timely care.

By Benjamin Widener, MD, of Sheridan Memorial Hospital Rheumatology

I am pleased to announce that Sheridan Memorial Hospital is opening a Rheumatology practice in August, where I will be working as a Rheumatologist.  I recently completed my Fellowship in Rheumatology at the University of Nebraska Medical Center (UNMC) in Omaha, Nebraska, and have returned to my hometown of Sheridan to continue serving the community and surrounding region. 

Many of you may know me as I previously practiced in Sheridan as an Internal Medicine physician before being accepted into the two-year Rheumatology Fellowship, where I received advanced training and education in the diagnosis and management of Rheumatic diseases. 

As a medical specialty, Rheumatology is new to Sheridan.  In assessing the healthcare needs of our community, Rheumatology was identified as a needed and valuable specialty for our community.    

Rheumatology fellowship develops a physician’s skills to better diagnose and treat diseases such as rheumatoid arthritis, gout, lupus, psoriatic arthritis, ankylosing spondylitis, and many other inflammatory and arthritic conditions.  This education inherently involves developing a deeper understanding of the immune system and of the rapidly advancing therapies being developed to help treat Rheumatic diseases.  My fellowship education consisted of clinical care of patients, academic research, teaching resident physicians and medical students, and advanced education in clinical Immunology.  

Additionally, I received dedicated education and training in the use of musculoskeletal ultrasound.  Thanks to the generosity of the Sheridan Memorial Hospital Foundation and our community, the hospital has been able to acquire a brand-new point-of-care ultrasound machine to facilitate this unique service.  This training and technology can be used to aid in the diagnosis of rheumatic conditions and guide therapeutic procedures, making them safer and more effective.

Access to a Rheumatologist is limited in many parts of the country, especially in rural communities, as there are around only 5,000 Rheumatologist in the United States.  Having worked in Sheridan previously and knowing the limitations my patients had in accessing Rheumatology care, I am passionate about providing this specialty care to the Sheridan community. 

Rheumatic disease and similar conditions can be complex, and patients benefit from the care of a specialist, particularly within a collaborative care network, such as the team available at Sheridan Memorial Hospital.   I am excited to continue to work with the Sheridan Memorial Hospital clinicians and staff to serve Sheridan and the surrounding community.  It is my hope that having local access to Rheumatology will allow many of our patients to stay here in Sheridan rather than traveling out of town for their healthcare.

If you are interested in seeing me, please contact your primary care provider about sending a referral to Sheridan Memorial Hospital Rheumatology.  I will begin seeing patients when the new practice opens in the Outpatient Center beginning August 3, 2020. 

By Cheryl Varner, M.D.

I am a physician in the Navy reserves just returning to Wyoming from serving in New York City.  I was deployed to the Javits New York Medical Station in early April and began seeing COVID patients by April 8.  This was at the peak of the number of COVID cases happening in NYC, the top of their “curve”.  During that time, NYC hospitals were operating above capacity and our mission at Javits was to offload some of the less acute patients in order to make room in local hospitals to care for the sickest patients. 

Javits was not a full-service hospital (think field hospital set up in a convention center).  We provided approximately 4,700 hospital bed-days of relief to local NYC hospitals during our mission.  Most of our patients got better and were discharged home, which was definitely cause for celebration.

The public health conditions of NYC are very different from Sheridan, WY.  Population density, social determinants of health, and Health Care Systems all look quite different here.  Retrospectively, it appears that COVID has not had community spread in Sheridan, even though we have had a few cases.  When community spread occurs, we will likely see more cases and some hospitalized patients.  I feel Sheridan County is prepared for community spread, if and when it occurs.  If it does occur, we will need to protect each other (and vulnerable people) using the same tactics we have been employing so far, wearing facemasks in public, practicing frequent hand hygiene, and being tested if we have COVID symptoms. 

Because someone can be sick with little to no symptoms (asymptomatic), they can spread COVID to other people unknowingly.  It is also known that there is a pre-symptomatic phase of COVID when you can spread the virus unknowingly.  This is why my family will wear a facemask, even if we feel well, to help reduce the spread of COVID.  This was especially important in NYC with such a high prevalence of COVID and high population density.

I am overjoyed to be back home in Sheridan.  I missed my family, friends and community desperately.  Your support while I was gone meant the world to my family and me. I appreciate you all so much.

Cheryl Varner, M.D.

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