ESTERHAZY — Last August, Nicole Smalley got a new job in Esterhazy, and she’s been very busy ever since. Smalley accepted the role of executive director at St. Anthony’s Hospital, drawing from her registered nurse background from Yorkton where she spent a decade in emergency plus three years in management.
Previous Executive Director Daniela Fiske had retired in June, 2024, with an interim director filling the position until Smalley came on board permanently.
“I had come from Yorkton, where I was the manager of Medicine and Pediatrics,” Smalley said, adding that the move to St. Anthony’s and Emmanuel Health was made easier with the supportive nature of Emmanuel’s CEO Corey Miller.
“That’s one reason why I made the move and came to Emmanuel Health and Esterhazy, is because, in our interviews, he was so supportive of forward-moving work and whatever I had in mind for innovations and changes,” Smalley said.
Smaller centres such as Esterhazy seemingly get missed in terms of innovation, according to Smalley, with larger centres receiving much of the focus.
“We kind of forget about the small rural communities like Esterhazy, who serve a huge population — especially with the mines — there is so much potential for emergency room needs with those three mines there.”
Immediately, Smalley saw the needs at St. Anthony’s and started enacting change.
“We’ve got to start looking at forward-moving work and making things essentially better for not only the nursing staff but the whole facility, as well as the town of Esterhazy and the residents coming in to access those services,” Smalley described of her internal call to change.
The shift from Smalley’s previous role to a much wider scope brought its own challenges, but she has been able to adjust to the executive director position.
“Yorkton is quite a busy hospital, so it was busy, but my focus was only the nursing staff,” she explained. “So I only had one set of staff, one set of criteria, and then I came into Esterhazy, and it’s like, ‘OK, you’re the one and only in charge of not only the whole building, not only nursing but lab and x-ray, housekeeping, maintenance, administration, staff, payroll, scheduling.’ It definitely has taken some collaboration and time, and the staff has been very good with me.”
Before accepting the new position at St. Anthony’s, Smalley was familiar with one Esterhazy resident in particular — Mayor Randy Bot.
“I’ve worked with him for years,” Smalley said. “He’s one of our EMS, so I’ve worked with him, and just having him be part of the town, it’s such a benefit for us because he knows firsthand exactly what is needed and what we’re lacking.”
Given all the various commitments Smalley has taken on with the new role, there is one overriding goal that has remained prominent throughout her career in health.
“I got into nursing because I truly care about people and I really care about our health care system and what we can offer in optimal care,” she said. “We all, at some point in time, need to access health care. Making the facility a better place, residents come in and they’re just so happy with the care that they receive for themselves or a loved one. It’s so worth the time and energy, so I’m enjoying it for sure!”
Lots of upgrades
Since joining the St. Anthony’s team, Smalley has made several improvements. Many of the items also have future compatibility in mind when a new hospital is built in Esterhazy.
“A lot of our support comes from our local foundation, as well as charity golf, so they’ve raised a lot of funds to support us,” Smalley said, adding that the Foundation has been quite trusting in her suggestions.
“They have trusted me 110 per cent,” she said. “They have really trusted my opinion. And I think working in emergency, and having that experience, they understand that I wouldn’t just want to purchase something to purchase it, right? So they have definitely given me the trust to move forward with these projects.”
Pyxis Medication Machine
Picture a vending machine, and you might have a rough idea of what a Pyxis Medication Machine looks like. It’s something that cities have been using for quite some time, and Smalley felt it was crucial to have one locally.
“Essentially, what was used in the past was a medication cart,” Smalley said. “You could either lock it or key in a code, and you would have a bunch of drawers with medications. You would get the orders from the physician and from the pharmacy, and then you would—based on what are in those drawers—pull them out.”
What Smalley noticed under the former system was nursing staff devoting extensive work to the medication side of the job. Having experience with Pyxis machines, Smalley knew there was a more efficient way.
“It’s hooked up straight to the pharmacy, so it’s essentially a computer on top of a bunch of drawers,” she explained. “It’s smooth, your potential or your risk for medication errors decreases tenfold.”
The Pyxis will also come with a part-time pharmacy tech to load medications twice per week.
“When they load them into this machine, they scan them through so it alerts pharmacy if anything is going to expire within the next 10 days, or if we ran out of the medication, it will alert them so they know exactly what to stock,” Smalley said. “It’s going to take a huge workload off of the nursing staff.”
Vein finder
Another item not commonly found in smaller hospitals across the province is a vein finder, but Esterhazy has one.
“It’s one of those newer machines that Emergency or Nursing and lab staff would access,” Smalley explained. “It’s essentially a vein illuminator. So you turn it on, it illuminates your veins, you would shine it right above, say, your forearm. It shows you exactly where veins are, regardless of how deep they are or if you could see them by just looking at your arm. It’s like a little X-ray picture of all your veins.”
For people coming into the hospital for bloodwork with hard to find or smaller veins, the tool is an extremely valuable asset.
“A lot of our elderly patients, they have these small, tiny, little veins that are really hard to access and sometimes you’re trying to start an IV or draw blood from them, and you’re poking them numerous times, which is increasing pain and making the patient uncomfortable and you’re doing the best you can,” Smalley said. “This machine, if you have a patient like that, or for anyone—even kids—it works really well. Those deeper veins that are a little bit bigger that you could access in one poke if you can, they’ll be illuminated on this screen.
“It’s just one of those tools that helps us do our jobs a little bit better,” she continued. “And it helps all of our patients because we don’t have to poke them numerous times and cause them more discomfort than they’re already in.”
Bladder scanner
Previously, numerous ambulance transfers took people from St. Anthony’s to Yorkton for bladder scans. By bringing a $25,000 bladder scanner to Esterhazy, not only are those patients seeking help saved hours on the road, but EMS service is also not impacted as often.
“We have limited EMS resources out of Esterhazy, so you’re taking two of our paramedics out of the community for at least two to three hours,” says Smalley. “That’s taking away from the community or potential emergencies that are happening in the community.”
Smalley says something they see a lot are elderly patients coming to the hospital with extreme abdominal pain.
“They are retaining urine in their bladder, but we don’t know exactly how much, we don’t know if it’s emptying out completely,” she explained. “You want them to get out of pain, essentially, but you don’t want to jump to the most uncomfortable procedure of catheterization.”
This is where the bladder scanner comes in—a small machine on a rolling cart that can accurately report how many millilitres of urine is in the patient’s bladder. The scanning process takes 10 seconds, complete with a printed image.
Not only has the scanner saved needless hours of discomfort while in transport, but it has streamlined services locally.
“Now we can do it straight out of our emergency, and then we can move forward with our treatment plan,” Smalley said.
New X-ray machine
One thing that surprised Smalley when she first came to Esterhazy was the amount of lab work and X-ray work that happens at the facility, for inpatients and outpatients alike.
“When I came in, the decision was made that we were going to get a new X-ray machine,” confirmed Smalley. “It’s way more convenient. It’s a little bit smaller and the technology is advanced from the one that we had.”
Smalley anticipates the new X-ray should be arriving in the next couple of months.
“We’ve decided on what machine we want to go with, and they’re actually coming in here in February,” she said of representatives from GE. “Their reps are going to come in February and do the final walk around and get an idea of exactly where we’re putting things and setting up the machines.”
As with the bladder scanner, Smalley noted that time spent on the road will be decreased for patients.
“The fact you don’t have to truck once again to Yorkton or Moosomin is huge for residents,” she said.
Distance diagnostics
Something that piqued the interest of Smalley and Miller was the robotic ultrasound project in Gravelbourg, so much that the duo took a roadtrip to the town.
“Gravelbourg right now is running a pilot project with a couple of physicians, and it’s actually a company they created out of Saskatoon,” Smalley explained. “What they’re trialing, essentially, is a robotic ultrasound machine.”
St. Joseph’s Hospital/Foyer D’Youville is another Emmanuel Health facility and received the MELODY Telereobitic Ultrasound System in November 2022. The goal of the pilot project was to improve rural access to diagnostic care.
It was a first on a national scale, and the Virtual Care and Robotics program research lab at the University of Saskatchewan in Saskatoon was the only initiative of its kind to use the MELODY system in North America.
“They can do a majority of ultrasounds, from abdominal to prenatal, and it collaborates with a computer and an ultrasound tech out of Saskatoon,” Smalley said.
An operator in Gravelbourg places the robotic arm on the patient’s abdomen while the ultrasound tech in Saskatoon controls the device, communicating in real-time via video.
“It’s a pretty cool, innovative machine,” Smalley said.
She would like to bring the technology to Esterhazy once the trial in Gravelbourg comes to a close.
“Then we could once again do ultrasounds out of Esterhazy and residents wouldn’t have to travel the hour and a little bit to Yorkton or Moosomin.”
Virtual physician
Several area health facilities have incorporated the virtual physician program into their service delivery. In Esterhazy, a soft launch will happen in February for staff to become familiar with how to program works.
“It will be something that we can access if ever we come to that point in time where we’re looking at a bypass due to physicians,” Smalley said. “We’re kind of lucky, though, right now—knock on wood. We have five very active physicians in the community. It’s given us some time to upgrade that education and make sure we’re ready to go with it.”
As with other places in the region that have adopted virtual health, Smalley sees the program as something that could take some of the stress off physicians. One possibility is having every sixth weekend of emergency call be with a virtual physician.
“It would give our physicians that break,” Smalley said. “What people don’t realize is the areas our physicians are servicing—two of them go to Langenburg a couple days a week and work out of the clinic there, plus they work out of our home clinic in Esterhazy. Plus they see inpatients at both the nursing home and the hospital, and then they work the emergency. So like everywhere, we’re spreading our physicians thin. And if we could access this every sixth weekend, it would give them that well-needed break so that they could come back and not be so overworked.”
Sterilization machine
Another item that will save round trips to Yorkton was the purchase of a sterilization machine for St. Anthony’s. Previously, equipment would be packaged up and transported to Yorkton to be sterilized before making the trip back to Esterhazy.
“It’s just something that’s going to save immense time plus cost,” Smalley said. “We’re paying courier services two to three times a week back and forth to Yorkton, and Yorkton is doing a huge amount of work for their facility and surrounding areas. I felt like it was a need for our facility here.”
Critical care co-ordinator
Having a Critical Care Co-ordinator was another idea Smalley brought to St. Anthony’s.
“When I worked out of Yorkton, there were four managers. Each of us had our own care co-ordinators,” she explained. “They’re still an in-scope RN, but essentially they’ll work Monday to Friday alongside us, and they’re kind of the in-between, the individual between management and the patients and the ward staff.
“Right now, we have one discharge planner, and the amount of work that she does for the residents and the community, she is so overworked with the amount of assessments and paperwork and things that she has to do.
“So with this role, it not only helps the patients, because they’re getting more one-on-one care and discharge planning appropriate for their needs, it helps the nursing staff because right now they’re going in and doing case conferences and family conferences and our meetings with social work and whatever it may be, and it’s taking away time for them to be on the floor and providing that bedside care.”
