Breaking Barriers and Bridging Gaps: A Nurse’s Journey to the Frontlines of Rural Healthcare...

In the bustling corridors of our healthcare institutions, amid the beeping monitors and hurried footsteps, there exists a field of dedicated professionals who possess an unwavering love for their vocation: the nurses. Standing out among these compassionate caregivers is Dr. Jason S. Litzinger, DNP, APRN, FNP-BC —a nurse who not only ardently serves the needs of patients but also holds an unshakable reverence for the nursing profession in the face of its continuing challenges and impending shortages.

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Dr. Jason S. Litzinger Nurse

Dr. Jason S. Litzinger, DNP, APRN, FNP-BC, was initially drawn to medicine due to his interest in science and mathematics. However, he was motivated to pursue nursing by the loving care he witnessed his grandmother receive when he was young.

“When I was a teenager, my grandmother became ill. My family took care of her up until she passed. Seeing the dynamics of that really spoke to me. I was like, hey, I really want to help people in the future.”

He turned to higher education, earning an associate degree in nursing from the Community College of Allegheny County, a bachelor’s degree in nursing from Slippery Rock University, and a master’s degree in nursing from Chamberlain College of Nursing.

Of all the nursing sub-specialties, Dr. Litzinger was particularly interested in family practice since it allowed him to treat a wide range of patients. “You are able to take care of all age groups, basically from birth up through geriatrics,” he says.

Inspired then by his growing experience in treating patients, Dr. Litzinger pursued a doctorate of nursing practice in leadership through Aspen University, where he focused on the use of telemedicine in rural areas for his dissertation. Growing up, he had seen firsthand the lack of accessibility to healthcare in certain parts of the country. “I actually grew up in a very small town, and our closest hospital was roughly 30 miles from our home,” he says.

“Starting as a family practitioner, I saw that the demographics were quite broad. When I say demographics, I mean age groups, income, as well as family size. The availability to always get into a doctor’s office wasn’t there.”

A central question in his research was how much of an effect the widespread use of telemedicine would have on a small town.

“I thought, how beneficial would an on-demand virtual telemedicine visit be for an individual who needs care but can’t physically get into the doctor’s office.”

He explains that, apart from the immediate need for some treatments, the lack of access can also harm the mental well-being of these groups of people.

“It’s really perception. While it might be urgent to patient A, patient B may say, ‘This is OK.’ For instance, a patient may be running out of blood pressure medications the next week. Some people are like, ‘Yeah, I’ll call the pharmacy later this week and get it,’ while others are like, ‘No, I need them now. I know I can’t go without.’ That’s urgent to them, so they need care that day.”

Securing a video visit with a medical professional to refill the medication and knowing it will be at the pharmacy waiting for them gives people valuable peace of mind.

Dr. Litzinger’s early experiences as a nursing assistant at a long-term care facility prompted him to also get involved in the management side of nursing now that he had earned his degrees.

“As an assistant, I loved what I did—being with patients, bathing them, feeding them, and spending time with their families. It was wonderful. But when I would report something to one of the nurses that I thought was important, it would sometimes fall to the wayside even though a nurse would say, ‘OK, we are going to address it.’ So, I was like, you know what? I can go to the next step and become the nurse to push for change.”

Even in an assistant position, he spoke up for the interests of the patients under his care, and his continued proactiveness significantly impacted their treatment.

“I was able to be a change motivator. When my patient needed something, I could advocate at a higher level. I was taken more seriously than frontline staff as far as the nursing assistants were taken, and that drive kept going because then, as a foreigner, I was like, no, my charge nurse isn’t pushing hard enough.”

He credits those formative experiences with propelling him toward a bachelor’s degree in nursing and charge nurse training. Ultimately, he found employment with the VA Pittsburgh Healthcare System as a charge nurse.

“Then, at that point, as the charge nurse, I found myself at times advocating for what the patient needed from the provider, knowing through scientific and evidence-based practice what they need, but the provider would drag their feet, or the provider would disagree.”

He found himself wanting greater opportunities to help more patients. “I wanted to be that provider that when someone comes in and says hey, I need this, I can come and explore all options with them, explain risk versus benefits,” he says.

While he succeeded in becoming that person, one of Dr. Litzinger’s most concerning worries is that the medical field will soon face a massive shortage of nurses. One reason there already exists a shortage of nurses is that few men choose to enter the field, hovering at only 12% of all nurses.

“The mindset that nursing started with Florence Nightingale, as the female being the primary caregiver, with all that being in mind, I think that sometimes there is a stigma that if you are a male in nursing, you are considered ‘soft,’ so to speak.”

He says that the most crucial part of nursing has to do with attributes that can be found in anyone who is genuinely interested in the well-being of others.

“The caring and compassion is needed, which can come from any individual. It does not matter what sex they are, but I feel that a lot of times, society says that men can’t struggle with emotions, be a caregiver or be sensitive. But the reality is all humans are capable of that.”

There is a greater demand for nurses now than ever before. The COVID-19 pandemic highlighted the weaknesses in our healthcare system and placed immense pressure on nurses. Many medical professionals left the field after the pandemic had been relatively contained due to mental and physical exhaustion.

“Healthcare during the pandemic was stressed to the max. I know healthcare had concerns prior to the pandemic, but it ended up pushing a lot of nurses, both male and female, over the edge because of all the constraints. Number one was the physical aspects and demands for the number of patients needing care—that became astronomical.”

The sheer number of patients necessitated nurses working long shifts with inadequate personal protective equipment. Hospitals were being overwhelmed, so the well-being of medical staff was not prioritized.

“You have to look at the hours worked. Burnout happened across the board, and in addition to that, folks were taking care of COVID patients that were passing away. Sometimes they were young and healthy individuals with no comorbidities. For any human being, no matter the career you are in, there will come a point where it becomes extremely emotionally taxing.”

To add to the struggle, Dr. Litzinger says that many nurses were losing their own family members while being tasked with caring for their patients. Processing those emotions while being up against a disease they knew little about, one with constantly changing variables, was a hefty weight to bear.

“I don’t feel that leadership really realized what the frontline workers were facing every day. Mental health is already an area that is vastly underserved nationwide. Living in rural Northern Arizona, we have limited resources here, but it is something that I even saw back in Pittsburgh. There were limited resources in such a large city.”

He thinks young people, who are especially at risk for mental health problems, are only partially supported due to a lack of resources and a failure of some healthcare institutions to take them seriously.

“When it comes to teenagers, hormones are all over the place, and there is a lot going on. When you have teens growing up in different areas, with variable diversity, location, and all these other factors, oftentimes, they are not taken seriously with the verbiage that they’re utilizing. And in that aspect, they are underserved.”

Dr. Litzinger makes an effort to foster an atmosphere of open communication with his younger patients. If he senses any hesitance, he may ask the guardian if they would mind sitting in the waiting room.

“If there is a teenager coming in to see me, who tells me I want to kill myself, I’m collecting the information from them unbiased. Because without the guardian in the room, they’re usually pretty free to speak, which is wonderful.”

In some cases, he calls a mental health crisis team when the patient is suspected to be a danger to themselves. He says that it is important to look at the situation as both a mandated reporter, but also as a person recognizing that this is a human being who needs help, and they need it now. Many physicians are intimidated to engage in these conversations because some patients are reluctant to receive treatment.

“When you get down to their level and speak face to face with them and breakthrough, oftentimes the patient understands why you’re getting the crisis team in place.”

Due to living in a rural part of Arizona, Dr. Litzinger understands how critical his role is in providing healthcare to younger people, especially those who have little recourse to advocate for themselves.

“I’ve had patients where I was like, ‘Hey, if you’re feeling that your parents aren’t hearing you and you need someone to talk to, get an appointment. Come back. I will be more than happy to take care of you. I can do a same-day appointment. Any day. Just call.’ Just knowing they have resources gives these kids hope.”

According to Dr. Litzinger, clinicians are sometimes forced into that role due to a lack of resources when dealing with people experiencing mental healthcare crises. In rural areas where healthcare providers are scarce, both providers and patients may have few options.

“I work in urgent care, where I precept many students. There are times when I have someone coming in with depression, anxiety, suicidal or homicidal ideations. I’m very grateful that I have the students. They help me manage these patients because what the folks need is time. Time is the pertinent thing. They need to be heard. They need to be validated.”

Dr. Litzinger is an experienced educator who has taught previously at Yavapai College and the Community College of Allegheny County as a clinical adjunct faculty member. He enjoys teaching because it allows him to watch others grasp the interconnections between nursing and subjects like science and math.

Dr. Jason S. Litzinger Nurse

“It speaks volumes to me when I see things clicking in students by answering their questions. Being the lead over these students and seeing them give care, develop while they are with me, and go from, ‘I’m the brand-new baby nurse student’ to, ‘I’m doing this on my own’ is incredibly rewarding.”

Dr. Jason S. Litzinger Nurse

He also works with Northern Arizona Healthcare to mitigate risk by recognizing and preventing hurdles that may arise treating patients in a rural setting.

“When it comes down to it, each organization is very different with their risk management assessments. In different areas, you’re going to have different trends based on several variables that can include food, location, population served, and demographics. What might be a risk in one area might not be a risk in another. It comes down to prioritizing.”

He describes how in rural areas, the potential of delayed care especially serves as a risk to the elderly population. Given their more frequent need for care, the distance between patients and treatment centers is amplified.

“Geriatrics speaks to my heart on a number of levels. I feel that these individuals are living in an era that is very different from what they were raised in. A lot of them don’t understand how healthcare has evolved. There are so many opportunities to get excellent and amazing care, but a lot of times geriatrics are often overlooked. They’re not given the time and attention required.”

He says that one thing he loves about working with the elderly population is listening to their life stories or seeing them defy stereotypes, driving to treatment centers on their own at 90 years old.

“Father Time and gravity play their effects on us as we age, but it’s about quality of life. These patients are going to remember, ‘When my blood pressure started climbing, you took care of me,’ or ‘When my pain was uncontrolled, he talked to me about what I could do and gave me different resources.’”

Improving the approach to more holistic care by involving medical providers from different fields, anywhere from psychiatry to endocrinology, is one way to effectively treat a wide variety of patient populations.

“It’s a matter of saying what can we do for this person in all aspects to make sure they are being taken care of in the best possible way. We want to ensure that the quality of their care and life remains optimal.”

One board that Dr. Litzinger serves on is the Quality Improvement Committee, which looks at cases with suboptimal outcomes to see how they could have been improved. “It’s not a matter of pointing blame to say this provider didn’t do this or that; it’s a matter of looking at the case and understanding what went wrong, what we can do in the future to prevent that from happening again,” he says.

The administration of opioids is one field where such a committee is beneficial, given the ongoing opioid crisis across the country.

“I’ve seen patients dosed inappropriately—too high and/or too frequently. One thing I’m doing with Northern Arizona Healthcare is I’m part of the panel for opioid stewardship to recreate policies and procedures.”

In addition to being a family nurse practitioner for Northern Arizona Healthcare, he also is a provider informatics consultant with the IT team to carry out suggested rules and regulations.

“What we’re doing is we’re looking at the guidelines set forth by the state, as well as federal regulations, and redeveloping the opioid stewardship program to make sure patients are not put at risk for addiction and to make sure patients have their pain controlled appropriately. I’m working with the informatics team to get the IT builds in place to make tracking opioid prescribing and looking at pain contracts easily accessible via electronic health records.”

This type of system ties in with the idea of more holistic care, which turns to different specialists and modalities of treatment to solve the problem of pain before opioids are brought into the picture.

“So a provider can simply say, you know what? I have a person who has done cognitive behavioral therapy, has seen a pain specialist, and a spine surgeon, whatever the case may be. There’s nothing else we can do, so it comes down to being managed on opioids to keep them comfortable and at a good quality of life.’”

To combat the scarcity of providers in rural areas, he also helps with the onboarding process at Northern Arizona Healthcare, having plans and a clear system in each department.

“We’re looking at getting basically everything streamlined and a very efficient process in place because rural living presents the challenge of attracting qualified individuals interested in staying and working.”

Given the persisting lack of accessibility to care in those areas, Dr. Litzinger states that one way to increase access is to form partnerships with other organizations, allowing smaller organizations to offer new services so patients do not need to travel far.

Dr. Litzinger continues to work toward better serving his community and the profession of nursing in general. He stresses how demanding a job it is since nurses often have to wear several hats throughout their shifts.

“You’re learning to be the advocate for the patient. You’re their caregiver. You’re going to be whatever they need you to be. You’re going to be a dietician at 3 a.m. when they’re having trouble swallowing, and you need to downgrade their diet. When a patient is passing away, if the chaplain is not available, you’re going to be that resource for their faith to carry them and their family through their final hours.”

He experienced the latter in real life, describing how the family of a patient that was passing away once asked him to be involved in a cultural ritual bedside since he was considered the primary caregiver.

“It was so fulfilling to be invited into it, and more importantly, to know that the family cared that much about the person taking care of their loved one that I was part of their passage as they transitioned. It was amazing and so enlightening. I embraced that opportunity.”

The family reassured Dr. Litzinger when he was nervous, and the ritual became one of the most meaningful memories in his nursing career.

“I went home from work that day, and this patient passed, and it wasn’t a family that was sitting around crying, upset, and sad. It was a family that fully embraced their traditions, and being part of that just made me feel complete.”

With a job that can be so emotionally intense, he is a big proponent of self-support and self-care.

“At home, it’s a matter of taking care of yourself, making sure you’re resting, making sure you’re eating right. Back at the job, it’s making sure you’re doing what is feasible. I can’t tell you how many nurses, when it comes to going to the bathroom or eating, have an attitude of ‘I’ll get to that later.’”

As the shortage of nurses continues to grow, the pressure placed on nurses in understaffed hospitals and centers is unlikely to die down.

“When living in the city, your resources are richer. When you’re in a rural area, you’re stressed more because you’re working more and don’t have those additional nurses.”

In spite of these demands on both body and mind, many nurses love their jobs because of the unique connections they are able to make with their patients.

“I feel that in nursing, you are pulled into people’s lives in a much different aspect. Something someone said one time rang very true to me. ‘When you are walking down the hall, do you ever hear a patient yelling, doctor?’ You always hear them calling for the nurse. We have that multiplex role. You’re a janitor cleaning sometimes; you’re a florist because you’re delivering flowers; you’re a telephone operator because they don’t have a phone to call their family.”

For individuals looking to become nurses, he advises them to commit to that path for the right reasons.

“Are you considering it because you’re compassionate about people and you want to give good care, or do you feel it’s just a good career with financial stability? The first answer needs to be prominent. You do it because you care. The second thing is don’t let stigma affect that. Nurses have come from all races, sexes, and backgrounds.”

He also stresses that anyone who wants to become a nurse should be open-minded about the future of medicine. “I know that we live in a society where change is something scary, and we have so many change resistors; but being a nurse, you have to be open to change because healthcare is evolving daily,” he says.

Finally, he offers some advice on how to approach patients.

“I tell my patients this daily—I take care of you as if you were me.”

For any inquiries, you can reach Dr. Jason S. Litzinger at (928) 639-5555.

Dr. Jason S. Litzinger Nurse