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Serving Rural Communities as a Provider and CEO

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When Micki Lyons, CEO, DNP-C returned home to serve her patients as a nurse practitioner, she was surprised by a request to step into an executive role — and surprised herself in accepting.

Many nurse practitioners (NPs) discover early on in their lives that they have a passion for helping people, and one of the best ways to realize their full potential as a professional advocate and health care provider is to become a nurse. What NP students and new NPs may be surprised to learn is that this career path may include unexpected — and frequently rewarding — twists and turns.

For Micki Lyons, her career as an NP has been defined by grounding herself in the community in which she was raised — and by embracing both spontaneity and opportunity. Lyons spoke with the American Association of Nurse Practitioners® (AANP) about accepting the challenge of working as both a CEO and an NP at a rural clinic, and the journey that brought her back to where she began.

Q: How did you become interested in the nursing profession, and what inspired you to become an NP?

Micki Lyons: Interestingly, I never wanted to be anything other than a nurse. Ever since middle school, that’s what I knew I was going to do.

I graduated from high school and went to nursing school. It was kind of funny because one of my nursing friends was finishing her bachelor’s degree, and she said, “If I’m going to keep doing this, we have to do it now. So, do you want to go to NP school?” And I said, “Sure. [laughs] Let’s do it.” We went down that path together, and ended up staying in the communities that we grew up in.

Q: You have an interesting career path in that after becoming an NP, you became a CEO. What was your pathway to executive leadership?

Lyons: Initially when I went to school, it was a master’s program. I went to the University of Mary, and they came out with a bridge program to the DNP that was in organizational leadership. I thought that would be a very interesting path to go down because I was a clinic manager at the time; I’ve always had an interest in leading people. I thought, I’ll get my doctorate — and then maybe, eventually down the road — I’ll look at doing some consulting, some leadership-type things.

Shortly before I graduated with my DNP, the chairman for our hospital board approached me and said, “Hey, you’re a hometown girl, and you’re a nurse. What are your plans for the future? Have you ever considered being a CEO? I think that you could be a good fit to lead our organization." I was terrified and I thought he was crazy, as that was not something that had really occurred to be as a goal for the very near future. It just so happened that within a couple of months of that conversation I was being asked to step into the interim CEO role. I hesitantly agreed, and three years later here we are.

Q: How long have you been CEO?

Lyons: Three years.

Q: Why do you continue to practice as an NP in addition to your role as CEO?

Lyons: I see patients one day a week in the clinic in addition to my CEO role. I feel it is important to have your boots on the ground and understand the patient’s point of view, the staff’s point of view, the other provider’s point of view. You’re not just the scary CEO that sits in the chair and dictates how people do things and doesn’t understand any of it. I try to keep very involved and be a part of the team, as well as direct the strategic vision.

Q: Wyoming is the least populated state in the U.S. Are you working in a particularly rural area?

Lyons: We’re in northeast Wyoming, so it’s very rural. We have three outlying clinics; we have a small 16-bed hospital with an ER; we’re critical access with a 32-bed nursing home. Right now, I’m sitting over in our Hulett clinic, which is in a town of 300 people, because one of our providers had an emergency and somebody needed to cover — so that’s what I’m doing.

We’re trying to be strategic and ask what the vision of the organization looks like, while at the same time dealing with, “Oh hey, this patient needs a medication refilled and we don’t know if it can be refilled.” It’s interesting to kind of toggle back and forth between those roles. There’s just a lot.

Q: What specific challenges do you face in a rural area, and how do you think those differ from challenges in areas with a higher population?

Lyons: Large places, small places…in health care they all have their challenges, but one of the things that we find in Wyoming is that it’s truly all small communities with very long distances between them. We have no specialists, we don’t do surgery, we don’t deliver babies. But our patients still need those services, so trying to find access to those services for them without having to send them hundreds of miles away — I think that’s one of the biggest challenges that we have.

We have a very high Medicare population, and we need to be able to have enough providers that can take care of that population. This is typically the population with multiple comorbidities and the ones that need specialists. How do you get them those services? The challenge of figuring out telehealth and transportation has been a big issue for us.

Q: What are some of the solutions you’ve discovered?

Lyons: One thing we do in rural medicine — and that we do well — is that we’re creative. We don’t have IV teams, we don’t have respiratory therapy and we don’t have specialists right in our back pocket that we can bring in when we have an ER patient or a critical inpatient. I think it’s just about being creative, willing to branch out and learn a lot of different skills to be efficient and productive in a rural area.

Q: You mentioned that you’re originally from the area where you now work. What was important about returning to serve your community?

Lyons: I grew up in Crook County, but I live in Rapid City, South Dakota. I actually drive about 180 miles a day to come to my community and take care of the people I grew up with. I think that’s the important thing — there’s always life things that cause you to have to live in different areas, but being able to come back to Crook County and take care of my family, my friends, the people I went to high school with…I think that’s a big piece of why I do what I do, so I can take care of what I consider to be my people.

Q: From working as an NP and a CEO to that long commute – you’re very busy. What do you do, and what could you recommend to other NPs, to relieve stress?

Lyons: As a society, we’re in this time of burnout, and everybody’s stressed, right? We put so much focus on: “Work, work, work,” and making sure we’re the best at everything we do. One thing I would say is that work-life balance is very important. You have to realize that your family has to come first, and your health has to come before the job. Take 15 minutes of meditation, deep breathing or just step outside the back door and take a brief walk so that you can step away from what you’re doing. If you’re not healthy, you can’t take care of other people.

Become an Executive Leader with AANP

AANP members interested in embarking on their own leadership journey have until Sept. 30 to enroll in the “AANP Introductory Certificate on Leadership” program, “a leadership fundamentals program directed toward new and emerging leaders.” NPs may earn up to 11.5 contact hours of continuing education after completing this 12-module course.

Enroll in Program

NPs who earn a “AANP Introductory Certificate on Leadership” become eligible for AANP’s Executive Leadership Program when applications reopen early next year.