Myra Ray, MSN, RN, Manager of Surgical Services at Franciscan Healthcare

Summary

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Podcast Summary: Becker’s Healthcare Podcast

Guest: Myra Ray, MSN, RN, Manager of Surgical Services, Franciscan Healthcare
Host: Francesca Matthews
Date: November 15, 2025
Episode Theme:
This episode explores current trends, growth, and challenges in Ambulatory Surgery Centers (ASCs), with a focus on rural healthcare delivery. Myra Ray shares insights from her experience managing surgical services in West Point, Nebraska, highlighting strategies for growth, staffing, community engagement, and innovation in service offerings.

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Main Discussion Points & Insights

Myra Ray’s Background

• [01:02] Myra introduces herself as a nurse leader with 20+ years of experience in various perioperative settings, from trauma centers to ASCs.
  • She currently oversees pre-op, operating room, and PACU, managing patient care from pre-admission to discharge.

Key Trends in Healthcare & ASC Management

• Staffing Shortages & Labor Costs:
  • “We’re trending in monitoring staffing shortages and increased labor costs... recruitment and retention and how are we going to keep up with the increasing cost of labor.” (Myra Ray, [01:52])
• Higher Acuity Procedures:
  • There’s a notable increase in performing higher acuity and new procedures that were not previously done in-house.
• Reimbursement & Prior Authorizations:
  • “All the procedures that were once not requiring prior authorizations... insurers are seeking prior authorizations in things that we didn’t have to have before.” (Myra Ray, [02:36])

Growth and Expansion Strategies

• Excitement About Growth:
  • “We’ve expanded our volumes by about 25% in the last six months to a year. So we’re seeing a massive amount of growth. I’m out of space... it’s also a very exciting time.” (Myra Ray, [03:38])
  • New build or remodel is under consideration to accommodate this growth.
• Service Expansion Examples:
  • “We have a plastic surgeon that joined us about six months ago and he’s doing several new procedures. We just did a rib plating. We are looking at doing rhinoplasties.” (Myra Ray, [04:28])
  • Introduction of services previously unavailable regionally lessens patient travel burden.

Challenges of Growing in a Rural Setting

• Unique Staffing Solutions:
  • Difficulty sourcing staff in rural areas sparks creative solutions.
  • “We’ve created a scholarship program so that we pay ahead of the nurse going to school so that they don’t have the out of pocket expense… expanded that to other universities in the area.” (Myra Ray, [05:57])
  • Collaboration with local colleges creates a recruitment pipeline.
• Community Engagement:
  • Strong focus on involving the local community for facility support and reputation.
  • “It is so important that you have the support of the community and... that you’re getting the quality care that you could receive anywhere.” (Myra Ray, [07:03])

Staff Retention and Satisfaction

• Beyond Compensation:
  • “If you want a quality nurse, it’s not all about compensation. It’s about the benefits that you give them… the benefit of self-scheduling... their spouses are farmers... giving them the opportunity to be a parent at the same time of being able to provide for their family.” (Myra Ray, [08:12]–[09:45])
  • Emphasizes flexibility in scheduling and work-life balance as greater motivators than wage differentials.
  • Facilities offer opportunities for family integration, e.g., staff children can do homework at the hospital after school.

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Notable Quotes

• On Staffing:
  • “Partner with your nursing programs, colleges that have nursing programs... We provide a two year scholarship for an associate degree program here at the local college and we’ve expanded that to other universities in the area.” (Myra Ray, [06:00])
• On Community Engagement:
  • “Getting them [the community] involved in helping the hospital to grow, ensuring that they want to come to your facility, that you’re getting the quality care that you could receive anywhere.” (Myra Ray, [07:10])
• On Rural Work-Life Balance:
  • “Daycares don't open until 7 or 7:30. You give them the opportunity to say hey, you know, I’ll cover your early morning shift... You’ll be our late person this evening. Giving the opportunity for that sometimes is a lot more important to them than maybe another dollar or two on the hour.” (Myra Ray, [08:45])

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Timeline of Key Segments

• [01:02] — Myra’s background and introduction
• [01:52] — Top three ASC/healthcare trends (staffing, acuity, reimbursement)
• [03:16] — Current excitement: growth and expansion
• [04:28] — Growth strategies and new service lines
• [05:31] — Staffing challenges in rural ASCs and scholarship program
• [07:01] — Importance of community support
• [07:58] — Staff retention, satisfaction, and flexibility initiatives

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Tone of the Episode

The conversation is pragmatic yet optimistic, focusing on both the real challenges and innovative solutions in rural ASC management. Ray’s tone is practical, community-oriented, and deeply empathetic to staff and patient needs.

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Key Takeaways

• Growth in rural ASCs is possible and exciting but brings unique operational challenges.
• Creative partnerships with educational institutions and flexible staffing models are essential for recruitment and retention in rural healthcare.
• Patient and staff satisfaction are intertwined, with quality of life factors often outweighing monetary incentives.
• Community engagement and bringing new specialty services to rural areas can significantly impact access to care.

Transcript

[A]

@ Athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams, and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom Practicing medicine is complex, but running a practice can be that much simpler. With Athenahealth. See how simpler is [e-mail].

[B]

Hello, this is Francesca Matthews with the Beckers ASC Review Podcast. I'm thrilled to be joined today by Myra Ray, Manager of Surgical Services at Franciscan Healthcare. Myra, thank you so much for being here today.

[C]

Thank you for having me.

[B]

To start us off, could you please introduce yourself and tell us a little bit about your background?

[C]

Sure. I'm Mayra Ray. I am a Master's prepared Nurse in Nursing Leadership at Franciscan Healthcare in West Point, Nebraska. I have a background that spans over 20 years. I have been everywhere from a level 2 trauma center or to an ASCII and have worked in a variety of perioperative settings. Currently I am over pre op or in pacu. So we do everything from pre admission testing all the way through discharge.

[B]

Yeah. Excited to get into the discussion today. Just to kind of start us off, what are the top three trends that you're following in healthcare and ASCs today?

[C]

Well, of course, as with anyone, we're trending in monitoring staffing shortages and increased labor costs. It's always something that's on the forefront in our mind is recruitment and retention and how are we going to keep up with the increasing cost of labor Then a second thing that we're looking at is the higher acuity procedures. We've seen an increase in the last six months of higher acuity procedures, new procedures, procedures that we haven't done in the past. And just looking overall at ASCs across the country and what's going on, the third thing that we look at is reimbursement and difficulty of prior authorizations. You know, all the procedures that were once not requiring prior authorizations. We're finding more and more frequently that insurers are seeking prior authorizations in things that we didn't have to have before.

[B]

Definitely. Yeah. Those themes that you, you mentioned there are definitely resonate with, you know, the, the providers and administrators CEOs that I speak with every day here at Beckers and I'm curious, kind of moving from there. What are you most excited about right now as it relates to ascs healthcare? Anything in between.

[C]

You know, two of the things that I'm most excited about right now are growth. And the growth that we've seen here over the last six months have led us to seek a remodel or actually a new build to expand our services. We are, we've expanded our volumes by about 25% in the last six months to a year. So we're seeing a massive amount of growth. I'm out of space, whether it be for equipment or for patients. We're using unique areas that we haven't used in the past to pre op and discharge patients. So it's a challenge at best, but it's also a very exciting time to see the growth, to see the new potentials of increased acuity procedures. And it's just an exciting time overall and all the way around here.

[B]

Absolutely. Again, that just definitely resonates with what we're hearing here at Becker's. And you know, you mentioned growth. How curious. If you could kind of follow up on that. How are you thinking about growth over the next 12 months?

[C]

Prime example, we have a plastic surgeon that joined us about six months ago and he's doing several new procedures. We just did a rib plating. We are looking at doing rhinoplasties. Plastics is something that's new for us, we had not done in the past here. So looking at expanding services that we offer in a very rural area of Nebraska that haven't been seen around here, patients not having to travel as far, it's, you know, just amazing at being able to offer services that have not been in this region.

[B]

Yeah, I was about to say, I can imagine just being an asc, which I think everyone in the ASC space is looking at a lot of potential for growth. And then, yeah, being in an area where there's limited access, yeah, it seems like there's a lot on the horizon as far as where we can go from here.

[C]

And you know, with that, you know, with the growth and the excitement of it also comes the challenge of staffing. You know, how do you, being in a rural area, how do you come up with staffing that you haven't had before? And it leads to a whole plethora of a new, exciting venture. And if I could say anything, it's partner with your nursing programs, colleges that have nursing programs. And one of the things that we've done to try to recruit new nurses is we've created a scholarship program so that we pay ahead of the nurse going to school so that they don't have the out of pocket expense. So rather than an alternative to tuition reimbursement is the scholarship program. So we provide a two year scholarship for a associate degree program here at the local college and we've expanded that to other universities in the area.

[B]

Super interesting that you mentioned that. Yeah, I feel like, I feel like among the rural AIC leaders I speak with or even in just like, you know, less super crowded areas, be like that thing when I ask, you know, kind of how are you getting creative to talk about, to figure out staffing, how, how do you stay afloat when a lot of the times the cards are stacked against you? It's that connection to community and that, you know, kind of. Yeah, leaning on the community for support and having that, that connection there that is. Can kind of set you apart and keep, keep you afloat.

[C]

Absolutely. And you know, being in a rural area, it is so important that you have the support of the community and getting them involved in helping the hospital to grow, ensuring that they want to come to your facility, that you're getting the quality care that you could receive anywhere. I mean, we're an hour from Omaha, an hour and a half from Lincoln. They could easily travel there and back in a day's time. But we provide things here in town with the highest quality. And physicians that actually come from Omaha or Norfolk or Lincoln, you know, physicians that are traveling to other, from other larger areas to come here and practice in rural Nebraska.

[B]

Absolutely. Is there anything else that I haven't touched on so far that you feel like is important to discuss in this conversation? I.

[C]

Well, I think overall one of the biggest things is you're looking at not just patient satisfaction, but we also have to look at employee satisfaction. So if you're going back to the staffing shortage and the increasing labor costs, you have to come up with unique ways to attract staff. So you have to be open minded and creative when it comes to scheduling, when it comes to compensation. So you know, if you want a quality nurse, it's not all about compensation. It's about the benefits that you give them. So if you give them the benefit of self scheduling, of hey, we're in rural Nebraska, we have nurses that their spouses are farmers. That means it's harvest right now. It's the time of year that their husbands are in the field at 5:30 in the morning. So daycares don't open until 7 or 7:30. You give them the opportunity to say hey, you know, I'll cover your early morning shift. I'll come in early. What time can you get here? And then you're going to cover the late shift so you can come in at 7:30 and stay until 4:30, 5 o'. Clock. You'll be our late person this evening. Giving the opportunity for that sometimes is a lot more important to them than maybe another dollar or two on the hour. They're not going to drive to Omaha for a dollar or two an hour. When you give them the opportunity for their children who are in school a block and a half away to come over and do their homework in the cafeteria until they're ready to go home in the evening, giving them the opportunity to be a parent at the same time of being able to provide for their family.

[B]

Absolutely. Yeah. Yeah, definitely. I think that that rings true in rural areas specifically. Well, that is actually all I have for you today, Myra. Thank you so much for joining us.

[C]

Thank you, Francesca. You have a wonderful day.

[B]

Yep. It's been a pleasure speaking with you and I look forward to connecting with you again in the future.

[C]

Sounds great.

[A]

At athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom lines. Practicing medicine is complex, but running a practice can be that much simpler with Athenahealth. See how simpler is [e-mail].