Providing health care on the factory floor

Byrd takes nontraditional route with nursing degree

Dale Byrd has worked four decades in manufacturing in McDowell County. He works long hours, gets short lunch breaks and repeats the same physical motions over and over, loading plastic molding into a press to make floor mats and other accessories for cars.

Byrd’s son, Nick, has watched that life take a toll on his father’s health.

“He has to load it and then press it,” says Nick, a 2014 Wingate University School of Nursing graduate. “He does that motion nine hours a day, five days a week. He’s got bad knees. He’s got arthritis. He’s got heart disease. He’s on blood-pressure medicine. He’s on anxiety medicine. I joke with him, I say, ‘You’re like the opposite of the picture of health.’”

One day last year, a seemingly bad thing happened that may have saved Nick’s father’s life. Dale was mowing his yard when he went up an incline, fell off the mower and wound up pinned underneath it. The incident required a trip to the hospital.

“My mom was like, ‘I thank God you did that, because they found three health problems you weren’t even talking about,’” Nick says.

That scenario – minus the lawn-mower accident – is not so uncommon in McDowell and other small, rural communities that rely heavily on the manufacturing industry. Rates of diabetes, pre-diabetes, heart disease and other illnesses are high, and many people visit the doctor infrequently.

That’s one reason Dale and Tammy Byrd were so insistent that their son find a path out of that lifestyle. Unlike a lot of his classmates, Nick did leave his hometown of Marion, choosing Wingate over a baker’s dozen of other schools in North and South Carolina. But he didn’t want to leave forever, and in the four years since he has returned to live in his small mountain community, Nick has helped McDowell County make strides in workplace wellness.

Byrd has taken diabetes-prevention programs to schools and churches, arranged for better food options at manufacturing plants, helped coordinate a network of low-cost after-school childcare sites across the county, and initiated a program to bring paramedics into worksites to provide tips and collect health data on

It’s a job that Byrd is uniquely qualified for. He’s energetic, full of ideas, and passionate about helping the community he loves. And he has a nursing degree, though no desire to work in a doctor’s office or make rounds in a hospital.

He’s also somewhat restless, and as much as he loves his community, he feels he needs to leave once again in order to help McDowell and counties like it care for their residents’ health as well as possible. This fall, Byrd is going back to school, to get a Ph.D. so he can one day research ways to improve industrial health.

Finding his niche

The McDowell County that Byrd returned to in 2014 wasn’t much changed from the one he left in 2010 after graduating from McDowell High School. The county, with a population of 45,000, had an overall poverty level of around 20 percent, with over one-quarter of children living in poverty. Nearly half of all renters spent about a third of their income on housing. Most people were employed in manufacturing, which meant long work days and meals procured from vending machines.

Byrd, one of the 15 percent of people in the county with a bachelor’s degree, took a job as a personal trainer at the local YMCA, volunteering in a couple of programs on the side. It wasn’t long before his bosses realized that his nursing degree could be put to better use. He was asked to teach diabetes-education classes, and his career began to snowball. He soon became the diabetes intervention manager for the YMCA of Western North Carolina and Mission Hospital, coordinating the diabetes-prevention program across the mountains of North Carolina and helping create the Taking Control of Type 2 Diabetes program.

It wasn’t traditional nursing, but it fit Byrd to a T.

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“That was completely unexpected, but it was kind of one of those things that – and they told me this too – ‘Your nursing degree is what makes us feel comfortable putting you in this position,’” Byrd says. “I was in a really unique niche where I have this medical background and training. I wanted to come back to this small town. All these things kind of converged: my experience, my interests,
my volunteering, the community’s needs.”

With the YMCA, Byrd helped usher in a couple of key changes to the program. First, they created a soft landing for participants in the 16-week program by adding two months of biweekly meetings to the end of the once-a-week schedule, and then tacking on monthly meetings after that.

The idea, Byrd says, was to keep participants motivated while also weaning them off the program.

“After people lost that social support structure, we noticed they also lost their motivation, they lost their consistency,” Byrd says. “They were used to coming. You knew that next week you were going to have to see me. You were going to have to confess your dietary sins to me. We introduced a kind of purgatory, in a sense.”

He also took the program out into the community. “We were asking people to come to us,” he says. “We’ve got people who live in the mountains, in the boondocks, out in the woods. And we’re dealing with poor people. The poverty levels and diabetes levels are very parallel. These people might have one vehicle – two parents and two kids, and that one vehicle is their only means of transportation, and we’re asking them to come all the way to the YMCA. You might live 30 minutes away and we’re asking them to drive over here.

“This is a cliché public-health term – I don’t even like saying it – but if you take it to where they are, you’re going to have better success. Your adherence level’s going to go way up. Your statistics are going to go way up.”

So they started holding weekly classes first in schools and later in churches, which is where Byrd saw the biggest success. Byrd wound up getting a minor in psychology at Wingate, and his ability to relate to people, and to understand their needs, proved invaluable as he taught McDowell residents how to control their weight in order to control their diabetes.

At Glenwood Baptist Church in Marion, the group’s weight loss was astounding. “National average weight loss in a 16-week program is four percent. They want you to hit five if you can. That’s kind of your goal,” Byrd says. “That class lost 14 percent of their weight as a class in 16 weeks. It was a monster number.”

Discovering nursing

During high school, Byrd volunteered in McDowell Hospital – sort of a candy-striper position – but nursing was far from his mind when he chose Wingate over Wake Forest, UNC-Chapel Hill, Clemson and several other schools. He originally thought he wanted to be a pharmacist.

“I was a super-OCD, obsessive student in high school,” Byrd says. “I applied to 14 different colleges. I had a spreadsheet with majors I’d be interested in, financial packages I would receive, graduation rate. I was one of those kids.”

He’d gotten into several larger schools, complete with scholarship money, but felt more at home on Wingate’s smaller campus.

“I met Dr. (Chris) Dahm in the chemistry department,” Byrd says. “He was a pretty cool guy. I met Dr. (Krista) Wilson. I got to know some of the science professors. I kind of fell in love with the program.”

But with the subject of chemistry itself, the chemistry just wasn’t there. He found that he loved biology, physiology, nutrition, exercise science – even psychology, which he was loading up on in his schedule – but chemistry just wasn’t doing it for him. By the end of his second semester, Byrd realized that his aversion to chemistry meant he’d never be a pharmacist. Panic set in.

“I said I need a job where I can help people, that’s health-related, that I can use psychology, biology, things like that,” he says. “And they all come together for a major that offers me a good job after graduation.”

Turns out, Wingate was starting a nursing program just as Byrd was figuring out his major, so he signed up.

“I had never been in a cohort-model program,” he says. “It was you and the same 18 kids in every single class, every single clinical. It became your family for the last two years. It was a cool experience.”

Byrd enjoyed learning the ins and outs of nursing. But when he did his preceptorship – sort of a medical mentorship program – at Carolinas Medical Center Union (now Carolinas Healthcare System Union) in Monroe, he wasn’t wowed by the job. “I found I liked nursing, but I didn’t love it,” he says. “I didn’t think floor nursing was for me. When I graduated, I thought, how can I turn nursing into a nontraditional position?”

Byrd figured that out with the YMCA, and he was so effective in teaching people how to manage their diabetes symptoms that in 2016 he was asked by the McDowell County Health Coalition to create a healthy-living program he could take into worksites.

He was 24 and had been handed the keys to a program that could change the lives of the people in the community he loves – people like his father.

“I’ve always been super-driven, self-sufficient, to the point where I wanted a job where I could be a little more autonomous, where I really got to call something my own,” Byrd says. “Coming into the diabetes program – yeah, I got to help build it and make it what it was. But I wanted something that I was in control over, that I got to manage. The idea of being able to create a program in my hometown, that I grew up in, was unique. For a 24-year-old, it was an incredibly awesome opportunity.”

Making his hometown better

Byrd makes his passion for the program readily known as he eats at one of his favorite downtown Marion restaurants, Bruce’s Fabulous Foods. Outside the window, a near-constant flow of cars, trucks and foot traffic highlight a town on the upswing. Since Byrd has returned to Marion from Wingate, the town of about 8,000 a 40-minute drive east of Asheville has begun an incentive program to revitalize downtown, and it appears to be working. Main Street is bustling. “If you’d’ve come here two years ago, the traffic would have been a fourth of what it is now,” Byrd says. “And evenings were nothing. It was a ghost town.” Marion even has its first brewery now.

Byrd is proud to be a part of the change that is happening in his hometown. He’s equally as proud of the diversity of industry his neighbors are involved in. The red threads that stitch baseballs together, custom garage doors, intravenous and dialysis equipment – it’s all made in McDowell County.

The various manufacturing plants keep the area afloat, but Byrd understands that conditions could improve in a lot of industries. The program Byrd developed for McDowell County, WorkFORCE Wellness, entails taking chronic-disease-prevention tips, exercise and nutrition classes, health-insurance assistance, mental-health assessments and support services, substance-use-disorder treatment and other health-focused programs directly into worksites.

As he orders a slice of Bruce’s famous cheesecake – “I teach a whole lot about balance,” he says, smiling – Byrd relays some of his accomplishments in McDowell, including helping Bruce’s craft a menu with more options for health-conscious people. (Bruce’s was already part of the way there; it has never had a deep fryer, so fries are off the menu.)

Byrd wrote and received a grant for nearly $200,000 to bring additional health resources to McDowell County’s worksites, schools and churches.

He recently started an initiative that brings paramedics into worksites to respond to acute medical situations, screen employees so they know important data about their own health and can set health-and-wellness goals, and collect aggregate health data to measure trends.

And Byrd knows that financial health has a huge impact on people’s physical health. He’s working with the YMCA – where he continues his “side hustle” as a personal trainer – to create a network of childcare facilities in public schools.

“We’re one of the poorest counties in the state,” he says. “Childcare here is like 650 a week. Who can pay that? It’s unreal. They have to make the decision to live off welfare to stay at home with their kids because they literally can’t get a job that pays enough.”

For Byrd, the ideas just keep coming – all of them focused on helping his community thrive. He’s worked with a local church to establish a wellness ministry that includes a food pantry, cooking classes, and nutrition and exercise education for low-income residents. And he’s helped small-business owners get their employees affordable health insurance through the MATCH Program.

WorkFORCE Wellness has made such great strides in McDowell County that in November of 2017 the Isothermal Planning and Development Commission hired Byrd to expand the program to several other Western North Carolina counties.

“I do a lot of those things where I’m partnering with community partners to say, ‘Here’s a need. Let’s do something creative and innovative to make it better, to take it to employers,’” he says. “I’m a thinker, and I’m an ideas guy. I love to think up ideas, put them into action and see what happens.”

As Byrd walks around Marion or eats at Bruce’s, he’s constantly greeted by townsfolk. He throws out statistics about the area that only someone determined to help it continue its upward trend would know. It’s obvious he loves his hometown.

All of which makes it somewhat odd that he’s getting ready to leave. But there’s a larger plan there: to make more lasting changes. With any luck, Byrd will wind up in a doctoral program in industrial research. One day, he hopes to find a teaching position where he can spend much of his time researching how to make worksites – especially those in manufacturing hubs, like McDowell County – healthier environments.

Byrd is well aware of the stark contrast between his life as a 20-something and his dad’s at that same point. Dale Byrd has worked in the same job since he left high school – a situation that’s far from uncommon in places like Marion. And Nick calls the environment in most manufacturing plants “awful.”

Nick Byrd knows that improving the lot of manufacturing workers like his dad is a tall order. The model is established, and working around the 12-hour shifts and the need to produce, produce, produce is going to take some creative thought.

“There’s a huge under-researching of manufacturing worksites,” Byrd says. “That’s probably the hardest environment to be healthy in.”

He says that the Googles and Apples of the world naturally have great workplace-wellness programs already. “Of course they do,” Byrd says. “They can take an hour lunch break and go to the gym. In a manufacturing worksite, it’s production based. If I were to go to an HR manager and say, ‘Hey. Will you give your employees hour lunch breaks to go ride their bikes?’, the plant manager’s going to laugh me out the door. He’d say, ‘We’ll lose 10,000 dollars a day if I let them off for an hour.’ And that’s not going to change.”

Maybe not, but Byrd believes he could be the one to come up with solutions.

“The thought of getting a job where I’m paid to come up with unique and innovative and useful ideas, to create a research project or study and figure out how it works, it’s almost crazy to me that that’s an option in life,” he says. “Ever since I was young, monotony and repetitiveness have been my enemy. Getting a Ph.D. and becoming a professor and researcher, it almost seems like it shouldn’t even be a job. It just seems like my calling.”