FNU Quarterly Bulletin Spring 2019 Volume 94, Number 1

FRONTIER NURSING UNIVERSITY | VOL. 94, NUMBER 1 | SPRING 2019

QUARTERLY BULLETIN

Impact Report: Alaska Former U.S. Surgeon General to Speak at Commencement News, Notes & More!

Frontier Nursing University • Quarterly Bulletin 1

Former U.S. Surgeon General Dr. Joycelyn Elders to Speak at Frontier Nursing University Commencement Ceremony Dr. Joycelyn Elders, M.D., will be the keynote speaker at Frontier Nursing University’s commencement ceremony on Saturday, September 28 in Lexington, Ky.

Susan Stone, DNSc, CNM, FAAN, FACNM President

Dr. Elders became the 15th Surgeon General of the United States when she was appointed to that post by President Clinton in 1993. She also was the first African American, and only the second woman to serve as the U.S. Surgeon General.

Joan Slager, CNM, DNP, FACNM Dean of Nursing

“It is a tremendous honor to have Dr. Elders join us as the keynote speaker for our 2019 commencement ceremony,” said FNU President Dr. Susan Stone. “Dr. Elders’ amazing journey and ground-breaking achievements inspire us all. We are so thankful and proud that she is sharing her story with our graduates and their families.”

Born in 1933 in the rural farming community of Schaal, Ark., Elders was the eldest of eight children. She graduated from Philander Smith College in Little Rock, then joined the Army and trained in physical therapy at the Brooke Army Medical Center at Fort Sam Houston, Texas. In 1956, she enrolled at the University of Arkansas Medical School on the G.I. Bill.

She married Oliver Elders in 1960. After studying pediatrics at the University of Minnesota, she returned to Little Rock 1961 to do her residency. Over the next 20 years, she maintained a successful office practice while also researching pediatric endocrinology and becoming an expert in growth problems and juvenile diabetes.

In 1987, then Governor Bill Clinton named Elders director of the Arkansas Department of Health. Under her direction, 19 Arkansas schools opened health clinics. In 1989 the Arkansas State Legislature ordered the creation of a kindergarten-through-twelfth-grade curriculum including not only sex education but also instruction in hygiene, substanceabuse prevention, self-esteem, and equal sexual responsibility among both males and females.

“Health is more than the absence of disease; it is about economics, education, environment, empowerment, and community. The health and well being of the people is critically dependent upon the health system that serves them. It must provide the best possible health with the least disparities and respond equally well to everyone.”

“You can’t educate a child who isn’t healthy, and you can’t keep a child healthy who isn’t educated,” Elders said. “It is often easier for our children to obtain a gun than it is to find a good school.”

-- Dr. Joycelyn Elders

After serving as the U.S. Surgeon General, Dr. Elders returned to the University of Arkansas in 1995 as a faculty researcher and professor of pediatric endocrinology at the Arkansas Children’s Hospital. In 1996 she wrote her autobiography, Joycelyn Elders, M.D.: From Sharecropper’s Daughter to Surgeon General of the United States of America. Now retired from practice, she is a professor emeritus at the University of Arkansas School of Medicine and remains active in public health education.

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Maria Valentin-Welch, DNP, MPH, CDP, CNM, FACNM Chief Diversity and Inclusion Officer Rachel Mack, Ph.D., DNP, APRN, C-FNP, CNE Associate Dean of Academic Affairs Tonya Nicholson, DNP, CNM, WHNP-BC, CNE, FACNM Associate Dean of Midwifery and Women’s Health Lisa Chappell, Ph.D., FNP-BC Associate Dean of Family Nursing Jess Calohan, DNP, PMHNPBC Director, Psychiatric Mental Health Nurse Practitioner Program Jane Houston, DNP, CNM DNP Director Jacquelyne Brooks, DNP, MS ADN-MSN Bridge Director Michael Steinmetz, CPA, CMA, CSCA Executive Vice President for Finance and Facilities Shelley Aldridge, BA Chief Operations Officer Angela Bailey, MA Chief Advancement Officer

Contents

From the President Dear Friends, As we celebrate our 80th anniversary this year, it is impossible not to look back with amazement at our humble beginnings in the rural Appalachian mountains. From the Frontier Nursing Service in 1925 to the founding of the Frontier Graduate School of Midwifery in 1939 to Frontier Nursing University today, the goal has been to prepare advanced practice nurses and midwives to provide primary care for families in rural and underserved areas.

Features From the President . . . . . . . . . . . . . . . . 1 FNU Impact Report: Alaska, The Final Frontier . . . . . . . . . . . . . . . . . 2-9 Alumni Notes . . . . . . . . . . . . . . . . . . . 10-13 Courier Corner . . . . . . . . . . . . . . . . . . . 14-15 News and Notes . . . . . . . . . . . . . . . . . 16-17 Wendover Bed & Breakfast and Retreat Center . . . . . . . . . . . . . . . . 17-19 In Memoriam/Tributes . . . . . . . . . . . 20-22 Trustees / Board of Directors . . . . . . . . . . 23 Board Member Spotlight: Kitty Ernst . . . 24 80th Anniversary . . . . . . . . . . . . . . . . . . 25

Today, we are immensely proud that FNU’s presence continues to be felt not only in rural Kentucky, not only across the United States but across the world. As Frontier has grown, it has widened its impact while holding true to its mission.

Last fall, we introduced the first in our series of Impact Reports, discussing the impact of FNU graduates in eastern Kentucky. It is fitting that our next impact report, which you will find contained in the following pages, focuses on the presence of FNU graduates in Alaska, which, has been referred to as “the last frontier.” Alaska’s harsh climate, massive size, and extremely remote locations make it a prime area for graduates like ours who are trained and prepared to care for all people, especially those in rural, diverse, and underserved populations.

As you read the profiles of a few of our Alaska-based graduates, we hope you will recognize the presence of Mary Breckinridge’s spirit and original vision being lived through the lives and work of these amazing individuals.

In this issue, we also share the inspiring accomplishments of our students and faculty, welcome our new couriers, and pay tribute to special members of the FNU community who are no longer with us but whose legacies live on.

P.O. Box 528 • 195 School Street Hyden, KY 41749 FNU@frontier.edu • 606.672.2312

We hope you enjoy reading about the many great things happening at Frontier Nursing University and are as proud as we are. We thank you so much for being part of the FNU community and for sharing our vision, mission, and passion.

Sincerely,

Frontier.edu

Susan CNM, DNSc., FACNM, FAAN Susan Stone,Stone, CNM, DNSc, FAAN, FACNM Frontier Nursing University • Quarterly Bulletin 1

FNU Impact Report

ALASKA THE FINAL FRONTIER

Fairbanks

Anchorage Juneau

In this, the second in our series of Impact Reports studying the influence of Frontier Nursing University graduates on rural, diverse, and underserved populations across the country, it is appropriate that we examine FNU’s presence in the state known as “The Final Frontier.” Alaska is renowned and beloved for its natural beauty and wildlife but it also features a climate and terrain that can be harsh and unforgiving.

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Alaska is by far the largest state in the country but ranks 48th in total population, at approximately 736,000 people. It ranks last in population density with one person per square mile.

With a population of 300,000, Anchorage is the only city in the state with a population of more than 35,000. That means many Alaskans live far from cities, far from resources, and far from healthcare. Many communities are located at a considerable distance from hospitals and are not accessible via roads. For some, physicians, dentists, and other providers are only available on an itinerant basis. Treatment for serious conditions must occur at larger hospitals in urban centers for which air travel is necessary.

Alaska’s terrain includes 17 of the 20 highest mountain peaks in the United States, 70 volcanoes, more than 3 million lakes, and 3,000 rivers.* Imagine healthcare providers trying to reach patients in those remote locations. Mary Breckinridge faced similar challenges when she founded the Frontier Nursing Service (FNS) in 1925 in the Appalachian region of southeastern Kentucky. FNS nurses traveled via horseback over the mountains and through the creeks and rivers, to care for the local residents.

The FNS led to the founding of the Frontier Graduate School of Midwifery (now Frontier Nursing University) in 1939.

FNU holds true to its mission to serve rural, diverse, and underserved populations. It comes as little surprise that FNU graduates are making a significant impact on the healthcare needs in communities throughout Alaska.

This report examines the specific healthcare issues Alaska residents face. Profiles of four of the more than 80 FNU graduates who currently work and reside in Alaska illustrate the impact of FNU graduates in the state. FNU is extremely proud of the work of these graduates. We hope you will be inspired by their dedication and commitment to improving healthcare access and outcomes for the populations they serve.

The Challenges Its vast expanse, diverse wildlife, and unique climate are some of Alaska’s most endearing attributes. They also present daunting challenges regarding access to healthcare for its residents.

Remote Populations Alaska has 229 federally recognized tribes, accounting for approximately 140,000 people spread out in communities across 586,412 square miles of predominantly roadless land.

Federally recognized tribes in Alaska constitute over a third of all federally recognized Native American tribes in the United States. Alaska Native villages are situated mostly along the coast

and rivers of rural Alaska. As part of its trust responsibility to Alaska Native people, the federal government provides funding through the Alaska Tribal Health System for healthcare services for the American Indian/Alaska Native population. The Alaska Native Tribal Health Consortium (ANTHC) was organized as a statewide non-profit health service organization owned by Alaska Natives through its constituent tribes and tribal organizations.* Tribal health organizations, organized under the ANTHC, provide a vital component to the state’s safety net of primary care providers by providing primary care to approximately 200 communities. The Alaska Community Health Aide Program, supported by the Consortium, provides Community Health Aides/Practitioners to over 170 villages to assess and refer patients for medical care.

Historically the only sources of healthcare for many remote villages were nurses who traveled the state on foot, by dogsled, by steamship, and by train. Today the Department of Health and Social Services has a network of health centers in 22 communities and provides itinerant safety net services to 280 small communities and villages. Some of the functions performed by public health nurses include immunization of children and adults, education on disease prevention, connecting people with healthcare and social services, and promotion of injury prevention and healthy living.

Federally Designated Underserved Populations The Health Resources and Services Administration (HRSA) has designated most of Alaska’s geographic area as Health Professional Shortage Areas (HPSAs) based on the lack of primary care physicians, dentists, and psychiatrists. Federally designated Health Professional Shortage Areas (HPSAs), which can apply to geographic areas, population groups, and healthcare facilities, cover 96 percent of Alaska’s land mass (549,466 square miles of Alaska’s total 570,638 square miles) and 39 percent of Alaska’s population (284,047 people of 737,625 total population). † Alaska also has Medically Underserved Areas/Populations (MUAs/MUPs), which are designated by HRSA as areas that have too few primary care physicians, high infant mortality, high poverty, or a high elderly population. MUA/MUPs cover 95 percent of the Alaska land mass (543,396 square miles of Alaska’s total 570,638 square miles) and 78 percent of Alaska’s population (577,619 people of 737,625 total population).* An Alaska Health Workforce vacancy study was conducted in 2012 by the Alaska Center for Rural Health at the University of Alaska†. The study assessed the current demand for health Frontier Nursing University • Quarterly Bulletin 3

FNU Impact Report: Alaska, The Final Frontier workers by occupation, as estimated through vacant, budgeted positions and reported by employers for a specific time-period.

The findings substantiated that rural areas continue to suffer from high vacancies in traditional primary care occupations, which provide basic health care and serve as frontline providers.

Estimated rural vacancy rates were ¶: 21 percent for Family Physicians 17 percent for Family Nurse Practitioners 19 percent for Physician Assistants 18 percent Community Health Aide/Practitioners 19 percent Behavioral Health Aide/Therapists and Village Counselors Providers other than physicians include nurse practitioners, certified nurse-midwives, and physician assistants who serve in private clinics as well as several of the community health centers.

Especially in rural areas, Alaska relies on these providers more than most states. Less restrictive than in many other states, Alaska’s state practice and licensure laws allow for all nurse practitioners to have full practice rights.

High Cost of Health Care The shortage of primary healthcare providers and specialty providers contributes to Alaska ranking as one of the eight most expensive states for healthcare in the country.‡ This high cost can deter patients from seeking care. A report from the Alaska Department of Health and Social Services revealed that as many as 20 percent of Alaskans reported cost as a barrier to care.§

The FNU Model FNU’s community-based learning model addresses many of the issues at the core of poor healthcare in rural and underserved areas. It does so by educating and training nurse-practitioners and nurse-midwives in the same communities where they live and practice. The Frontier model of educating advanced practice nurses and nurse-midwives in their own communities is a critical part of the solution.

More than 80 FNU graduates practice in Alaska, serving diverse, rural, and underserved populations. Their presence alone doesn’t fix the healthcare gaps and disparities, but the presence of additional primary healthcare providers adds stability to the infrastructure and provides the basis for improved outcomes in the future.

Mission in Action In the following pages, you will read about four FNU graduates who are making a difference in access to healthcare in Alaska. You will learn about the challenges they face in their daily practice and the gaps they help fill in the communities they serve.

* World Population Review, Alaska Population 2019. Accessed 2019/05/27, http://worldpopulationreview.com/states/alaska-population/ † Health Planning & Systems Development, Alaska Division of Public Health. Alaska 2015-2016 Primary Care Needs Assessment. 2016/05/20, http:// dhss.alaska.gov/dph/HealthPlanning/Documents/Primary%20Care%20Needs%20Assess ment/AlaskaPrimaryCareNeedsAssessment_2015-2016.pdf ¶ Branch, Katherine. Alaska’s Health Workforce Vacancy Study, 2012 Findings Report. August 2014, http://dhss.alaska.gov/dph/HealthPlanning/ Documents/workforce/2012AKHealthWorkforceVaca ncyStudy_FindingsReport%20-%20FINAL%20Dec%202014.pdf ‡ Kiersz, Andy, and Emma Court. The 10 best states to live in where healthcare is the cheapest. 2019/03/19, https://www.businessinsider.com/the-10states-where-healthcare-is-relatively-cheap-2019-3 § Alaska Department of Health & Social Services and the Alaska Native Tribal Health Consortium. Healthy Alaskans 2020 Health Assessment: Understanding the Health of Alaskans. 2014/09/30, http://hss.state.ak.us/ha2020/assets/HA2020_HealthAssessment.pdf

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Kristina Amundson, DNP, CNM Kristina Amundson, DNP, CNM, Companion DNP Class 2, remembers vividly her days at Frontier Nursing University. Specifically, she recalls Kitty Ernst’s directive to the class: “Go forth and be a change.”

Early interest came largely from her own patients, but she hopes to expand it to a much wider audience, including the healthcare professionals in the area.

While Fairbanks is not rural, Amundson notes that many of her patients are from rural areas and have to go to great lengths to see her, some driving from as far as four hours away.

“At the time, I thought, ‘I’m just one person, how can I be a change?’”

Amundson recalls. “But it’s just one step at a time. That’s my attitude in providing excellent healthcare. You have the ability to make a difference, so go do it.”

Amundson has indeed gone forth and made a change. Originally from Traverse City, Michigan, Amundson was working as a traveling labor nurse when she met the man who would become her husband in Alaska. The year was 2009, and she’s been there ever since, working first as a labor and delivery nurse and then as a nurse-midwife at Interior Women’s Health in Fairbanks. She also has privileges at Fairbanks Memorial Hospital.

In her decade in Alaska, Amundson has come to realize that education is one of the biggest hurdles to healthcare for many people in the area.

“I find that women need increased access to evidence-based care, and the options in this community are sparse,” Amundson says. “The lack of knowledge of the available healthcare options results in a lack of self-advocacy to receive the best care. That’s the biggest thing, and I’m trying to address that.”

To address that gap, Amundson became an Evidence-Based Birth® Instructor, offering her first class in January 2019.

It’s a six-week, evidenced-based course for families on pregnancy and childbirth.

“I think FNU has touched this community in a positive way,” Amundson says. “We have more midwives than obstetricians. If we didn’t have the ability to go to FNU and have extended learning, that wouldn’t be the case here.”

“There is a high native population here,” Amundson says. “They generally have poor access to healthcare because many live in villages with no clinics or they are closed in on an island.”

“I think FNU has touched this community in a positive way. We have more midwives than obstetricians. If we didn’t have the ability to go to FNU and have extended learning, that wouldn’t be the case here.”

Amundson attends 60-70 births per year and estimates she has a patient population of 40-50 pregnant women in her care at any one time — in addition to providing other women’s health care. Her goal to increase the exposure of her course might well be aided by a network of other FNU graduates who also work in Fairbanks.

There are six other FNU graduates working as nurse-midwives in Fairbanks, including her sister-in-law, Courtney Amundson, MSN, CNM, Class 139, and Margaret Rader, MSN, CNM, Class 43, who was also one of Amundson’s preceptors.

There is also limited access to specialists in Fairbanks. For example, the only access to a child cardiologist is once a month when a child cardiologist visits from Seattle. In some cases, patients have to travel to Anchorage or Seattle to find the specialists they need to see, which Amundson notes, “can put an extreme financial hardship on a family.”

Another form of specialized care lacking in availability is appropriate mental health care. Amundson says that patients who are not suicidal and have no insurance are often unable to find help, and those who do have Medicaid still have a waiting list of up to a year.

“It is nearly impossible to find a place that will accept Medicaid insurance and even harder to find counseling for those who are not suicidal with Medicaid,” she says. “The patients that I see who are most affected by this are women suffering from perinatal or postpartum depression. In Alaska, I find that our incidence for this is a bit higher than the national prevalence.

When I was doing my Doctor of Nursing Practice project, I surveyed and screened

Frontier Nursing University • Quarterly Bulletin 5

FNU Impact Report: Alaska, The Final Frontier Holly Fisk, MSN, FNP, ONC At 8:29 a.m. on November 30, 2018, a magnitude 7.1 earthquake hit southcentral Alaska. The quake’s epicenter was about 10 miles north of Anchorage.

those seen in my clinic and 49% of women had some form (mild, moderate, severe) of depression in pregnancy or postpartum. I find that I am often prescribing for women who can’t seek care elsewhere. I am always encouraging counseling but the limited access is very problematic.”

To help address such gaps in access to mental healthcare across the country, FNU launched the Psychiatric Mental Health Nurse Practitioner degree path in 2017. Meanwhile, Amundson continues to be a champion for the quality of healthcare being provided in Fairbanks.

“People here advocate for change,” she says, noting that the cesarean rate is much lower than the national average. “I feel very positive about our community and how we are addressing healthcare issues.”

Indeed, Amundson and her fellow FNU nurse-midwives of Fairbanks are going forth and making a change.

The Anchorage Native Primary Care Center normally serves as a primary care center for Alaska Native and American Indian patients of all ages suffering from a variety of medical issues. On the day of the earthquake, however, its lobby became a triage center.

Holly Fisk, MSN, FNP, ONC, Class 142, who was born and raised in Anchorage, is a family nurse practitioner at Southcentral Foundation’s Anchorage Native Primary Care Center. “That’s the Alaskan way,” she says of the center’s care for the earthquake victims. “The emphasis [FNU places] on rural and underserved communities has been helpful for me in this role. We really take care of one another. In rural areas, you have to pull together and have teamwork.”

Teamwork helped provide the care for the earthquake victims, but additional challenges came in the form of extensive damage to Glenn Highway, one of only two roads out of Anchorage. While Anchorage itself isn’t rural, with a metro population of approximately 300,000, Fisk’s clinic serves patients from extremely remote areas, some of which are only

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accessible by plane. Community health aides in those areas help treat basic conditions and triage those who need to be transported to larger healthcare facilities.

Southcentral Foundation is part of the Alaska Native Tribal Health System, which works in conjunction with Alaska Native Tribes and Tribal organizations to provide comprehensive health services to 166,146 Alaska Native people.

The health care provided at Fisk’s clinic is prepaid via this system. “We call our patients ‘customer-owners’,” Fisk says, noting that essentially all of the patients seen at the clinic are Alaska Native or American Indian people. The clinic serves a population of about 65,000 customer-owners in the Anchorage area.

To meet the needs of those patients, the Anchorage Native Primary Care Center is divided into seven distinct smaller clinics. Each clinic has an integrated care team. Fisk serves as her clinic’s only nurse practitioner and is joined by two medical doctors, three physician’s assistants, a doctor of osteopathic medicine, an internal medicine physician, pain management, behavioral health consultants, and a nurse-midwife. “It’s a huge knowledge base we have here,” says Fisk, who treats patients of all ages and conditions, including well-visits. Fisk joined the clinic in November of 2018, shortly before the earthquake. Prior to that, she was an RN before graduating

from FNU in March of 2018 and taking time off to have a baby. Fisk’s grandparents moved to Alaska in the 1940s and the family has stayed there ever since.

Fisk, whose preceptor Christopher Haupt-Chronister, MSN, FNP, Class 71, also works at the clinic, says that while the clinic offers every kind of specialty, the access is limited. “There is not enough access to specialized care,” Fisk says. “We have every specialty, but they might come in from another city once a month.” As a result of the lack of access to specialty care, the cost of specialized care in Alaska can be prohibitive, Fisk says, noting that some patients go to Seattle instead, finding it more affordable even with flight and hotel costs.

FNU’s curriculum includes instruction on dealing with complex patients in rural communities where access to specialists may be sparse.

“Our graduates are well-prepared clinicians who are improving healthcare around the country and the world,” says FNU Associate Dean for Family Nursing Lisa Chappell, Ph.D., FNP-BC. “As a Frontier student, you will get to know the needs of your community.” One of those needs for Anchorage is mental healthcare.

“The biggest need is behavioral health services,” Fisk says. “It’s a three-month wait right now for intake. We have behavioral health consultants who bridge the gap until the patient can be seen by a psychiatrist.”

Fisk notes that the clinic has seen a significant uptick in the number of patients coming in with anxiety, depression, and PTSD since the

earthquake. The clinic’s behavioral health consultants assist with that, as does the clinic’s extended appointment times. “Alaskan Native people emphasize relationships, so we provide very relationship-based care,” Fisk says. “Most appointment times are 30 minutes. I love that about this place.”

David Moore, FNP Homelessness isn’t easy anywhere, but, as David Moore, FNP, Class 75, says, referring to Alaska’s harsh climate, “Homelessness in Alaska brings its own issues.”

Fisk says that her experience with FNU played a significant role in preparing her for her current career. “FNU prepared me for the more holistic kind of care that we do here,” Fisk says. “FNU does a great job of preparing us for relationship-based care.”

Fisk enjoys preventative care and educating her patients while she takes the time to talk to them and to understand their particular needs. Still, when the time comes for more urgent care, the clinic responds quickly to those in need. “We have really good same-day access,” Fisk says. “We keep appointment times open for those types of urgent situations. That’s what we do. It’s the Alaskan spirit.”

“I’m never shy to say that Mary Breckinridge is my nursing hero.”

In 2016, Moore joined the Front Street Clinic, part of the Southeast Alaska Regional Health Consortium, in Juneau, Alaska. Located in downtown Juneau, the Front Street Clinic frequently serves the city’s homeless population.

“The emphasis [FNU places] on rural and underserved communities has been helpful for me in this role. We really take care of one another. In rural areas, you have to pull together and have teamwork.”

“Most of my patients are homeless or medically underserved,” Moore says, noting that, in addition to providing healthcare, the clinic hands out free socks, gloves, hats, and hygiene kits to the area homeless population. A nationwide homeless count held in January 2018 found 235 homeless people in Juneau*, up 8.5% from 2017.

*Baxter, Adelyn. With Building Set for Demolition, Future of City’s Cold Weather Shelter Unclear. 2019/04/12, https://www.ktoo.org/2019/04/12/ emergency-shelter-closes-for-the-season-building-to-be-demolished

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FNU Impact Report: Alaska, The Final Frontier Moore did not come to work with the homeless and medically underserved by happenstance. A native of eastern Tennessee, Moore was inspired when he read Wide Neighborhoods, the story of Mary Breckinridge and the founding of the Frontier Nursing Service in southeastern Kentucky. “I’m never shy to say that Mary Breckinridge is my nursing hero,” Moore says. “I read Wide Neighborhoods even before I went to FNU. I bought my own copy and I fell in love with the mission. That’s why I went there.”

But he also loved the beauty of the pacific northwest and Alaska and was drawn to move there after graduation. “It’s gorgeous here,” he says. “It’s visually stunning. Plus, it offered me an opportunity to work with the homeless community.”

Moore is the only practitioner at the Front Street Clinic. He is joined by a small staff including an RN, two behavioral health specialists, and two case managers. Dental care is also offered a couple of days per week. Moore sees an average of five to seven patients per day, noting that most of his patients wait until they are extremely sick before seeking treatment. As a result, most of the cases are complex. “Most people who come in are present with chronic illnesses,” Moore says. “They aren’t usually coming in to be treated for a cold. A lot of our patients are transient, and we only see them when some crisis arises.”

Moore relates the story of one patient who was sent for a routine colonoscopy and was diagnosed with rectal cancer.

She would have to be treated in Seattle.

“She was a naturalized citizen but didn’t have her paperwork in order to be able to travel,” Moore says. “We got her to Seattle for surgery and got her in touch with a lawyer to help get her proper identification so she could travel back

and forth between here and Seattle. They wouldn’t let her on the plane otherwise.

That’s an example of the challenging situations we face in this region.”

A large reason for the complexity of these cases is the lack of specialists practicing in Juneau. Patients who need to be seen by specialists are commonly sent on twoto three-hour flights to Anchorage or Seattle. Because such travel is expensive, time-consuming, and prohibitive for many patients, including members of the homeless population, Moore utilizes e-consultants via AristaMD. This allows him to complete a patient’s chart and send it to a specialist online. That physician will respond within 24 hours with recommended treatment or instructions for the patient to be seen by a specialist.

At every turn, Moore looks for ways to increase access to healthcare for his patients. For example, he learned how to treat hepatitis C so those patients would no longer need to travel to Anchorage for treatment. He also handles substance abuse, currently treating more than 20 such patients. “We see a lot of psychiatric illnesses and co-occurring conditions such as substance abuse combined with psychiatric illness,” Moore says.

Moore credits FNU for helping to cultivate his desire to serve in rural and underserved areas and to look for solutions beyond what would be considered his normal scope of practice.

“The way the FNU program is designed, I had to be independent and dig for resources,” Moore says. “I had to find my own preceptors. It taught me independence and perseverance. It taught me to go above and beyond to get the job done.” You might say he’s gone the extra mile, but traveling from Tennessee to Alaska, Moore’s impact extends well beyond that.

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Karolina Priebe, DNP, ANP, FNP Nothing beats a road trip off the beaten path. There’s a bit of a thrill to see that sign that says “last chance for gas for the next 100 miles.” Imagine, though, if that sign said, “last chance for medical care for the next 500 miles”? There are no such signs, of course, but that’s essentially what Fairbanks represents for many Alaskans living in the extreme northeast regions of the state.

“Frontier was all about going where there’s a need and making an impact.”

“We are isolated from other areas of Alaska,” says Karolina Priebe, DNP, ANP, FNP, Class 17, Family Nurse Practitioner at Mountain View Medical Center in Fairbanks. “We are really the northernmost city in northeast Alaska in terms of access to healthcare. We cover thousands of miles of the area.” Priebe has covered thousands of miles herself.

Born and raised in Poland, she moved to Chicago when she was 16, eventually becoming a U.S. citizen and serving as a

medic in the military. Her husband was also in the military and his last station before retiring was in Fairbanks in 2015.

They fell in love with the community and continue to make their home there.

At Mountain View Medical Center, Priebe is the only primary care provider doing family practice daily. She is joined by an internal medicine physician and a physician’s assistant. Many of the patients they treat come from very remote locations and only visit the city once or twice a year. “The bush people of Alaska have no roads,” Priebe says of the population made famous by the “Alaskan Bush People” television series. “How they get to us in summer is via boat or four wheelers, in the wintertime many travel by snow machines, until they either reach a road system or a small airport. They come to town once every six months or once a year. We address as much as we can in one visit.” That means a lot of acute care and little time left over for addressing lifestyle, education, and preventative medicine.

The result is a gap that Priebe is trying to fill.

Noting a significant issue with obesity in her patient population, Priebe launched an obesity program in August 2018. She devotes approximately two-thirds of her time providing primary care and the other one-third on the obesity program. She is treating approximately 50-60 patients in the program.

“Nobody is doing obesity management. In primary care, there’s no time to address that,” Priebe says.

“Weight management is built into my work schedule for patients interested in medical weight loss. I’m treating chronic conditions such as diabetes or high blood pressure along with obesity at the same time. It saves the patient time and money.”

Patients in the program begin by keeping a food journal for a month. Priebe then reviews it and helps them find healthier alternatives to the foods they enjoy.

Access to fresh and affordable healthy food is a significant hurdle for many in the community. “There are many components to the obesity problem,” Priebe says. “A lot of my patients don’t have access to proper food. Fresh produce is very expensive here, especially in winter.

Our food bank is a great resource but it mainly has packaged foods. A lot of people can’t afford the fresher, healthier foods.”

Affordability is also an issue when it comes to medical bills and, as a result, many are reluctant to seek the care they need. To help address this issue, Priebe serves on the board of KarmaCare, a local nonprofit that offers people assistance with their bills. Patients who qualify for the program are asked to volunteer in their community. In exchange for their service, KarmaCare will pay up to $4,000 per year toward their medical bills. “That’s the community we have,” Priebe says.

“There is a unity of the community in Fairbanks and that’s why we stayed here.”

There’s also a can-do spirit. When gaps are identified, solutions are sought. There is a limited amount of specialized care in Fairbanks, so Priebe and her team

arrange appointments with specialty care providers in Anchorage or Seattle.

“Thankfully there’s a good working relationship between us and Anchorage and Seattle,” Priebe says. “They are good about working our referrals in. We have to sit on the phone for many hours to figure out where to send these patients.”

Priebe credits Frontier Nursing University with helping to prepare her to be innovative and community-driven in her work. “Frontier was all about going where there’s a need and making an impact,” Priebe says. “Every day I’m trying to see how I can help my patients, what’s needed, and how I can make an impact.

I’m still trying to figure out how we can make medical care better here.

“Frontier is so focused on meeting patients where they are and making improvements in the community,” Priebe continues. “It prepared me to open my eyes to look at bigger issues, to look at what needs need to be addressed in the community to benefit not only the patient but their families as well.”

Frontier Nursing University • Quarterly Bulletin 9

Alumni Notes Alumni Spotlight: Maria Mayzel, MSN, CNM, WHNP Maria Mayzel, MSN, Class 87, is a nursemidwife at Bay Area Midwifery Center in Annapolis, Maryland.

There, she has the opportunity to serve in both a hospital setting and a birth center for patients looking for an out of hospital (OOH) option.

The midwifery center’s patient population is 25-35 percent Spanish speaking.

Mayzel, along with the Center’s nurses and office secretary, are bilingual in English and Spanish, enabling them to better communicate and care for their patients. “We serve a large population of recent immigrants and are able to offer care in their native language,” Mayzel says.

“These clients often have no one else to care for them and have found a home at our center.”

The birth center also serves a large number of local military families, providing birthing options. “Without our birth center and hospital practice, these families would be forced to travel to far-away bases to receive prenatal care or deliver their babies,” Mayzel says. Bay Area Midwifery Center is one of only three birth centers in Maryland, which helps them fill a void in OOH birth options in the state not only for military families and immigrants but to all families looking for an OOH or hospital birthing experience.

Patients who desire OOH birthing experiences have the support of the midwifery center staff as well as additional support from the hospital if needed.

Mayzel and her colleagues are hospital

employees and work closely with the Obstetrician Hospitalist team to comanage higher risk clients. “I believe our collaborative model works to improve patient outcomes and satisfaction,” Mayzel says.

Although Mayzel has been busy serving her community as a nurse-midwife, she has still managed to add to her knowledge of best nursing practices. Since graduating from FNU in 2014, she has received her Obstetrics-Based Advanced Cardiac Life Support certification, Electronic Fetal Monitoring certification, and additional training in Limited Obstetrical Ultrasound and First Assist for Cesarean Section. In 2017 she received her WHCNP Post-Graduate Certificate so that she could offer even better care to her patients. “Adding on my WHCNP was important because I am committed to providing evidence-based well-woman care to our clients and feel all clients should have the option of midwifery-led GYN care if they are low-risk,” Mayzel says. “I want to make a difference in my clients’ lives, not just during one moment in their pregnancy, but throughout the entire journey.”

Precepting 101 Why become a preceptor for FNU students? Here are just a few of the many reasons: • Promote your profession through the education and guidance of your future peers • Help expand access to quality, compassionate care, to rural and underserved populations • Earn an honorarium based on the percentage of time spent precepting students • Gain access to free CEUs including sessions on pharmacology and other exciting topics.

Please consider the rewarding experience of becoming an FNU preceptor today! To learn more about becoming a preceptor, please visit https://portal.frontier.edu/web/ fnu/preceptor.

Rachel Gruenberg Joins CHI St. Alexius Health Minot Medical Plaza Rachel Gruenberg, MSN, FNP, Class 110, has joined the patient care team at CHI St. Alexius Health Minot Medical Plaza in Minot, North Dakota. As a family nurse practitioner, Gruenberg is dedicated to serving the health needs of the community and care for patients ages two and up. She focuses on annual wellness checks, treatment of common illnesses, and the management of acute and chronic health conditions.

10 Frontier Nursing University • Quarterly Bulletin

Sandi Hayes, APRN, CNP (left) with preceptee Kelly Papesh, DNP, Class 26.

Tarnia Newton Selected to Present at Prestigious Conferences Tarnia Newton, DNP, Class 28, was one of six finalists selected for the “Pitch Perfect” Research Competition at the International Forum on Quality and Safety in Healthcare in Glasgow in March. Her poster was titled “Improving Diabetes Care in a Nurse Practitioner-Led Clinic: A QI Project”.

Newton also served as a moderator at the Sigma Theta Tau International (STTI) Honor Society of Nursing Conference in New Orleans, Louisiana and has a podium presentation titled “Building Team Engagement a Catalyst for Improving Diabetes Care” at the STTI’s 30th International Research Congress in Alberta, Canada, in July 2019.

Paige Hardy Beats Blizzard to Serve Patients

Paige Hardy, APRN, CNM, MSN Class 152, lives in rural Chokio, Minnesota, 14 miles from Stevens Community Medical Center. As the area residents prepared for a blizzard this April, Paige and her husband Rich made plans to make sure Paige could be present to deliver her patients’ babies. Paige, whose story was featured in the Twin Cities Pioneer Press, was afraid the blizzard would prevent her from making the commute. She and her husband set up their ice fish house in the parking lot at the University of Minnesota Morris, just a few blocks from the hospital, enabling her to see her patients despite the blizzard.

Kasey Ladd Joins Northern Light Gynecology

Audrey Patterson Joins Launch of New Midwifery Clinic

Kasey Ladd, CNM, MSN, Class 152, has joined the team at Northern Light Gynecology in Bangor, Maine to provide comprehensive evaluation and management of a full line of gynecology services for women of all ages. Ladd specializes in women’s well care, firsttrimester obstetrics, and contraceptive administration.

Audrey Patterson, MSN, Class 145, is part of a team of three nursemidwives providing care for women’s health needs at the Ascension Providence Hospital new midwifery clinic in Waco, Texas. The clinic is located in the Waco Center for Women’s Health, adjacent to the hospital.

Sarah Updegraff Presents at Central Pennsylvania Food Bank Nutrition Workshop Sarah Updegraff, MSN, FNP, Class 146, presented at a nutrition workshop coordinated by the Central Pennsylvania Food Bank in March 2019. Updegraff, who is employed at River Valley Health and Dental Center in Williamsport, Pennsylvania, presented on making smart choices and the nutritional benefits of foods made from scratch.

Linda Nelson Joins Banner Health Clinic Linda Nelson, CNM, MSN Class 69, has joined Banner Health Clinic in Loveland, Colorado, where she provides midwifery care.

Mimi Niles Published in the Journal of Midwifery & Women’s Health Faculty member and alumna Mimi Niles, CNM, LM, MPH, CNEP, Class 52, recently had her submission “Internet Search for Midwifery Fellowship Programs” published in the Journal of Midwifery and Women’s Health.*

*Niles, Mimi & Hunt, Ronald. (2018). Internet Search for Midwifery Fellowship Programs. Journal of Midwifery & Women’s Health. 63.

10.1111/jmwh.12924.

Frontier Nursing University • Quarterly Bulletin 11

Alumni Notes Eldar Spahic Completes Ironman Ultra-Triathlon Eldar Spahic, DNP Class 30, finished second in the 2018 Quintuple Ironman World Cup Ultra-Triathlon in New Orleans. The 702-mile race consisted of 12 miles of swimming, 560 miles of biking, and 130 miles of running. Spahic, who is married to Erin Spahic, DNP Class 30, was able to complete the race in 132 hours and 18 minutes.

outcomes for patients with diabetic foot ulcers. Tayyebi was advised on the project

by FNU Dean of Nursing Joan Slager, CNM, DNP, FACNM, and FNU faculty member Niessa Meier, DNP, CNM.

Jana Esden Writes Lead CEU Article for Nursing Publication FNU faculty member and alumna Dr. Jana Esden, DNP Class 6, was published in The Nurse Practitioner. Her article was titled “Adverse Childhood Experiences and Implementing Trauma-informed Primary Care”.*

Leslie Ferrell Receives Distinguished Alumni Award Leslie Ferrell, MSN, FNP, DNP, Class 09, received the Distinguished Alumni Award from Southeastern Illinois College on May 9, 2019. Ferrell is the vice president and chief nursing officer at Harrisburg Medical Center in Harrisburg, Illinois. Ferrell was awarded the Illinois Rural Health Practitioner of the Year in 2011. She is currently active in the American College of Healthcare Executives, Illinois Society for Advanced Practice Nurses, American Nurses Association, and American Academy of Nurse Practitioners.

FNU Alumni, Faculty and Staff Enjoy March Cruise More than 150 FNU alumni, leadership, and staff members enjoyed the FNU Alumni cruise to the Bahamas on March 24-28. Among the many events, the cruise featured a catamaran excursion, a group cocktail party, and two pharmacology CE sessions.

To make sure you don’t miss any of our upcoming alumni events, be sure to follow our FNU alumni Facebook page and sign up for our monthly alumni e-newsletter. If you have any questions or a change of contact information, please contact us at alumniservices@frontier.edu.

Azam Tayyebi Recognized as Healthcare Innovator Azam Tayyebi, DNP, FNP, Class 27 was recently named one of 57 healthcare “Innovators Who Are Making Healthcare Better, Faster” by CareZooming. Tayyebi, who works at Elmhurst Wound Care Clinic in Elmhurst, Ill., a suburb of Chicago, led a Quality Improvement Project to improve *JL Esden, “Adverse Childhood Experiences and Implementing Trauma-informed Primary Care,” The Nurse Practitioner, 2018 - journals.lww.com

12 Frontier Nursing University • Quarterly Bulletin

Andrea Tiffin Joins HSHS Medical Group Andrea Tiffin, MSN, FNP, Class 145, recently joined the HSHS Medical Group in Effingham, Illinois. Tiffin sees patients at HSHS Medical Group Gastroenterology and Weight Management as well as at HSHS Medical Group Colorectal and General Surgery.

Joseph Adams Assumes New Role at Canton-Potsdam Hospital

FNU Alumni Association The Frontier Nursing University Office of Alumni Relations is here to support YOU! Our purpose is to find new and meaningful ways to engage and support Alumni — from graduation throughout your career. Alumni are an integral part of FNU’s development because you demonstrate the excellence of FNU in everyday practice and because you are our primary recruiters and most loyal donors. We appreciate your commitment to FNU, and we plan to offer additional rewarding programs in return soon.

Services are open to all graduates of FNU. We currently have more 6,000 alumni in all 50 states and many countries around the world.

We encourage you to explore the services, programs, and activities offered and to become involved. There are several wonderful ways to stay in touch with friends and connected to FNU including; reunions, conference receptions, case days, eNews, and our very active Facebook Group. To take advantage of all member services, please make sure we have your updated contact information by emailing us at alumniservices@frontier.edu.

Formerly an RN at Canton-Potsdam Hospital in Potsdam, New York, Joseph Adams, MSN, FNP, Class 154, recently transitioned into medical provider status at the hospital. He now delivers care to patients in the emergency department at the hospital’s main campus.

Kim Benning Joins St. Luke’s Urgent Care Kim Benning, MSN, FNP, Class 87, joined St. Luke’s Urgent Care in Duluth, Minnesota, in May 2019. Benning sees patients at St. Luke’s Denfeld Medical Clinic, Mariner Medical Clinic, and Miller Creek Medical Clinic Urgent Care locations.

Frontier Nursing University • Quarterly Bulletin 13

Courier Corner Meet the 2019 Summer Couriers Every summer, FNU gives college students from around the country an opportunity to participate in the Courier Program. This service-learning experience is an opportunity for students interested in public health, health care, or related fields to see what it is like to provide medical care to an underserved population. This summer, nine students are answering the call to serve in rural Kentucky.

Sarah Baldree Sarah is a 20-year-old attending Williams College in Massachusetts.

Originally from Macon, Georgia, Sarah is working on a double major in biology and psychology and will be spending fall 2019 studying in Amsterdam, Netherlands.

Breanna Bowling Breanna is a public health pre-med student at Eastern Kentucky University.

She is involved in the honors program, the service council, and Alpha Phi Omega. In the future, she wishes to pursue an MD, MPH dual degree.

Audrey Cameron Audrey is a rising junior at the University of British Columbia (UBC) in Vancouver, Canada. She is studying honors philosophy with a minor in health and society. Audrey is part of her school’s first aid team, providing coverage at UBC community events.

She also works with the education and outreach branch of the team, facilitating workshops on student health.

14 Frontier Nursing University • Quarterly Bulletin

Emily Cross Emily is a recent Skidmore College graduate from Andover, Massachusetts.

She has a degree in neuroscience and a minor in theater. She spent the last year working on her thesis examining maternal and paternal methamphetamine use in fruit flies. She has been an EMT for three years and has volunteered with several hospice organizations. She hopes to become a palliative care doctor or a forensic pathologist.

Daniel Goold Daniel is a 22-year-old from northern California. He is currently a student at Brigham Young University. Daniel is passionate about the medical field and hopes to attend medical school after graduation.

Reilly Hail Reilly is a 21-year-old from northern California but will be relocating to Franklin, Tennessee after completing the Courier Program to start a nursing program in August. She would like to become a nurse-midwife and is excited to learn from other nurse-midwives.

FNU would like to thank these Couriers for answering the call to serve in Appalachia this summer. We know that this will be a rewarding experience for you and those you serve.

Welcome to the FNU Courier family!

Eric Lakomek Eric is a 20-year-old rising junior from Saint John, Indiana. He attends Wabash College, where he is majoring in psychology with a minor in global health and chemistry. His hope is to attend medical school. He is a member of Phi Delta Theta and has been involved in the Wabash Dance Marathon, Global Health Initiative, the Public Health Organization, and the baseball team.

Dorn McMahon Originally from New Jersey, Dorn moved to Maine in the summer of 2001.

Dorn is a junior in the nursing program at the University of Maine at Fort Kent and hopes to continue working in the medical field with a focus on population health.

HaLee Morgan HaLee is from Hyden, Kentucky. FNU’s first official “local courier,” HaLee graduated from Leslie County High School in Hyden. She plans to obtain her RN license next year. After that, she hopes to attend FNU to obtain her FNP degree. Her ultimate goal is to become a pediatric nurse practitioner and serve rural communities.

Interested in Being an FNU Courier?

To learn more about the FNU Courier program, please email the Courier Coordinator, Tara Dykes, at courier.program@frontier.edu.

Calling All Former Couriers!

Have a story you remember and want to share? We publish stories about former Couriers on our website and in the Quarterly Bulletin. Or you can share your story via “Courier Coffee,” our vlog series that showcases present and former Couriers. If you are interested in doing recording a Courier Coffee, please email Courier.Program@ frontier.edu for more information.

Frontier Nursing University • Quarterly Bulletin 15

News and Notes Chi Pi Honor Society Fall 2018 Scholarship Recipients Eight FNU students who are members of the Chi Pi Honor Society received $750 scholarships for the fall 2018 scholarship cycle. Chi Pi Honor Society is FNU’s Sigma Theta Tau International Chapter.

The mission of Chi Pi is to promote global health and wellness. The mission will be accomplished by supporting the efforts of Sigma Theta Tau International (STTI) in promoting, advancing, and recognizing nursing excellence through developing nursing scholarship, leadership, and service.

FNU’s eight Chi Pi Honor Society scholarship recipients are: • Traci Buran • Riana Damjanovich • Thomas George • Jennifer McCammond • Pamela Maslen • Olga Rybakov • Miriam Sward • Michelle Van Druff

FNU Student National Certification Exam Pass Rates Exceed National Averages

Here are what some of the winners have to say about receiving the Chi Pi Honor Society Scholarship: “I would like to say thank you so much for this scholarship. My desire is to continue the master’s program, and eventually get my DNP at FNU. This scholarship will support me in reaching this goal! I had to cut down on work hours because of the amount of time I spend studying every week, and every bit helps me to reach my goals.”

“I am filled with both sincere gratitude and excitement to have received a Chi Pi Honor Society scholarship during my journey at Frontier. I plan to put every penny of this generous gift toward my tuition which will continue to bring me closer to my dream of serving women as a Certified Nurse-Midwife in a rural community.”

“On an average day, I commute between 110 and 130 miles to my clinical sites, often through heavy snow. This scholarship will be an enormous help in covering some of the tuition and additional expenses associated with my clinical experience including before aftercare for my three, school-aged children, gas, and tolls. Thank you for believing in me and supporting me.”

“I am humbled and truly grateful. As a veteran, current military spouse, and father of two kids in college, this scholarship allows me to work less so I can expedite my clinical experience.

Once clinicals are done, I will head back to Guam to provide care for underserved indigenous people of the Marianas Islands.”

FNU Nurse-Midwifery, Nurse Practitioner, and Women’s Health Specialty Track Programs National Board Examination Pass Rates

Year after year, FNU students perform well above the average. We are proud of our outstanding students and our excellent faculty who have prepared them. FNU takes pride in preparing our students not only to excel on these exams, but more importantly, to provide excellent healthcare to those in their communities.

Upcoming Events FNU Commencement 2019 Saturday, September 28 12:00 p.m. Bluegrass Ballroom, Lexington Center Lexington, KY FNU Alumni and Courier Homecoming October 4-6 Hyden, KY 16 Frontier Nursing University • Quarterly Bulletin

Wendover Report Jane Houston, DNP, CNM, Named DNP Program Director FNU announced that Jane Houston, DNP, CNM, has accepted the position of Program Director for the Doctor of Nursing Practice (DNP) Program.

Jane Houston Dr. Houston has been at FNU since 2015, serving as the Clinical Director for the Midwifery and Women’s Health programs. We also extend our gratitude to Deborah Karsnitz, DNP, CNM, FACNM, who served as the Interim Director for the DNP Program for the past year.

FNU also named Dr. Katheryn Arterberry as the new Clinical Director for the Family Nurse Practitioner (FNP) and Dr. Audrey Perry as the new Clinical Director for Community-based Nursemidwifery Education Program / Women’s Health Nurse Practitioner (CNEP/ WHNP) effective with the Spring term.

FNU Faculty Member and Alumni Work to Improve Depression Screening

Diana Jolles

Ann Schaeffer

FNU faculty member Diana Jolles, Ph.D., CNM, DNP Class 24, and Ann M. Schaeffer, DNP, CNM, had their recent work featured in Health Leaders Media. Their publication is titled “Not Missing the Opportunity: Improving Depression Screening and Follow-Up in a Multicultural Community.”*

The Wendover Bed & Breakfast and Retreat Center A stay at the Wendover Bed & Breakfast and Retreat Center is filled with history, scenic beauty, comfortable accommodations, and ample peace and serenity. Wendover, which has recently undergone several upgrades and renovations, was once home to Frontier Nursing Service (FNS) founder Mary Breckinridge and stands today as a registered National Historic Landmark.

Wendover, which is located along the Middle Fork of the scenic Kentucky River, features 17 newly renovated guest rooms in The Big House, The Garden House, The Wendover Barn, and The Cottage.

The Big House is a lovely log home that was built in 1925 by Mary Breckinridge.

It features four guest rooms and two shared baths. The Garden House offers one suite with a private bath and six single rooms with one shared bath.

View from The Barn

Conference Center

Once the place where Mary Breckinridge kept the FNS horses, today The Barn is now home to the Wendover Gift Shop and Historic Photo and Artifact Gallery.

It also includes one apartment with a private bath and four guest rooms with two shared baths.

Finally, The Cottage is the newest of the Wendover buildings. Built in 1970, it offers three guest rooms with one private bath and one shared bath, making it the perfect location for families or small groups. The Cottage includes its own fullsize kitchen and laundry room, and has been used for small group retreats.

For larger groups, the Livery Retreat Center is a perfect location for retreats, meetings, conferences, and reunions.

An outdoor fire pit, rock barbecue grill,

The Cottage

The Big House

* Schaeffer, Ann M. & Jolles, Diana. (2019). “Not Missing the Opportunity: Improving Depression Screening and Follow-Up in a Multicultural Community”. The Joint Commission Journal on Quality and Patient Safety 2019; 45:31-39. https://www.jointcommissionjournal.com/article/S15537250(18)30020-5/pdf

Frontier Nursing University • Quarterly Bulletin 17

Wendover Bed & Breakfast and Retreat Center Report Special Knit Items Homemade baby caps, blankets, and scarves continue to be very needed for our FNU Students. Frontier nurse-midwifery students present a baby cap to the family of a baby whose birth they attend, and our nurse practitioner students present lap quilts or scarves to their patients. As our university continues to grow, we will need more and more of these wonderful items. The size needed for lap quilts is approximately 40 by 42 inches. Yarn should be worsted weight.

We greatly appreciate the many knitting groups and friends who send items to us. These baby caps, scarves, and blankets are circling the globe as our students pass them on to women and families and share the story of Mary Breckinridge and the Frontier Nursing Service. It’s such a special way to pass on the vision and mission of Frontier!

Please send your donated items to: The Garden House

and plenty of fenced-in property provide a private but spacious location for groups large and small.

Guests at Wendover Bed & Breakfast and Retreat Center also enjoy complimentary breakfast and optional lunch and dinner. Wendover is renowned for its delicious Southern meals, prepared fresh daily by our talented cooks.

FNU is extremely excited about the renovations that have taken place recently, but it will always be the history of Wendover that makes us proud and its historic location that brings us back for another wonderful visit. We hope you will take the time to visit too and see why the Wendover Bed & Breakfast and Retreat Center is truly a one-of-a-kind place that will forever hold special significance for the Frontier Nursing University community.

Book Your Stay or Retreat at Wendover Bed & Breakfast and Retreat Center To plan your stay, please contact Wendover Operations Manager, Debra Turner, at 606-672-2317 or visit wendover@frontier.edu to book online. You can follow Wendover on Twitter, Facebook, and Instagram.

18 Frontier Nursing University • Quarterly Bulletin

Michael Claussen, Development Officer 132 FNS Drive Wendover, KY 41775 Thank you to the following individuals who have recently sent items to Wendover: Barb Bowling Alumna Dianne Lytle Alumna Jill Nobles-Botkin with the Oklahoma State Department of Health Former FNS Nurse-Midwife Harriet Palmer Ann Pongrace Alumna Dawn Sneathen Mary M. Williams

Quality Maternal and Newborn Care Research Alliance Holds Strategic Planning Retreat at Wendover The Wendover Bed & Breakfast and Retreat Center served as the site of the Quality Maternity and Newborn Care Research Alliance Strategic Planning Retreat, May 9-12, 2019.

The Quality Maternity and Newborn Care (QMNC) Research Alliance is an alliance of researchers, clinicians, advocates, and policymakers working together to foster and support research to improve quality maternal and newborn care. The group developed out of the seminal work published in the 2014 Lancet

QMNC Research Alliance Strategic Planning Retreat Attendees Abigail Aiyepola

Jane Houston

Susan Stone

Naturopathic physician; Midwife; PhD student in medical anthropology

Midwife; Midwife Educator

Nurse-Midwife; Professor

Frontier Nursing University

President, Frontier Nursing University

Country/Region Represented: United States and United Kingdom

President, National Association to Advance Black Birth

Series on Midwifery*, with follow-up papers on setting research priorities† led by Dr. Holly Powell Kennedy (FNU class of 1985).

The QMNC Research Alliance’s mission is the promotion of sustainable, context-specific, highquality care and research to promote and support optimal physical, psychological, and social wellbeing, survival, and health for women, newborn infants, and families in both the short and longer term. This also includes striving for equitable quality health outcomes and the empowerment of midwives to meet this mission. Further, the stated purpose of the QMNC Research Alliance is global collaboration to improve and expand the knowledge base to support the United Nations/ World Health Organization (UN/WHO) “survive, thrive, and transform” agenda and other agendas that address the quality, equity, and dignity of maternal and newborn health care.

Twenty-two members of the QMNC Research Alliance attended the retreat, which provided an opportunity to set a strong, shared vision for future work together. FNU was represented at the retreat by president Dr. Susan Stone and DNP program director Dr. Jane Houston. * The Lancet Series on Midwifery Executive Summary Writing Team. Midwifery: An Executive Summary for the Lancet’s Series. June 2014, https://www.thelancet.com/ pb/assets/raw/Lancet/stories/series/midwifery/midwifery_ exec_summ.pdf † Kennedy, Holly P., et al. “Asking different questions: A call to action for research to improve the quality of care for every woman, every child.” Birth Issues in Perinatal Care, vol. 45, no. 3, 2018, pp. 222-231. https://onlinelibrary. wiley.com/doi/full/10.1111/birt.12361

Country/Region Represented: United States

Country/Region Represented: United States; Nigerian born

Tamar Kabakian-Khasholian

William Stones

Health Services Research

Spee Braun

American University of Beirut

Obstetrician-Gynecologist; Researcher Malawi College of Medicine

Facilitator; Management Consultant

Country/Region Represented: Middle East

Country/Region Represented: United States

Holly Powell Kennedy

Andrew Symon

Professor; Researcher; Midwife

Professor; Researcher; Midwife

Melissa Cheyney

Yale University

Professor; Midwife Oregon State University Country/Region Represented: United States Manju Chhugani Professor Jamia Hamdard University Country/Region Represented: India/Asia

Country/Region Represented: United States

Saraswathi Vedam Professor; Researcher; Midwife

Dundee University

University of British Columbia

Country/Region Represented: United Kingdom

National Childbirth Trust

Boston University Country/Region Represented: United States Soo Downe Professor; Researcher; Midwife

Country/Region Represented: Europe

Country/Region Represented: United Kingdom Emmanuelle Hebert Midwife International Confederation of Midwives Country/Region Represented: Canada Caroline Homer Midwife; Researcher; Program Director Burnet Institute Country/Region Represented: Australia

Country/Region Represented: Canada Rachel Zaslow Midwife; CEO Mother Health International Country/Region Represented: Uganda

Carol Sakala

Jinguo Helen Zhai

Advocate; Researcher

Professor; Researcher; Midwife

National Partnership for Women & Families

The University of Central Lancashire

Country/Region Represented: United Kingdom

Professor; Researcher; Midwife

Persistent Maternity Activist

Professor, Political Scientist

Dundee University

Allison McFadden

Mary Newburn

Gene Declercq

Country/Region Represented: Sub-Saharan African

Country/Region Represented: United States

Southern Medical University Country/Region Represented: China

Jane Sandall

Advisors to Group:

Professor; Researcher; Midwife

Mary Renfrew

King’s London College

Professor; Researcher; Midwife

Country/Region Represented: United Kingdom

University of Dundee

Yoko Shimpuku

Country/Region Represented: United Kingdom

Professor; Researcher; Midwife

Petra ten Hoope-Bender

University of Kyoto ( Japan); World Health Organization Collaborating Centers

United Nations Population Fund

Country/Region Represented: Asia-Pacific

Researcher; Midwife

Country/Region Represented: Netherlands and Switzerland

Frontier Nursing University • Quarterly Bulletin 19

InInMemoriam Memoriam / Tributes Remembering Treasured 1958 FNS Graduate Sylvia Joan Leatherwood Enriquez Editor’s Note: Ric Enriquez, son of Sylvia Joan Leatherwood Enriquez, shared this tribute to his mother. He also shared several images, many of which recall her experiences with Frontier Nursing Service.

Our mother, Sylvia Joan Leatherwood Enriquez, 82, of Colts Neck, New Jersey, passed away peacefully on Tuesday, January 22, 2019, at Meridian Nursing and Rehab in Brick, New Jersey. She was surrounded by her loving family.

Sylvia Leatherwood, was born in Mobile, Alabama, on June 6, 1936. She was child number seven of nine, and her early days were not easy, though she often spoke of them fondly.

She was five when World War II broke out and by age seven she lost her favorite brother, Robert, who served in the U.S. Navy. Her mother could not cope with the loss, and her father, who was serving in the merchant marines, was not around. Soon after she and her four sisters found themselves shuffled between foster homes and convent schools.

She graduated high school at the top of her class, but only had one pair of shoes. She left her foster home the day after she graduated and put herself through nursing school in New Orleans.

Sylvia was in her early 20s when she read Wide Neighborhoods,

by Mary Breckenridge and it changed her life. Determined to be one of the nurses on horseback, after graduating as an RN from Hotel Dieu, she joined the Frontier Nursing Service as part of the midwifery class of 1958.

For three years, she worked or was on call 24 hours a day, seven days a week for 46 weeks a year, as was the standard back then.

20 Frontier Nursing University • Quarterly Bulletin

For three years, she was one of a relatively small group of nurse-midwives stationed in a small scattering of cabins covering a 700-square mile range of the Kentucky mountains. Without electrical power or even roads, she was one of the brave, groundbreaking, and extraordinary young women traveling by jeep or horseback to provide whole family care for 10,000 of America’s poorest citizens.

She had 60 years of life beyond her first day in Hyden, but it was those three years in the FNS that were undoubtedly her favorite.

Between 1961–1971, Sylvia, would go on to get married and give birth to, and raise, seven children. In 1977, she returned to nursing full time and worked for another 40 years before retiring in 2007 at age 71.

But it was always the stories and memories of her time at FNS that she spoke most fondly of. All of her children have come to know about her happiest times and her incredible adventures.

Whether it be the stories of her roommates in Mardi Cabin, the time Mary Breckinridge scolded her for being sarcastic, or the time she slid her jeep off an icy wooden bridge, landing sideways and partially underwater in the river at Route 421 on her way to deliver a baby from Beech Fork.

We, her children also cherish, as she did, the many photographs of her years in Hyden; Young nurse Sylvia, astride her favorite horse Streamline, with her dog Pal in tow; her friends and classmates

Ruby Day, Jean Van Beek, Mavis Powell, and others; Molly Lee, a woman she held in such high esteem, and her pup Holly; Dr. Beasley, and of course, many, many, many new born babies.

her, which left me with the view of my mother once again, surrounded by young nursing students in the exact same spot, but now 58 years later. It was pure magic.

In 2016, we were lucky enough to come visit FNU with our mom on two different occasions and share in the magic that she lived. The first trip was a surprise, she did not know where she was being taken when we told her to pack a suitcase and “get in the car”. It was her first time returning to Hyden since 1961, but she felt like she had come home, especially because so many of the original buildings remain wholly preserved but also, because of the wonderful reception she received from the staff of FNU and the town itself.

For us children, our time at FNS with our mom was the opportunity to put into context the scope of her life there, and to see for the first time the very same buildings we knew so well, but only from old black and white photographs. And it was in these two trips that FNS became a cherished place with priceless memories for all of us.

And for Sylvia’s last three years, we spoke often of these trips and of FNS in general. Her favorite photos and her books from FNS were always with her.

Everywhere we went, friendly In 2016, Sylvia returned to Hyden and was photographed And though we have been forced strangers would approach and in the exact same spot as she was in 1958. to say goodbye, Sylvia is survived politely ask if she was “one of the by four sisters, six children and mountain nurses.” And each time, nine grandchildren.

She has been laid to rest in Miami, Florida, they would offer her thanks. Many times, when discussing the beside our brother Carlos, who died as child in 1967. names of some of the babies she had “caught,” the response would be “That’s my uncle!” or “She’s a cousin.”

On behalf of Sylvia, and all of her children, we say thank you Perhaps, my favorite memory is when my mom, now age 79, was standing in the same spot she had taken a photo with her classmates 58 years early in 1958, when she 22. While she was standing there, a small group of nursing students in their early 20s spotted her and approached. “Excuse me, are you a Frontier Nurse?” Upon confirmation, they excitedly gathered around

to the FNS and FNU, for continuing the important work she loved and helping to ensure that mothers, babies and families receive the best care possible.

Thank you,

Ric Enriquez, youngest child of Sylvia Leatherwood Enriquez

Frontier Nursing University • Quarterly Bulletin 21

InInMemoriam Memoriam / Tributes Beloved Former FNS Graduate and Preceptor Passes The FNU community mourns the passing of Mary E. Weaver. Born on May 15, 1944, Mary was a graduate of Frontier Nursing Service. She went on to serve as the Nursing Director at Mary Breckinridge Hospital and was a preceptor for many FNU students. Ms. Weaver passed on January 26, 2019.

Born in Philadelphia, Pennsylvania, to Mary Estelle Davies Kleyla and Vincent Robert Kleyla II, she was raised in Ridgefield, New Jersey, and graduated from Ridgefield Memorial High School. After receiving her nursing degree from Orange County Community College, Mary studied midwifery at the Frontier Nursing Service in Hyden, Kentucky. She became a licensed midwife and a family nurse practitioner and was later the Director of Nursing for Mary Breckinridge Hospital in Hyden.

Mary’s devotion to patient care and her desire to help those in need led her finally to the Lexington-Fayette Health Department where pediatrics was her favorite clinic. Mary married the late William Cookman Weaver in 1966. Together they raised two children, Dorothy Chandler Weaver of Oklahoma City, Oklahoma, and Daniel Davies Weaver of Hoboken, New Jersey.

Although raised in New Jersey, Mary called Kentucky her home. She was brought up in a family of Boy Scouts and she loved the outdoors including camping, whitewater kayaking, and fishing. Recognized as a Kentucky Colonel in 1998 for her accomplishments and service to others, she often said to her children that the only thing she wanted people to remember about her was that she tried. Her tenacity and perseverance in the face of obstacles undoubtedly helped many people who might not have known they had a guardian angel looking out for them.

She was a loving, protective mother; a fierce advocate for women’s equality; a gentle, skillful healthcare provider; and a faithful,

Memorial Donations The following people gave contributions to Frontier in memory of their friends of loved ones. The names in bold are the deceased

Sylvia Leatherwood Enriquez Mary Bailey Carolyn Conrad Jessica Cope Vana Lauren Dabney Erin Martin Jamie Marrs Debra Myers Ruthie Wyatt

22 Frontier Nursing University • Quarterly Bulletin

devoted friend who will be missed by many. Mary is survived by her children, Dorothy and Daniel; her brother, Vincent (Michelle) Robert Kleyla III; her grandchildren, Georgena Linnie Weaver, and Gabriel Weinpahl Weaver.

Cherished FNU Trustee and Wendover Committee Member Passes Angela Collett Feltner of Asher, Kentucky, passed away Tuesday, April 16, 2019, at her residence at the age of 48. Angela was born February 4, 1971, in Hyden, Kentucky, the daughter of Edmond Collett and Edith Smith Collett. A lifelong resident of Leslie County, Angela had a distinguished career in education. She was employed as a teacher for the Leslie County School System, teaching English, drama and special education.

She attended the University of Kentucky and received her bachelor’s degree in sociology from Berea College and her master’s degree in education from Union College. Angela was very active in both school and community activities. She was the founder of the Leslie County Drama Club and was instrumental in starting a horse club for 4-H members.

A Frontier Nursing University trustee, Angela also served on the Wendover Advisory Committee. She was a member of the Solid Rock Church in Hyden, Kentucky, Grace Point Church at Hyden, Kentucky, and Upper Grassy Branch Pentecostal Church at Essie, Kentucky.

Angela was preceded in death by her loving and devoted husband, Douglas Feltner, paternal grandparents, Emanuel and Edna Mosley Collett, and maternal grandparents, Troy and Juanita Smith. She is survived by her parents Edmond and Edith Smith Collett of Asher, Kentucky, sister Mary Elizabeth Hackworth and her husband James Daniel of Essie, Kentucky, and nieces Harper Quinn Hackworth and Everly Bronwyn Hackworth.

Carolyn Gregory Rakar West Jerri Pumroy Jane Hope Jane Tyrrell Virginia McAlister Shanan Williams

Elizabeth “Bubbles” Moore Caroline Werth Emma J. Sandin Floyd Sandlin

Trustees / Board of Directors TRUSTEES

BOARD OF DIRECTORS

Mrs. Tia Andrew, Hamilton Parish, Bermuda

Mrs. Patricia Lawrence, Westwood, MA

Ms. Sarah Bacon, Brooklyn, NY

Mrs. Henry Ledford, Big Creek, KY

Mrs. Andrea Begley, Hyden, KY Mrs. Heather Bernard, Hamilton, NY Gov. Steven Beshear, Lexington, KY Mrs. Betty Brown, Louisville, KY Mrs. Amy Pennington Brudnicki, Richmond, KY Dr. Timothy Bukowski, Chapel Hill, NC Dr. Wallace Campbell, Berea, KY Miss Anna Carey, Hyden, KY Mrs. Jean Chapin, Oldwick, NJ Dr. Holly Cheever, Voorheesville, NY Mrs. Lois Cheston, Topsfield, MA Mrs. Julia Breckinridge Davis, Winston-Salem, NC Mrs. John Dete, West Liberty, OH Mrs. Selby Ehrlich, Bedford, NY

Mrs. Marian Leibold, Cincinnati, OH Dr. Ruth Lubic, Washington, DC Mr. William Lubic, Washington DC

Chair Michael Carter, DNSc, DNP, Tumbling Shoals, AR Vice Chair Michael T. Rust, Louisville, KY Secretary Wallace Campbell, Ph.D., Berea, KY

Mr. Robert Montague, JD, Urbanna, VA

Treasurer

Mr. Wade Mountz, Louisville, KY

Emma Metcalf, RN, MSN, CPHQ, Louisville, KY

Ms. Judy Myers, Ph.D., RN, New Albany, IN Ms. Barbara Napier, Irvine, KY Ms. Sandra Napier, Stinnett, KY Dr. Spencer Noe, Lexington, KY Mr. Dean Osborne, Hyden, KY Mrs. Helen Rentch, Midway, KY Mrs. John Richardson, Washington, DC Mrs. Linda Roach, Lexington, KY Mrs. Georgia Rodes, Lexington, KY

Board Members Carlyle Carter, Evanston, IL Peter Coffin, Chair, Frontier Nursing Service, Inc. Foundation Chestnut Hill, MA Eunice (Kitty) Ernst, CNM, MPH, Perkiomenville, PA Nancy Hines, Shepherdsville, KY Jean Johnson, Ph.D., RN, FAAN, Cabin John, MD Phyllis Leppert, RN, CNM, MD, Ph.D., FACNM, Salt Lake City, UT Marcus Osborne, MBA, Bentonville, AR

Mrs. Robert Estill, Raleigh, NC

Mrs. Sandra Schreiber, Louisville, KY

Mrs. Noel Smith Fernandez, Pomona, NY

Mrs. Sherrie Rice Smith, Franklin, WI

Ms. Mary Ann Gill, Versailles, KY

Mrs. Austin Smithers, Lyme, NH

Mr. John Grandin, Chestnut Hill, MA

Mrs. Robert Steck, Arlington, MA

Dr. Joyce Fortney Hamberg, Southgate, KY

Mrs. Mary Clay Stites, Louisville, KY

Board Members Emeritus

Dr. Horace Henriques, Lyme, NH

Mr. Richard Sturgill, Paris, KY

John Foley, Lexington, KY

Ms. Mary Frazier Vaughan, Lexington, KY

Marion McCartney, CNM, FACNM, Washington, DC

Mr. & Mrs. John Hodge, Berwyn, PA Mrs. Robin Frentz Isaacs, Lincoln, MA Mrs. Rosemary Johnson, Versailles, KY Mrs. Mary Carol Joseph, Mayor, City of Hyden Ms. Deborah M. King, Westport, MA

Mrs. LouAnne Roberts Verrier, Austin, TX

Kerri Schuiling, Ph.D., CNM, FAAN, FACNM, Marquette, MI Peter A. Schwartz, MD, Wyomissing, PA Nancy Fugate Woods, Ph.D., RN, FAAN, Seattle, WA May Wykle, Ph.D., RN, FAAN, FGSA, Cleveland, OH

Kenneth J. Tuggle, JD, Louisville, KY

Dr. Patience White, Bethesda, MD Mr. Harvie Wilkinson, Lexington, KY Ms. Vaughda Wooten, Hyden, KY

Frontier Nursing University • Quarterly Bulletin 23

Board Member Spotlight: Kitty Ernst Kitty Ernst, FACNM, BS Ed, MPH, DSc (hon), has been a part of the FNU community since she first began her career as a midwife in 1951 with the Frontier Nursing Service (FNS). Now, as a member of FNU’s Board of Directors, Kitty’s work is focused on educating more midwives so that all women can have access to safe healthcare.

After serving as a nurse-midwife for several years, Kitty began to advocate for nurse-midwives to have a strong role in American healthcare, something she continues to do today. Over the course of her career, she has published valuable information defining the role of a nurse-midwife and even played a crucial role in the first accreditation of nurse-midwife programs in the United States.

Since Ernst’s work has been dedicated to midwifery, a path she only pursued because of Mary Breckinridge’s influence on her life, it’s natural that she’s an integral member of FNU’s Board of Directors. As Mary Breckinridge Chair of Midwifery at FNU, she is able to help promote the education of nurse-midwives at Frontier who will bring safe maternal healthcare to their patients.

Ernst chose to work for FNS because she was inspired by the work of founder Mary Breckinridge, who pioneered a workable, affordable system of birth and health care for mothers and families in the least accessible and most impoverished mountains of Southeast Kentucky. Not only did Mary Breckinridge lead Kitty to FNS, but she also led her down the path of midwifery.

Although Kitty is now hailed as one of the United States’ greatest proponents of midwifery education, her path to midwifery wasn’t straightforward. It wasn’t until she experienced the home birth of a strong mountain woman during her time as a student at FNS that Kitty realized how important midwifery is for the health of women and families. The work of Mary Breckinridge inspired her and helped her see the valuable role midwifery plays in the health of families. Because the midwives trained by Mary Breckinridge were able to have such a great impact on their community in Kentucky, Kitty knew that educating new nurse-midwives was essential to transforming health care not only for mothers but for their families as well.

“All healthcare begins with the care and education of the mother.”

-Kitty Ernst

“All healthcare begins with the care and education of the mother,” said Kitty, quoting one of the key beliefs of Frontier Nursing Service.

24 Frontier Nursing University • Quarterly Bulletin

There are so many enjoyable parts of her job that Ernst finds it hard to choose one favorite.

She has enjoyed seeing the growth and expansion of FNU over the years while still keeping tuition affordable. What is even more gratifying, however, is seeing how the dedication of faculty, staff, and leaders at FNU enables students to master nursing skills, pass their certifying exams, and eventually go on to work in rural and underserved areas just as Mary Breckinridge did.

Kitty is revered not only by FNU but by other institutions as well. Each year, the American College of Nurse-Midwives presents the Kitty Ernst Award to a midwife or women’s healthcare professional who has demonstrated creativity and innovation in their field.

FNU is forever grateful for Kitty and her long legacy of promoting midwifery education.

In honor of FNU’s 80th Anniversary, we are excited to announce FNU’s new “$.80 for 80” Campaign. We know how much you love FNU and believe in the vision put into action by Mary Breckinridge 80 years ago. We continue to advance her mission by preparing excellent leaders in primary care to serve all individuals with an emphasis on women and families in diverse, rural, and underserved populations. This is all made possible by your support!

Through the $.80 for 80 campaign, alumni and friends are encouraged to donate $.80 per day. That comes out to $24 per month. All donors pledging $.80 per day for 12 months ($288), will receive an exclusive “80th Anniversary lapel pin!

To make your pledge, please visit http://weblink.donorperfect. com/80thAnniversaryAlumniCampaign or contact alumniservices@frontier.edu. Thank you so much for your continued support and for representing FNU by providing outstanding healthcare in your communities every day!

Frontier Nursing University • Quarterly Bulletin 25

Do you have a new mailing or email address?

Please let us know. Simply email us at FNUnews@frontier.edu.

Thank you!

26 Frontier Nursing University • Quarterly Bulletin

P.O. Box 528 • 195 School Street Hyden, KY 41749 FNU@frontier.edu • 606.672.2312

Frontier.edu Our mission is to provide accessible nurse-midwifery and nurse practitioner education to prepare competent, entrepreneurial, ethical, and compassionate leaders in primary care to serve all individuals with an emphasis on women and families in diverse, rural, and underserved populations.