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  • FNU President Featured in Leadership Today

    FNU President Featured in Leadership Today

    Frontier Nursing University President Dr. Brooke A. Flinders was recently named a recipient of Insight Into Academia magazine’s 2026 Trailblazer in Higher Education Award. This national honor recognizes senior leaders whose bold, innovations have advanced institutional excellence, strengthened community and connectedness, and created meaningful, measurable impact for students, employees, and the broader academic system.  Adam Mendler from Leadership Today reached out to Dr. Flinders to discuss leadership in higher education. Read the full interview below.  

     Adam: Thanks again for taking the time to share your advice. First things first, though, I am sure readers would love to learn more about you. How did you get here? What experiences, failures, setbacks, or challenges have been most instrumental to your growth?   

    Dr. Flinders: My path has been somewhat unconventional. I began as a registered nurse, working in long-term care, home visiting, and labor and delivery, then trained as a Certified Nurse-Midwife. I moved into academia through part-time clinical teaching and advanced from visiting professor to full professor before transitioning to administration. I served as department chair, associate dean, and associate provost. Nearly two years ago, I became president of the same graduate nursing university where I earned my master’s and doctorate. For me, having experience as a student, having experience as a clinician, having experience as a faculty member, having experience as a chair (and so on) has been most instrumental to my growth and my capacity for success. I have “been there”, so I can more fully understand the experiences and positions of others.  

       

    Adam: What would surprise people most about the role of a university president and how you allocate your time, energy, and focus?   

    Dr. Flinders: People are often surprised by how important accessibility is. Being approachable and authentic takes intention. While I strive not to micromanage, I spend significant time with faculty and staff myself. Building trust, understanding concerns, and supporting people are the most complex and most important parts of my role.  

       

    Adam: What are the biggest challenges you face as a leader in higher education today? How are you navigating them?   

    Dr. Flinders: Key challenges include potential enrollment concerns related to the demographic cliff, increasing external mandates, and, within healthcare, the growing demand for advanced practice nurses and nurse educators amid workforce shortages. I proactively address enrollment on an ongoing basis, navigate external pressures collaboratively with my executive team (one day at a time), and focus on strategic planning and continuous improvement to advance healthcare education and, ultimately, improve healthcare access, particularly for rural and underserved populations.  

       

    Adam: In your experience, what are the keys to managing change and leading through uncertainty?   

    Dr. Flinders: Staying calm, being patient, communicating clearly, and listening deeply are important. My nursing background helps me manage stress, coach through difficult moments, and act with integrity. I trust my judgment, adjust decisions as new information emerges, and remember that reactions to change are rarely personal.  

       

    Adam: What do you believe are the defining qualities of an effective leader?   

    Dr. Flinders: Being trustworthy, not just trusted. Effective leaders are steady, strategic, emotionally perceptive, and collaborative. They make difficult decisions, take responsibility for them, communicate transparently, and create shared vision by meaningfully engaging others.  

       

    Adam: How can leaders and aspiring leaders take their leadership skills to the next level?   

    Dr. Flinders: I lead with  what feels like a lot of common sense, but I should give myself credit for the extensive experience that makes it feel like that. That takes time. I’ve exposed myself to new ideas and approaches through every leadership development opportunity that has come my way. What I value a lot right now is dedicated time and space for reflection with an executive coach. If that time is not on my calendar, it will not happen. Aspiring leaders need opportunities to learn, the safety to make mistakes, and exposure to new ideas through coaching and development. It takes practice.  

       

    Adam: What do you believe are the most important skills needed to succeed in today’s and tomorrow’s workforce?   

    Dr. Flinders: Flexibility, agility, and a little confidence go a long way. The world and technology, in particular, are changing so quickly and so unpredictably that we can’t settle in and believe for a moment that we have it all figured out. We can’t. So, we must learn, grow, and shift continually.   

       

    Adam: What are your three best tips applicable to leaders in business, government, and education?   

    Dr. Flinders:   

    1. Take calculated risks and get comfortable being uncomfortable.  
    1. Seek trusted mentors inside and outside your field.  
    1. Build and support a strong leadership team, trust them fully, and share the credit.  

       

    Adam: What is the single best piece of advice you have ever received?   

    Dr. Flinders: I have received so much good advice over the years. I’ll share three pieces.   

      From my dad: “Don’t forget where you came from.”  

     From a faculty mentor: “Do what you want to do when you’re tenured.”   

    And from an administrative mentor, “You could run this place,” helping me see a possibility I hadn’t yet seen myself.  

       

    Adam: Is there anything else you would like to share? 

    Dr. Flinders: I would say that if you want to lead for your own benefit, you’ll probably be miserable. It won’t be worth it. It is very difficult work. I have found purpose and meaning in leading and supporting others. If I’m doing a great job as president, my team has what they need, their teams can thrive, and our students are well-served. I have the most rewarding, supportive role there is.    

  • Why Precept? Just Ask Jen Garate!

    Why Precept? Just Ask Jen Garate!

    Jen Garate, CNM (Class 104), was recently named the first midwifery manager at Banner Health, a healthcare system based in Arizona that operates 33 hospitals across six states. She is tasked with building the midwifery practice to be modeled at other Banner sites. 

    This undertaking begs the question: where does she find the time to be a preceptor, and why does she do it? Jen graciously provided the answers below. 

    Jen Garate, CNM

    Where are you from originally and when did you become interested in a career in healthcare? 

    Arizona, born and raised. I knew I wanted to be in healthcare since early childhood. My mom kept a paper from elementary school where I said I wanted to be a baby doctor when I grew up. 

    How did you hear about Frontier and what prompted you to come to Frontier? 

    When I decided to become a midwife, I did my research. Frontier stood out as the leader in midwifery education, flexibility, and reputation for preparing their students for independent practice on day one. 

    In 2025, a total of 1,475 FNU students worked with 4,208 preceptors, including 841 FNU alumni.

    Please describe your experience at Frontier. 

    While continuing to work full time as an L&D charge nurse, I attended FNU full time as well. My time with Frontier was far from easy. We lost loved ones, got married, and toured Europe for our honeymoon, all while keeping on track with the flexible FNU schedule. 

    Please describe your work history and current practice. 

    I knew the women being served in my community needed more options and support. I opened a private practice the day after I graduated in the same city I was born. I grew that practice from literally zero patients to the largest OB practice in our county. I was voted #1 medical provider. I consistently did the most births almost every month for the last two years I was in practice. This was a blessing and a curse: I had grown to a size not manageable by one CNM. At the time I was looking into my options, a midwife from a neighboring FQHC (Federally Qualified Health Center) asked if I would be interested in opening their newest clinic. I felt this was a sign and joined the FQHC, closing my practice just after five years, but bringing 100% of my current patients with me to the new clinic, over an hour away. I started at a new clinic, again with no patients, staff, or supplies. Over the course of the next six years, I grew that clinic to an efficient, evidence-based, highly sought out women’s health center. Most recently, I joined Banner Health as their first midwife manager, building their flagship midwifery service line. The plan is to grow this program and then repeat this success in Banner Health locations across the U.S. 

    How many students have you precepted? 

    I have not kept track. I took my first break from being a preceptor for nine months last year. Other than that small break, I have had a student almost every week since my second year of practice. 

    The average Frontier student needs three clinical sites to complete all required experiences. The need is great, and the competition for clinical sites is heavy.

    What prompted you to become a preceptor? 

    If we don’t teach the next generation, how will they ever become midwives? 

    What do you find rewarding about precepting? 

    Knowing that what I teach today will help mold their practice for years after they’ve graduated and moved on. 

    What did you not know about precepting until you started doing it? What concerns or doubts did you have? 

    It takes a lot of time, patience, and inner reflection and growth. It took a while before I felt “worthy” to teach someone else. Imposter syndrome is a hard battle to win. 

    What would you say to others who are unsure about precepting? 

    Do it. You had one. Return the favor, pass it forward. 

    What are your current and future career goals? 

    Building a midwifery service line that will be the foundation for midwifery practices across the country! 

    Why Become a Preceptor 

    • Help expand access to quality, compassionate care to diverse, 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 current topics. 
    • Promote your profession through the education and guidance of your future peers. 
    • Gain access to the latest clinical guidelines to stay current in practice. 
    • Earn a 10% discount on all non-matriculating courses at FNU. 

    “The student who was placed with me was very knowledgeable. I felt that she had adequate training prior to her clinical rotation with me. She was kind, compassionate, developed rapport, and was eager to learn.” 

    Contact Us

    To learn more about precepting at Frontier Nursing University, contact FNU’s Department of Clinical Outreach and Placement at ClinicalAdvising@frontier.edu. 

    BECOME A PRECEPTOR

    This is a story from the digital Frontier Nursing University Quarterly Bulletin • Winter 2026 

  • Graduate Spotlight: Dr. Julian Williams, DNP, FNP-C, enhances patient care and clinical leadership with a DNP

    Graduate Spotlight: Dr. Julian Williams, DNP, FNP-C, enhances patient care and clinical leadership with a DNP

    At the heart of Frontier Nursing University is a talented community of students, graduates, faculty, staff, Couriers and preceptors. Spotlight blogs feature members of our FNU community who are focused on the mission of educating nurse-midwives and nurse practitioners to work with all people, with an emphasis on rural and underserved communities. 

    Frontier Nursing University graduate Dr. Julian Williams, DNP, FNP-C, has built his career around expanding access to high-quality, patient-centered healthcare. He currently serves as Director for Ageless Men’s Health in Manhattan, a position that draws on his extensive experience in community health, clinical care, patient education and leadership. 

    Williams began his clinical training as a Family Nurse Practitioner (FNP), earning his Master of Science in Nursing (MSN) with an FNP specialty from Frontier in 2018. He said he was drawn to this work because it allows for a comprehensive, relationship-based approach to healthcare. Family medicine, he noted, is especially meaningful because of its focus on caring for patients across the lifespan, giving providers the opportunity to build lasting therapeutic relationships. 

    “I’ve always been interested in prevention, health education, men’s health, and empowering patients to make informed decisions about their health,” he said. “The FNP role combines clinical autonomy with a strong focus on patient advocacy, which aligns closely with my personal and professional values. It also allows me to treat the whole person, not just the disease, by considering lifestyle, environment, and psychosocial factors that influence health outcomes.”  

    Williams was born in Bridgeport, Connecticut, but spent much of his youth in North Carolina before relocating to New York City after college. Throughout his career, he has worked in community-based healthcare settings, caring for diverse patient populations, and addressing both acute and chronic medical needs. During the height of the COVID-19 pandemic, Williams was called upon by the Federal Emergency Management Agency (FEMA) to assist with disaster response at Coler Rehabilitation and Nursing Care Center in New York City. 

    The next phase of Williams’ professional development was to pursue his Doctor of Nursing Practice (DNP). The DNP strengthened his leadership skills, deepened his understanding of evidence-based practice, and gave him the tools to improve healthcare delivery at both the patient and system levels. 

    “I chose FNU because of its strong focus on preparing nurse leaders who can translate research into real-world clinical practice,” he said. “The program emphasized leadership, quality improvement and healthcare innovation, skills that are essential for clinicians who want to make meaningful changes within healthcare systems. The flexibility of the program also allowed me to continue practicing clinically while advancing my education.”  

    “The program emphasized leadership, quality improvement and healthcare innovation, skills that are essential for clinicians who want to make meaningful changes within healthcare systems. The flexibility of the program also allowed me to continue practicing clinically while advancing my education.”  

    Williams said earning his DNP allowed him to significantly enhance the way he approaches patient care and clinical leadership, improving his ability to critically evaluate research, implement evidence-based interventions, and lead quality improvement initiatives within clinical settings. 

    “In practice, this means I’m constantly looking for ways to optimize care delivery, improve patient outcomes, and ensure that treatment approaches are supported by the latest clinical evidence,” he said. “My DNP training at FNU has also helped me become a stronger leader, whether that involves mentoring clinicians, improving workflow processes, or implementing strategies that enhance patient engagement and long-term health outcomes.”  

    Williams leverages the knowledge and experience gained through earning his DNP in his role with Ageless Men’s Health, where he focuses on men’s health and hormone optimization, particularly testosterone replacement therapy.  

    Previously, he served as Medical Director at the Crown Heights site of Community Healthcare Network in Brooklyn, where he helped lead clinical teams and implement initiatives focused on improving quality of care, preventive services, and population health outcomes. He said many of his patients came from underserved communities and often faced barriers to care such as limited resources, chronic disease burdens, and social determinants that impact overall health. 

    “What I was most passionate about was building long-term relationships with patients and empowering them through education,” Dr. Williams said. “Helping patients understand their conditions, take ownership of their health, and see measurable improvements over time was incredibly rewarding. I also valued mentoring other clinicians and fostering a team culture focused on compassionate, evidence-based care.”  

    Williams said his advice to anyone considering a DNP is to pursue it if they are passionate about advancing both their clinical expertise and their leadership impact in healthcare. He said the degree is particularly valuable for clinicians who want to move beyond individual patient encounters and contribute to improving healthcare systems, policies, and outcomes. 

    “The DNP experience benefits professionals who are motivated, curious, and interested in translating research into practical improvements in patient care,” he said. “It’s also ideal for clinicians who aspire to leadership roles, academic positions, or advanced clinical practice. Most importantly, the journey requires commitment and discipline, but the knowledge, perspective, and professional growth that come from earning a DNP are incredibly rewarding.”  

    Thank you, Julian, for your dedication to advancing patient-centered care and representing FNU’s mission to care for underserved communities through compassionate, evidence-based practice and leadership.  

    To read more graduate stories, visit the FNU Alumni stories page. 

    An Update Regarding FNU’s DNP Program

    FNU’s online DNP Program is now open to more nurses! FNU is welcoming more master’s-prepared RNs than ever—including Clinical Nurse Specialists, Nurse Educators, and other APRNs—opening the door for more nurses to advance their impact and leadership in healthcare.   

    LEARN MORE
  • A Conversation with Janet Skeslien Charles, bestselling author of Miss Morgan’s Book Brigade 

    A Conversation with Janet Skeslien Charles, bestselling author of Miss Morgan’s Book Brigade 

    Authored By: Anne Z. Cockerham, PhD, CNM, WHNP-BC, CNE, FACNM, Associate Dean for Teaching Excellence and Innovation

    As a lover of historical fiction, it was a privilege to talk recently with Janet Skeslien Charles, bestselling author of Miss Morgan’s Book Brigade. Published in 2024, Miss Morgan’s Book Brigade is a dual-timeline historical fiction novel featuring Mary Breckinridge as a major character in the novel. 

    The 1918 portion of the novel is set in post-World War I France and features the work of the American Committee for Devastated France (known as CARD for its French acronym). Philanthropist Anne Morgan hired Jessie “Kit” Carson to establish children’s libraries to help rebuild French villages and morale after the war. Nurses performed other crucial work for CARD, and Mary Breckinridge provided leadership and nursing care to the people CARD served. 

    Having enjoyed Miss Morgan’s Book Brigade, especially the scenes featuring Mary Breckinridge, I jumped at the chance to ask Janet Skeslien Charles questions about her research and writing processes and more. Here is our conversation, lightly edited for length and clarity. 

    Anne Z. Cockerham: Thank you so much for taking the time to talk with me. 

    Janet Skeslien Charles: Thank you for reading the work. Mary Breckinridge is incredible. What she accomplished with the English, French, and Americans was amazing, especially how she brought that knowledge home and created the first comprehensive healthcare system in America. 

    AZC: I love historical antecedents and the ways that Mary Breckinridge’s experiences in France set her on a course for the rest of her career. 

    JSC: Yes. There was so much tragedy in her life, losing a husband and children. She could have just worn black for the rest of her life but instead, she dedicated her life to others. It’s inspiring. 

    AZC: I’m curious about the path that led you to include Mary Breckinridge so prominently in Miss Morgan’s Book Brigade. 

    JSC: As I did the research for the book, I discovered that she was an incredible person. She wanted to be a nurse, but at a time when her family and society expected her to get married rather than work. Her first husband died of appendicitis and then she divorced her other husband after losing her children. I was amazed at how she was able to pick up the pieces. Many of us would have been devastated, and those losses would have defined us. But she decided instead to help others and make sure that other women would not have the same losses that she experienced. 

    JSC: Something that is amazing to me about Mary Breckinridge was how important facts were for her. In France after World War I, she weighed the babies. Instead of saying, “I think they’re losing weight,” she had the facts, including babies’ weights over time. She used facts to reassure parents, and I found that inspiring. 

    AZC: She built on Florence Nightingale’s work as a statistician, didn’t she? 

    JSC: Yes, in some ways, today we’ve lost sight of the facts and of how important medicine and research are. 

    AZC: Mary Breckinridge is well-known in some circles and not in others. I’m curious if you have any thoughts about why that might be. 

    JSC: Women’s history is often set aside. When I watch Peter Jackson’s documentary, They Shall Not Grow Old, and other films about World War I, I’m always disappointed that they don’t feature women. They feature trenches. When we don’t see women in these major war documentaries, we don’t learn about them and it’s like they didn’t exist. 

    JSC: For the staff of the American Committee for Devastated France (known as CARDs), the work was arduous and dangerous. CARDs received the Croix de Guerre (War Cross) Medal for their courage under fire, working just a few miles from the front. In one instance, the Army asked the CARD chauffeurs to evacuate all villagers, thousands of them, even the ones debilitated by war fatigue. That’s why it’s important to remember women and to restore them to their proper place in history. 

    AZC: Miss Morgan’s Book Brigade is richly textured with major elements and small details about Mary Breckinridge, despite her CARD time not being as well-documented as her later years. One example of rich detail is “Breckie” as a nickname for Mary Breckinridge. What can you share about that? 

    JSC: The CARD staff used diminutives and nicknames for each other such as “Kit” for Jessie Carson, after Kit Carson the explorer. When Mary Breckinridge was in France, she was still using her married name of Thompson, so they called her “Thompy.” However, I didn’t want to feature her in the book as Thompy because after leaving France, she petitioned to take back the Breckinridge name rather than be known as Thompson. Breckie was her little boy who passed away and she loved him so much. I came up with this solution to still have a diminutive but not a name that she herself did not want. Those choices are what writing a novel is all about. 

    AZC: I appreciate how that decision conveys your respect for her. 

    JSC: Something else I wanted to convey was the friendships the CARD members had with each other, and nicknames were part of that. This is similar to military settings. In many ways, CARD was influenced by the military with their uniforms and protocols. Also, they were really there for each other. 

    JSC: The CARD experience helped Mary Breckinridge become more sure of herself and come into her own. We can see that in letters in the University of Kentucky collection that discuss how Mary Breckinridge and Jessie Carson dealt with a forward Frenchman. They did it with such grace and were actually worried about hurting his feelings. 

    AZC: What, if any, challenges did you experience as you applied the historical fiction genre to Mary Breckinridge? 

    JSC: For nonfiction, sticking to the facts is hard, because sometimes you don’t have all the material that you need. With historical fiction, you can connect the dots or you can create the dots. One area in which I was able to connect the dots was the friendship that developed between Mary Breckinridge and Kit Carson. I found some discussions in Wide Neighborhoods about Kit and then I found a census document that shows Jessie Carson working as a librarian at Wendover. 

    JSC: It was incredible to spend several years with Mary Breckinridge and to see what kind of person she was. I found that she prioritized putting other people at ease. For example, she went to a fancy Swiss boarding school and spoke French. But instead of communicating something like, “I speak 3 languages; I’m so intelligent,” she said, “I’m sure no girl ever spoke as badly as I did in 3 languages.” She wasn’t boastful even though she came from a wealthy and prominent family. 

    AZC: One of the aspects of your books that I enjoy is that place is at the heart of what you write about. I’m curious if you have any impressions of the place in which Mary Breckinridge did her later work, eastern Kentucky. If you were to write about eastern Kentucky, how would you address place there? 

    JSC: What comes to mind is the photo of the nurses on horseback, one of the most iconic photos I’ve ever seen. The terrain and transportation in eastern Kentucky are so different than what the CARD staff experienced in France. In France, they could go from place to place in motorized vehicles, even though the roads were destroyed and the roads damaged the tires. 

    JSC: By contrast, for the FNS in eastern Kentucky, the terrain was so rough they couldn’t get where they wanted to go by car. If the horse stepped wrong in the rocky terrain, they were in a lot of trouble. That speaks to how brave the women were, to be on horseback and even transport babies on horseback. You can feel the pride, power, and devotion. That kind of land shapes who we are. The FNS nurses were tough. I have so much respect for everyone involved in the FNS. 

    AZC: During your book tour for Miss Morgan’s Book Brigade, did any discussion about Mary Breckinridge come up from any of the participants? 

    JSC: People mentioned being impressed that the first comprehensive healthcare system in America started with a woman from Kentucky. On my book tour and doing Zoom talks, I show the stamp of Mary Breckinridge. Few people have their own stamp and it really is a badge of honor. 

    JSC: When they see the stamp and they see the nurses on horseback, they’re surprised to learn about the history. It’s important for people to know that the mortality rates were lower in Kentucky, where she worked, than the national rates at the time. It’s incredible to think about that rural area thriving, thanks to Mary Breckinridge. We can still learn a lot from her today, about the transformational power of learning internationally and sharing our knowledge. 

    AZC: Was the juxtaposition of librarians and nurses purposeful in Miss Morgan’s Book Brigade? 

    JSC: The only character I knew when I first started the book was Jessie Carson. Then to learn about Mary Breckinridge and the impact that she had not only in France, but in the United States, was incredible. That’s what I love about writing and reading, is how much you learn. 

    JSC: Teachers, nurses, and librarians are feminized professions, and they don’t earn as much as some other professions. But another way to look at it is they’re in charge of what we learn and how we feel. Think about how many lives they change for the better, and that is powerful. 

    AZC: I want to ask about your latest book, The Parisian Chapter, the third book in the trilogy. What can you tell us about that book? 

    JSC: It will be published May 5, 2026, but it’s already out as an audiobook, recorded in 11 voices. The book includes Lily from The Paris Library. It’s set in about 1995 so it’s a continuation of the other books but can be read as a standalone. I had been thinking about institutions like Frontier Nursing University and the American Library in Paris. The institutions are what we make them. Many people work together and put their hearts and souls into them so others can enjoy them and learn. 

    JSC: In addition to The Parisian Chapter coming in May, one of my favorite things is my monthly newsletter where I write about the different CARD staff. I have photos, because the Réunion des Musées Nationaux, the national museum system in France, has amazing photos of the CARD staff but they aren’t easily accessible online. I paid for the right to use about 150 photos on my website. In my newsletter, I focus on a theme like nurses, farming, or librarians, and every month I write something about the CARD staff. I find so much pleasure in writing a short piece because novels take me 10 years, but a newsletter article takes me a couple months. 

    AZC: Is there anything else we haven’t talked about that you want readers to know about Mary Breckinridge’s story? 

    JSC: I want people to know about her time in France. She had so many interesting chapters in her life. I’m excited that people who might not be as familiar with Mary Breckinridge’s French chapter will get to know about her work there. 

    AZC: It’s been a real pleasure to talk with you. Thank you! 

    This piece was originally published in the Winter 2026 Quarterly Bulletin.

  • The Unsung Heroes of the Frontier Nursing Service: The Horses 

    The Unsung Heroes of the Frontier Nursing Service: The Horses 

    Recognition and Care of the Horses 

    The nurses of the Frontier Nursing Service (FNS) have been widely celebrated for their commitment and courage in providing nursing and midwifery services in some of the most rugged, remote, and impoverished areas of southeastern Kentucky. However, much less has been written about the nurses’ partners in service, their horses. With almost no roads in the FNS service area, the nurses relied on their horses to navigate a network of rugged mountain trails to reach their patients. Traversing those isolated trails in challenging weather, day and night, required close collaboration between the nurse and her horse. The horses played an essential role in enabling the nurses to get to their patients and transport people in need to urgent services. 

    Although stories of the FNS nurses often overshadow the role of the horses, the nurses knew that the horses were essential and treated their beloved equines with great care and respect. Beyond providing transportation in a place where vehicles could not travel, the horse served as the nurse’s companion and partner in her work and was often the only company the nurse had for long stretches of time. 

    The FNS needed horses with the stamina to glide smoothly and quickly for long periods of time through the mountain trails. They selected naturally gaited horses such as the Tennessee Walking Horse because they could be trained to use a running walk, often described as a smooth, gliding walk. The smooth walk was necessary to protect the medical supplies in the saddlebags and provide the most comfortable ride for both the nurse and the horse, who often spent hours a day on the trail. The smooth ride was particularly important when the nurses had to carry an infant or child on their horse, and certain horses would “settle” and move even more quietly whenever a child was in the saddle with a nurse. The running walk was also faster than the typical walk, which was important since many families lived miles away from the nursing center and when there was a woman in labor or a serious illness or injury, the nurses had to travel quickly. 

    One of the best examples of the nurses’ love of their horses was Mary Breckinridge. Although she had broken her back while rolling off a runaway horse, she returned to riding when able. Her horse, Babbette, was well known for her ability to walk smoothly carrying a child or when carrying Mary Breckinridge after she recovered from her injuries. Breckinridge wrote that her back would give out after three hours in the saddle and she would tell Babbette, “The back has crashed, take it easy,” and her horse would immediately switch to a gentle walk. 

    FNS nurses dressed in uniform sit on horses, lined up side by side in a misty forest with bare trees and a rocky ground.

    Although the nurses guided the horses to where they needed to go, the horses knew their area, and the nurses had been taught that if they were ever lost, they should loosen their hold on the reins and let the horse “have its head,” and the horse would take them home. The nurses were also closely tuned into their horse’s senses. If a horse stopped on the trail, the nurse knew that it sensed danger such as a snake, a stranger, smoke, an odd odor, or even something that was out of the ordinary. Whenever this happened, the nurse knew to proceed with caution or turn around and take another trail. 

    In addition to carrying nurses and supplies to where they were needed, the horses also had to wait while the nurse made her visits. Waiting while tied to a rail is difficult for horses for any length of time. Indeed, there are several iconic FNS photos of a horse tied to a rail labeled “Waiting.” Although most visits were relatively short, when the nurse was attending a labor and birth or a serious illness or injury, the wait for the horses could be hours. Families always cared for the nurse’s horse, providing fresh water and oats, but the horse still had to wait for its warm, comfortable stable and regular feed. Some of the horses knew that when they heard a baby cry, that meant they would be going home soon. At one birth, a horse named Commando was tied near the open window of a mountain home and when the baby cried, he put his head through the window and “whinnied joyfully.” But the nurse’s work was not done when the baby arrived. After a birth, the nurse had to wait to make sure that both the mother and baby were doing well and then clean and repack her supplies in the saddlebags. When the nurse’s work was done, she would mount her horse and head for home, where she would unsaddle her horse, brush and rub it down, feed it, and secure it in its stable for a well-earned rest. 

    The horses often faced significant risks in their service. Trails were ungroomed, so the ground was uneven with rocks and tree roots, and some had precipitous drop-offs. The horses also endured harsh conditions such as snow and ice, which sometimes required the use of “ice nails” in the horse’s shoes for traction. The ice nails did not hurt the horses; they stuck out of the horseshoe, enabling the horse to get better traction. One midwifery student described the experience of following her supervisor to attend a birth on a moonless, cold winter night when the only thing she could see was the sparks from her supervisor’s horse’s ice nails. The horses also had to ford rivers and occasionally encountered quicksand near the riverbanks. One of the trails was so steep that after a long climb up the mountain, the horse had to sit back on its haunches and slide down the trail on the other side. This maneuver was incredibly difficult for a horse and required a skilled rider and a well-trained, trusting horse. 

    Horses were well cared for by many staff members. The FNS couriers provided most of the routine care of the horses. Farriers cared for the horses’ hooves and replaced horseshoes. Many of the local people had extensive knowledge of caring for horses. Although few veterinarians were nearby, they could be consulted by telegram, letter, and later telephone. Occasionally, horses had to be cared for by their nurse, especially when out on the trail or at the remote district nursing centers. When possible, the nurses sought consultation with someone who had veterinary expertise to provide a plan of care for the horse. But if no consultation was available, the nurses treated the horses using the therapies and medications designed for their human patients and improvised as needed. 

    How the Horses Cared for the Nurses 

    Horses were assigned to each of the nurses. Mary Breckinridge personally oversaw the naming of horses and their assignment to individual nurses and staff members. The decision of which horse was assigned to which nurse was based on the nurse’s skill as a rider, her personality, and the horse’s personality. A horse assigned to a nurse was generally a permanent assignment so that over time, the horse and the nurse developed a deep, trusting relationship and knew each other’s signals and habits. 

    In addition to safe transportation, the horses also provided comfort to the nurses. Horses are known for their calming and therapeutic presence, and that quiet, calm presence was often needed after the nurse managed a difficult labor and birth, a serious illness or injury, or a death. The nurses almost always worked alone, providing the best possible care for a patient and supporting the family through the event. After a difficult encounter, the nurses had no colleagues nearby to talk to and no way to call a friend. But they had their horse. It must have been a tremendous comfort to be able to complete their work and come out and mount their warm, strong, calm horse to go home; it was the nurse’s turn to depend on someone else. 

    The horses also had to be a comfort for the nurses when they were riding alone, especially at night. Although no person ever harmed a FNS nurse, and a family member almost always accompanied the nurse at night, sometimes the nurse had to ride ahead of the family member in an emergency or ride alone if the person summoning the nurse did not have a horse. Some of the homes were hours away, so the journey was long. The darkness and quiet of the mountain trails had to be terribly lonely for the nurses, and the size, strength, and warmth of the nurse’s horse served as far more than transport. 

    Legacy of the Horses 

    Although horses are no longer part of Frontier Nursing University’s daily work, their contribution to the FNS and the university endures, and the nurse on horseback remains at the center of Frontier Nursing University’s logo. The nurse on horseback symbolizes the bravery and determination to reach patients and provide excellent care regardless of the circumstances —  qualities that we value to this day. 

    Through a century of transformation of the original nursing service into a university, the logo remains unchanged because it depicts the innovation of using nurses with advanced training and horses who could safely move the nurses to where healthcare was needed. The image of the nurse and horse moving together demonstrates the FNS/FNU commitment to finding innovative methods of serving people in need and educating nurses who can meet those needs, regardless of where they live. 

    Editor’s Note: In 2025, we celebrated the 100th anniversary of the forming of the Frontier Nursing Service. We shared many of the stories of the people and events that framed Frontier’s history and led the university to where it is today. Among the many lessons we learned from these stories was that we have many more to tell. Three FNU faculty members suggested the idea of a standing history column in the Quarterly Bulletin and graciously agreed to share their knowledge and expertise in writing these informative and engaging stories that are forever part of the fabric of FNU. 

    This piece was originally authored by the following FNU faculty members in the Winter 2026 Quarterly Bulletin:
    Janet L. Engstrom, PhD, APRN, CNM, WHNP-BC, CNE 
    Joanne M. Keefe, DNP, MPH, APRN, FNP-c, CNE 
    Anne Z. Cockerham, PhD, APRN, CNM, WHNP-BC, CNE 

  • Women’s Health Nurse Practitioners (WHNPs) Strengthen Care and Access in Communities

    Women’s Health Nurse Practitioners (WHNPs) Strengthen Care and Access in Communities

    Many rural and underserved communities have limited access to obstetric care, which often means fewer Women’s Health Nurse Practitioners (WHNPs) practicing in those areas. This gap creates an opportunity for nurses who want to influence health care outcomes in their communities with a focus on women’s health.  
     
    WHNPs are advanced practice nurses who specialize in comprehensive, continuous health care for women across the lifespan. With a specialization in women’s health, nurse practitioners can expand access to routine and preventative care closer to home, reducing barriers that often cause women to delay or go without care. WHNPs also provide compassionate care with an understanding of the personal, cultural, and social factors that shape a woman’s health decisions.  
     
    The scope of a WHNP’s practice includes well-woman visits, primary care, reproductive and gynecologic care, and prenatal and postpartum services. In addition, WHNPs emphasize health promotion, disease prevention, patient education, and shared decision-making. Their responsibilities include routine wellness exams, menopause management, prescribing contraception, and diagnosing and treating gynecologic and other conditions. WHNP practice can include procedures like ultrasound, biopsy, and contraceptive insertion. WHNPs practice in a wide variety of settings, including OB-GYN offices, community health centers, hospitals, private practices, and more. Specialty roles of the WHNP include infertility, pelvic pain, sexual health, gynecologic oncology, gender-related care, and maternal-fetal medicine. 

    female provider with long brown hair listening to female patient's heart.

    According to a 2024 study published in the Journal of Perinatal & Neonatal Nursing, there are approximately 13,000 board-certified WHNPs in the United States. While this is meaningful progress, it falls short of meeting national demand. The American Association of Nurse Practitioners (AANP) reports that only about 2 percent of licensed nurse practitioners nationwide specialize primarily in women’s health. 
     
    Given the scope, complexity, and growing demand for women’s health care services, more WHNPs are needed in the United States for several key reasons: 

    • Continuity of care – Relationship-based care is essential to positive health outcomes. WHNPs are uniquely positioned to care for patients across the lifespan, from adolescence and pregnancy to menopause and beyond. This continuity fosters trust and leads to better care plans. With earlier detection of health concerns, women can experience better long-term outcomes. 
    • Maternal health outcomes – Maternal mortality rates and disparities in the United States remain deeply concerning. WHNPs are essential partners in improving maternal health outcomes through preventive care, education, and ongoing clinical support. 
    • Complexity of reproductive health care – As access to reproductive health care becomes increasingly complex and constrained, the full-scope role of the WHNP has never been more critical. WHNPs provide comprehensive, patient-centered care and serve as advocates within their communities. 

    How to Become a WHNP with an MSN or PGC 

    Meeting this growing demand requires accessible, high-quality educational pathways for future WHNPs. Frontier Nursing University (FNU) offers a graduate Women’s Health Nurse Practitioner specialty track that can be pursued full– or part-time while completing a Master of Science in Nursing or a Post-Graduate Certificate. Students also have the option to pursue a Doctor of Nursing Practice at FNU. 
     
    Frontier’s flexible online format allows students to complete coursework in their home communities while building a larger network with peers, faculty, and alumni. Students often point to the faculty’s consistent presence and support as a hallmark of their FNU experience.  
     
    Following completion of their didactic coursework, students gain hands-on clinical experience working alongside preceptors. FNU has a dedicated clinical outreach and placement team to assist students in identifying potential clinical sites.  
     
    Take the Next Step Toward Becoming a WHNP 

    Ready to take the next step in your nursing career? A Women’s Health Nurse Practitioner MSN can open the door to new opportunities and meaningful impact. At FNU, WHNP students are equipped to provide evidence-based care for women throughout every stage of life, supported by real-world clinical training and strong support from the FNU community. 

    To learn more about the online WHNP specialty program at Frontier Nursing University, click here. 

    To explore all Frontier Nursing University degrees and specialties, click here. 

  • Graduate Spotlight: Caroline Riegel catches first baby born on U.S. soil in 2026 

    Graduate Spotlight: Caroline Riegel catches first baby born on U.S. soil in 2026 

    At the heart of Frontier Nursing University is a talented community of students, graduates, faculty, staff, Couriers and preceptors. Spotlight blogs feature members of our FNU community who are focused on the mission of educating nurse-midwives and nurse practitioners to work with all people, with an emphasis on rural and underserved communities. 

    Frontier Nursing University (FNU) graduate Caroline Riegel, MSN, APRN, CNM, RNC-OB, C-EFM, had a truly once-in-a-lifetime experience to kick off 2026: delivering the first baby born on United States soil in the new year. 

    A resident of the Northern Mariana Islands, a U.S. Commonwealth, Riegel helped welcome the baby at 4:09 a.m. Chamorro Standard Time. Back on the East Coast, the clock read 1:09 p.m. on Dec. 31, underscoring just how early her New Year began. 

    “I will forever have bragging rights to catching the first baby born on U.S. soil in 2026, and I look forward to pulling that out as a conversation topic at parties,” Riegel said.  

    Riegel has served as a nurse-midwife with the Commonwealth Healthcare Corporation in the Northern Mariana Islands since 2023 and currently holds the role of Midwife Co-Chair for the Obstetrics Department. She earned the hospital’s “most babies caught” honor in both 2024 and 2025. In fact, she also delivered the first baby born at the hospital in 2025.  

    “2026 was especially exciting because I caught the very first baby to be born on U.S. soil, beating Guam,” she explained.  

    At Commonwealth Healthcare, Riegel cares for rural and underserved patients across the Northern Mariana Islands, a remote U.S. Commonwealth made up of a 14-island chain. While the southern islands of Saipan, Tinian, and Rota are the most populated, the majority of residents live on Saipan, home to the Commonwealth’s only inpatient hospital. Riegel noted that many of her patients rely on Medicaid, while others are uninsured due to their work-visa status. 

    In addition to her role as a hospitalist in the Labor & Delivery Unit, Riegel provides full-scope care at the hospital-based Women’s Clinic, serving patients from menarche through menopause. Her patient population reflects the diversity of the islands, with approximately 30% identifying as Indigenous Chamorro and Carolinian islanders, 30% Filipina, 20% Southeast Asian—including Chinese, Japanese, and Korean—and 20% of mixed heritage or other backgrounds. Riegel provides comprehensive well-woman gynecologic care, along with prenatal, intrapartum, and postpartum services for the local pregnant population. The hospital delivers approximately 500 babies each year. 

    “My favorite part will always be the moment at birth when the baby takes his/her first cry and the parents get to meet their new baby,” she said.  

    Riegel is also involved in the indigenous-based Latte Group Prenatal Care program, launched last year by her midwife colleague and fellow FNU graduate, Corie Parada. The program takes its name from the ancient Latte stones, massive pillars once used by the Chamorro people to support their homes, and reflects a culturally grounded approach to prenatal care.  

    In addition, Riegel serves as chair of the hospital’s STEPS team as part of the CHAMPS National initiative, a collaborative effort led by the Centers for Disease Control and Prevention and the Center for Health Equity, Education, and Research at Boston Medical Center. The initiative works to strengthen maternal and child health practices nationwide by supporting 100 hospitals. Through participation in CHAMPS, the hospital has significantly increased the number of families able to experience an uninterrupted “Golden Hour” after birth and has improved breastfeeding initiation rates, Riegel said. 

    Beyond her clinical work, Riegel is deeply committed to education. She serves as an adjunct instructor in the nursing program at Northern Marianas College, where she teaches skills lab and clinicals for the Maternal Child Health course. Riegel has also supported the next generation of midwives by serving as a preceptor for a Frontier nurse-midwifery student from October 2022 through January 2023. 

    Riegel earned her Master of Science in Nursing (MSN) in Nurse-Midwifery at Frontier in 2020 and is currently pursuing a Doctor of Nursing Practice (DNP), with plans to graduate in March 2027. 

    After graduating from nursing school in 2015, Riegel began her career as a Labor & Delivery nurse at a large hospital in the metro Atlanta area. She worked alongside several provider groups that included midwives, an experience she credits with inspiring her path into midwifery. Among those who influenced her were FNU graduates, Dr. Corie Abrams and Dr. Amanda Zimmerman. 

    Riegel said she ultimately chose to pursue her MSN at FNU for a combination of reasons, including the clinical skill and professionalism she observed in FNU graduates, the distance education model, and the institution’s values and ethos. 

    “Once I learned more about Mary Breckinridge and the Frontier Nursing Service, I realized that I held similar values in providing care in rural and underserved environments,” she said.  

    After earning her MSN, Riegel worked as a nurse-midwife for Geisinger Health System in Pennsylvania from 2021 to 2023 before taking on her current role in Saipan. She said when applying for both positions, she was recruited and interviewed by FNU graduates.  

    “I felt confident and assured in accepting each position knowing that I would be working with midwives who had been through the same rigorous program,” she said.  

    Riegel said she remains connected to the FNU community through social media. 

    “We still circle-up together for a midwife in need, and that’s a beautiful thing,” she said.  

    Riegel said she encourages those interested in becoming a nurse-midwife to be prepared to network extensively, advocate for their salary and benefits, and remain open to relocating in order to find the right opportunity. 

    “Midwifery is a lifestyle and you have to have a passion for it,” she said. “Sleepless nights, crazy schedules, and sometimes challenging outcomes are very much a reality.”  

    Outside of her professional work and studies, Riegel is deeply committed to animal welfare, with a particular focus on trap-neuter-release (TNR) efforts and cat rehabilitation on the island of Saipan. With no permanent veterinarian on the island, she described the stray cat and dog situation as “dire.” Since relocating to Saipan, Riegel has helped spay and neuter more than 40 cats and has placed 20 kittens into adoptive homes. She currently cares for two indoor cats and seven outdoor cats. 

    Riegel also enjoys traveling internationally, taking advantage of her location in the Western Pacific to explore destinations such as Japan, Korea, Hong Kong, Macau, Singapore, and Malaysia. 

    Thank you, Caroline, for the care, passion, and leadership you bring to your patients, your community, and the global midwifery profession. 

    To read more graduate stories, visit the FNU Alumni stories page. 

  • Family Nurse Practitioners Can Chart Their Own Course in Health Care 

    Family Nurse Practitioners Can Chart Their Own Course in Health Care 

    In communities across the country, access to quality care is dependent on a highly skilled, trusted provider: the Family Nurse Practitioner (FNP). Serving patients across the lifespan, FNPs are advanced practice registered nurses who provide comprehensive, patient-centered care to individuals and families.  

    For health care professionals, becoming an FNP opens the door to a wide range of practice settings, patient populations, and focus areas. FNPs provide ongoing, comprehensive care in primary care clinics and private practices; serve as essential providers in rural and frontier health clinics; and work within hospital and health system settings, including outpatient clinics and collaborative care teams. Many FNPs also practice in community health centers caring for underserved populations; deliver care through telehealth and virtual platforms; and support older adults in assisted living and skilled nursing facilities. 

    While grounded in primary care, many FNPs pursue specialized areas of interest that allow them to shape their careers around their passions. These areas may include chronic disease management, preventive and wellness care, women’s and men’s health, geriatric care, behavioral and mental health, and population-focused care initiatives. Because of their broad training, FNPs may serve infants, children, adolescents, adults, and older adults, as well as families and multigenerational households. 

    Whether serving as a primary care provider in a rural clinic, leading a community health initiative, or launching an independent practice, Family Nurse Practitioners play a vital role in improving access to high-quality, patient-centered care. 

     Frontier Nursing University (FNU) has been at the forefront of family nursing education since introducing the first FNP program in the United States in 1970. The FNP curriculum is built on a strong academic and clinical foundation and is designed to develop not only skilled practitioners, but also healthcare leaders and entrepreneurs. 

    “Our graduates are well-prepared clinicians who are improving health care across the country,” said Audra Cave, DNP, FNP-BC, Department Chair of Frontier’s Department of Family Nursing. “Frontier students gain firsthand insight into the needs of their communities and learn the skills necessary to start their own practices, if that’s the path they choose.”

    FNU’s accredited community-based, distance-learning FNP program offers affordable tuition, flexible online coursework, supportive faculty and staff, and dedicated clinical placement services. Frontier graduates consistently excel on the national certification exams administered by the American Academy of Nurse Practitioners (AANP) and the American Nurses Credentialing Center (ANCC). In 2025, 99% of FNP MSN graduates and 100% of FNP PGC graduates passed the AANP exam, while 100% of both FNP MSN and PGC graduates passed the ANCC exam in 2024 — far surpassing the national pass rate of 83% recorded for both exams in 2024.  

    Frontier students can enroll full– or part-time and complete 100 percent of their coursework online, with clinical practicums carried out in their own communities. Before diving into didactic and clinical work, students come together for two brief on-campus immersion experiences designed to help them connect with peers and faculty and build a support network that carries them through the program. After earning an MSN, graduates may continue to complete a Doctor of Nursing Practice (DNP) at FNU with just 30 additional credit hours. 

    To learn more about FNU’s online FNP program, visit frontier.edu/family-nurse-practitioner.  

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