Since its foundation in 1939, Frontier Nursing University (FNU) has adopted a mission of reaching rural, diverse and underserved populations. This mission is still being lived out today, where more than 80 FNU alumni are answering the call in Alaska. In the coming months, we will be highlighting several of these alumni who serve in our country’s most remote and unforgiving state.
Kristina Amundson, DNP, CNM, remembers vividly her days at FNU. Specifically, she recalls Kitty Ernst’s directive to the class: “Go forth and be a change.”
“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. The six-week, evidence-based course teaches families what to expect during pregnancy and childbirth. Early interest came largely from her own patients, but she hopes to expand it to a much wider audience, including fellow healthcare professionals in the Fairbanks area.
Amundson attends 60-70 births per year and estimates she has a patient population of 40-50 pregnant women in her care at any given 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.
“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.”
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.
“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.”
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 patients on Medicaid are put on 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 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.