Alaska | Frontier Nursing University

Alaska Spotlight: Karolina Priebe

December 19, 2019 By frontieredu

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.

Karolina Priebe, DNP, ANP, FNP, Class 17 is the final alumna featured in our Alaska Spotlight series. She is a family nurse practitioner at Solstice Medicine and Wellness in Fairbanks.

Fairbanks represents the last chance for medical care for many Alaskans living in the extreme northeast regions of the state.

“We are isolated from other areas of Alaska,” said Karolina. “We are really the northernmost city in northeast Alaska in terms of access to healthcare. We cover thousands of miles of the area.”

Born and raised in Poland, Karolina’s family moved to Chicago when she was 16. She eventually became a U.S. citizen and served as a medic in the military where she met her husband. His last station before retiring was Fairbanks in 2015. They fell in love with the community and continue to make their home there.

At Solstice Medicine and Wellness clinic, Karolina 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,” Karolina said of the population made famous by the ‘Alaskan Bush People’ television series. “In summer they get to us via boat or four wheeler, and in the wintertime many travel by snow machine 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, resulting in a gap that Karolina is trying to fill.

Noting a significant issue with obesity in her patient population, Karolina launched an obesity program in August 2018. She devotes approximately half her time providing primary care and the other half on the 60-80 people in the obesity program.

“Nobody is doing obesity management. In primary care, there’s no time to address that,” Karolina said. “Weight management is built into my work schedule for patients interested in medical weight loss. I’m treating chronic conditions such as diabetes and 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. Karolina 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,” Karolina said. “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, Karolina 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,” Karolina said. “There is a unity of the community in Fairbanks and that’s why we stayed here.”

Another challenge facing the Fairbanks community is the limited amount of specialized care, so Karolina 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,” Karolina said. “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.”

Karolina 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,” Karolina said. “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,” Karolina continued. “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 patients but their families as well.”

Thank you to Karolina, Kristina Amundson, David Moore and Holly Fisk who along with many other FNU alumni are answering the call to serve the underserved in Alaska.

Alaska Spotlight: Holly Fisk

November 25, 2019 By frontieredu

Holly Fisk, MSN, FNP, ONC, Class 142 is a family nurse practitioner in Anchorage, Alaska where she was born and raised. On November 30, 2018, when a magnitude 7.1 earthquake hit south-central Alaska, her center’s lobby became a triage center.

“That’s the Alaskan way,” Holly said 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.”

Holly and her team at Southcentral Foundation’s Anchorage Native Primary Care Center helped 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, Holly’s clinic serves patients from extremely remote areas, some of which are only 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 more than 160,000 Alaska Native people. The health care provided at Holly’s clinic is prepaid via this system.

“We call our patients ‘customer-owners’,” Holly said, 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. Holly 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.

Holly, 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,” Holly said. “We have every specialty, but they might come in from another city once a month.”

The lack of access to specialty care often results in exorbitant costs of care, which acts as a barrier for many. Some patients go to Seattle instead, finding it more affordable even with flight and hotel costs.

According to Holly, her time studying at FNU helped prepare her for the challenges of working with a rural and remote population. 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,” said 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 patients is mental healthcare.

“The biggest need is behavioral health services,” Holly said. “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.”

Holly 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, and they have started offering extended appointment times.

“Alaskan Native people emphasize relationships, so we provide very relationship-based care,” Holly said. “Most appointment times are 30 minutes. I love that about this place.”

Holly’s experience with FNU played a significant role in preparing her for her current career. “FNU did a great job in preparing me for the more holistic and relationship-based kind of care that we do here,” she said.

Holly 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 excellent same-day access,” Holly said. “We keep appointment times open for those types of urgent situations. That’s what we do. It’s the Alaskan spirit.”

Alaska Spotlight: Kristina Amundson

September 19, 2019 By frontieredu

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.

Alaska Spotlight: Karolina Priebe

Alaska Spotlight: Holly Fisk

Alaska Spotlight: Kristina Amundson

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