Jessica Bacon Answers the Call … From the White House

May 17, 2023 By Frontier Nursing University

When the White House calls seeking your expertise, it is a pretty good indication that you are doing something right. That is exactly what happened to Jessica Bacon, CNM, APRN, MSN, and her colleagues at Wentworth-Douglas Hospital in Dover, New Hampshire.

Among her duties in the hospital’s Women and Children’s Unit, Bacon is part of Seacoast STRENGTH, the multidisciplinary care team for pregnant people with substance use disorder. She and her colleagues, Katie White, RN, and Lindsay Ginter, Case Manager, met with Federal officials via Zoom to answer their questions about their approach to caring for pregnant people who have substance use disorder.

“As they were getting ready to roll out their recommendations for programming, they reached out to different hospitals that have programs for substance use and pregnancy just to talk about the barriers and what has been working well,” Bacon said of the hour-long meeting with the White House representatives. “They were just trying to gather ideas from different people. We discussed where we currently are at with our program and what our hopes are going forward.”

Their goals are ambitious but attainable, much like Bacon’s were growing up in Ludlow, Massachusetts. By the time she was in high school, she already knew she wanted to work in women’s healthcare. She went to nursing school and worked as a nurse for 12 years before graduating from Frontier Nursing University as a nurse-midwife in 2012.

Like the rest of the country, substance use is prevalent in New Hampshire, Bacon says. A sad fact that led to the creation of the Substance Use Disorder Team.

“It’s an example of something that is being developed out of need, unfortunately,” Bacon said. “In New Hampshire, we have a high rate of opioid use disorder. It’s especially concentrated in the area that we live and work in. The New Hampshire Maternal Mortality Review Committee recently cited that 62 percent of our maternal mortality is related to a drug overdose. In our area, it’s not really the postpartum hemorrhages and untreated hypertension that’s killing people. It’s a drug overdose, particularly seven to 12 months postpartum.”

The overwhelming data demonstrated the need, and Bacon and her colleagues began to develop a plan. With the support of the hospital administration, Seacoast STRENGTH became reality. The learning curve was steep, however.

“From precepting different students, I think that there is now some integration of substance use disorder into the midwifery programs, but it wasn’t a thing when I was in school, and the same was true for most of the providers here,” Bacon said. “We just kind of jumped in and learned everything that we could about it because we were having people present to us in withdrawal. Unfortunately, even though we had local prescribers of buprenorphine, a lot of them wouldn’t prescribe to people that were pregnant because they were concerned about the effect on the pregnancy. There is, in recent years, lots of data establishing that both methadone and buprenorphine are appropriate medications for opioid use disorder in pregnancy.”

The care provided is free of judgment and infused with compassion and a simple desire to help someone who is ill. Treating the immediate threat and establishing a level of trust are essential first steps toward long-term positive outcomes.

“We try our best to normalize it like any other chronic condition – just like people with diabetes need extra care or extra medications,” Bacon said. “This is a chronic disease.”

All patients are screened verbally when they present for alcohol or opioid use. With consent, they may also be drug tested. Bacon says those tests almost always indicate that the street drugs are being laced with any number of other drugs, such as meth, cocaine, fentanyl, and heroin.

“When we get these test results, it reveals that the drugs are contaminated,” Bacon said. “That’s what is contributing to a lot of the overdoses because you don’t know what you’re getting. It’s no longer a single substance in most cases. So, we have to keep in mind the model of risk or harm reduction, where anything we can do for them is better than them getting opioids off the street and having these lethal overdoses.”

There are many hurdles to keeping these patients off the street, starting with getting them to ask for help in the first place. Transportation, insurance, finances, and lack of trust are imposing hurdles. Bacon said the Unit treats between 40 and 50 patients with opioid disorder per year, dating back to 2017.

“Pregnancy seems to be a pretty motivating time for people,” Bacon said. “It’s a time when people want to make changes in their life, but it’s really hard. So it’s not uncommon to make contact with people three or four times before they are even willing to attempt medications. We are in the process of developing a program where people can come to us, and we will support them with initiation for either buprenorphine or methadone. With help of the hospital’s Substance Use Response Team, we have done a lot of training with our providers and nurses for trauma-informed care, motivational interviewing, and all things substance abuse related. With time, the staff has gotten really comfortable with the process.”

As one process is perfected, the next looms on the horizon. Transportation and childcare remain the most significant hurdles for most patients. The thought of having to go to obstetric appointments, recovery services, and their buprenorphine prescriber can be overwhelming.

“Our goal this year is to integrate that recovery care with prenatal care as well,” Bacon said, noting that they have applied for grants to support this goal. “We have a small team of us that are going to provide continuity of care for the prenatal care. They will be able to get their prenatal care and recovery services all at the same time. They are going to come once a week for a two-hour session. An hour of that will be group work with a curriculum where we discuss safety planning, relapse prevention, emotional regulation, and other similar topics. They also will attend classes such as childbirth education and breastfeeding. Included an hour where they can meet individually with me for prenatal care or their case manager to work on the social determinants of health and get the resources that they need.”

These types of projects and planning come naturally to Bacon, who is also the nursing practice specialist at Wentworth Douglas. She is responsible for being up to date on current evidence-based practice and working with her team to implement policies, procedures and programs as needed to fill gaps in care. Because of those responsibilities, Bacon came back to Frontier and is currently enrolled in the DNP program (Class 48).

“In this role as the nursing practice specialist, I’m doing a lot of quality improvement work, and I want to do it right,” Bacon said of her decision to pursue her DNP.

The decision to return to Frontier was just as easy as her initial choice to attend Frontier to become a certified nurse-midwife.

“The initial draw (to Frontier) was the ability to do the courses in my own community,” she said. “I had young kids, and I had a job here. Picking up and moving and going to a brick-and-mortar school was not feasible for me because there are none in my area. Frontier has been doing distance learning for a very long time, and they’ve worked out a lot of the kinks. I think now you’re seeing more and more institutions offer that as an option; they’re still having to work through a lot of those issues, whereas Frontier had done that work long before I got there. My experience there was great.”

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Alumni Spotlight: Nurse-Midwife Iniko Sallee Earning DNP To Educate

May 18, 2020 By Frontier Nursing University

Certified nurse-midwife (CNM) Iniko Sallee became a nurse-midwife to build deeper relationships with her patients, and now she is completing her Doctor of Nursing Practice (DNP) to educate others following in her footsteps.

Iniko graduated from Frontier Nursing University (FNU) in 2018 with her Master of Science in Nursing (MSN) degree (Class 148) with a specialty in nurse-midwifery. Prior to earning her MSN, she worked as a labor and delivery staff and charge nurse for 17 years.

“While I thoroughly enjoyed working with expectant moms and families as a nurse, I knew I wanted to develop deeper relationships with my patients before, during and after pregnancy,” said Iniko.

“I wanted to have more say in helping women and families formulate their birth preferences and assisting them in the reaching of their goals, and I wanted to catch babies.”

Iniko also has experience teaching, and she is currently enrolled in FNU’s DNP program to allow her to educate at a higher level.

“I have had the opportunity to educate through childbirth classes, as a nurse leader and as adjunct faculty for a nursing university. I have had wonderful teachers in my life who have assisted me through my education, and obtaining my DNP is a step toward educating practitioners in the future,” she said.

Her DNP studies have also paid off in her current role as a CNM at Baptist Health Lexington in Lexington, Ky.

“As a part of a quality improvement project for my DNP, I recently implemented a new process for educating, assessing and providing treatment and follow-up for perinatal depression and anxiety.”

FNU was an easy choice for Iniko due to its reputation, history and distance learning format. She said, “Frontier has a wonderful reputation and ranking in the nursing community. It has a rich history and great success rate in developing nurse-midwives and nurse practitioners. Being a part of a university and community birthed in Kentucky was a big draw for me, even while pursuing my degrees online worked best for me and my family.”

Iniko credits the FNU network with enhancing not only her studies but also her career. “Going from a nurse to a practitioner was a big step, and I have felt so supported through the transition. As a practicing nurse-midwife, I continue to network with current Frontier students, faculty and alumni.”

We are proud of Iniko for furthering her education not only to offer a deeper level of care to her patients, but also to pass her knowledge on by educating future nurse-midwives and nurse practitioners.

To find out more about any of FNU’s programs and offerings, visit Frontier.edu.

What is a Certified Nurse-Midwife (CNM)?

Certified Nurse-Midwives (CNMs) are educated in two disciplines: midwifery and nursing. They earn graduate degrees, complete a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME), and pass a national certification examination administered by the American Midwifery Certification Board (AMCB) to receive the professional designation of CNM. Certified Midwives (CMs) are educated in the discipline of midwifery. They earn graduate degrees, meet health and science education requirements, complete a midwifery education program accredited by ACME, and pass the same national certification examination as CNMs to receive the professional designation of CM.

COVID-19 Front Lines: Dee Polito Calms the Fears of Expectant Mothers

April 22, 2020 By Frontier Nursing University

The Frontier community is proud to have students and alumni serving on the front lines of the COVID-19 pandemic. Throughout the next few weeks, we are committed to sharing their stories in order to provide insight, hope and encouragement. Thank you to all the health care workers who are risking their own well-being daily to serve our nation. Click here to read more stories of courage and dedication.

Even in the best of times and conditions, expectant mothers understandably experience a range of emotions such as excitement, fear, joy and uncertainty. Now, many are facing an additional stress element in the form of the COVID-19 pandemic, and it’s a fear understood and, at times, shared by their providers.

“Each new day brings a heightened level of concern from our families and while we try to practice social distancing; birth is a very intimate process,” said Dolores (Dee) J. Polito, APRN, CNM, who is the Director and Chief Midwife at the University of Kentucky Midwife Clinic in Lexington, Ky.

“Mostly we are seeing high levels of anxiety among staff and patients both. It is difficult to maintain a calm demeanor when staff is anxious about exposure and to encourage staff to portray calmness to patients for their care is challenging. I work with an amazing team of CNMs (FNU graduates JoAnne B. Burris, APRN, CNM, Class 130 and Hayden Murrell Meza, APRN, CNM, Class 136, along with Chrissie Adams, CNM). They demonstrate strength and creativity and I am proud of their responsiveness, dedication and perseverance. They inspire me to be innovative and I wouldn’t want to be in a crisis with anyone else.”

Dee with FNU alumni Hayden, Chrissie and JoAnne

Dee, who received a certificate in midwifery from Frontier Nursing University (FNU) in 1997 and is certified by the American Midwifery Certification Board, offers both pregnancy support and non-pregnancy services at the UK Midwife Clinic. For women with healthy, normal pregnancies, the certified nurse-midwives provide care and guidance through the pregnancy, up to and including delivery.

In 2019, Dee completed the Substance Abuse and Mental Health Services Administration (SAMHSA) training to be able to prescribe Buprenorphine, allowing her “to create a midwifery-led centering model of group care for pregnancy in the setting of substance abuse with the support of medication-assisted therapy.”

The ability to understand and adjust to the needs of the women and families in her career has always been important, but never more critical than in the midst of the pandemic. Dee credits FNU with helping furnish her with the skills to face this challenge.

“FNU prepared me for my role as a leader and an advocate for women and families in their independent, community-based learning platform,” Dee said.

“When I was a student, we sent our assignments to our faculty by snail mail and it seemed innovative at the time. The innovation and creativity it took to translate midwifery education to a community-based model was unique at the time and those same traits were instilled into me as a student. Being innovative and creative is a requirement when faced with the challenges and uncertainty of the global health crisis for COVID-19.”

Part of that innovation for Dee and her team has been the implementation of Telehealth to reduce risk of exposure.

“I think it’s very important to preserve some normalcy and doing this project together – but separated – allowed my staff to be creative and have some fun . We have to remember that the work we do and the care we give cannot stop because of coronavirus. Women and families still seek our caring attitudes, our warmth and our friendliness. And they can count on a smile even if it’s under a mask,” said Dee.

“We are responding to many patient concerns about keeping their pregnancies healthy and safe and we are having to be creative in getting patients the care they need,” Dee said.

“Telehealth is teaching us that this may be a valuable tool in how we provide care. There have been wrinkles to iron out and we continue to learn how to make the experience better and how to meet all the requirements for appropriate and timely billing. Telehealth will be a part of our services going forward.”

Even though there is fear and uncertainty every day for Dee, her patients and her staff, Dee leads the way, understanding that she has been prepared to handle this challenge. Experience, training, education, innovation, and leadership are just some of the tools she has acquired throughout her career to give her the confidence to face the COVID-19 pandemic day after day.

“I was a student of Kitty Ernst,” Dee said. “She was my faculty for the Birth Center Course. She was perhaps the most influential force to prepare me for my role now.”

“During Midwifery Bound, Kitty met with a small group of students and talked to us about our journey to midwifery school. She asked, ‘What important thing have you done in your life?’. I responded that I hadn’t really done anything important in my life thus far. She asked, ‘Are you a mother?’ and I responded that I was indeed a mother. She exclaimed, ‘Then you have done the most important thing in the world. You are a mother.’”

“From then on,” Dee continued, “I felt empowered, inspired and motivated to achieve any goal I set for myself.”

What is a Certified Nurse-Midwife (CNM)?

COVID-19 Front Lines: Certified Nurse-Midwife Jennifer Scott

April 8, 2020 By frontieredu

The Frontier community is proud to have students and alumni serving on the frontlines of the COVID-19 pandemic. Throughout the next few weeks, we are committed to sharing their stories in order to provide insight, hope and encouragement. Thank you to all the health care workers who are risking their own well-being daily to serve our nation. Click here to read more stories of courage and dedication.

With the spread of the COVID-19 pandemic, Jennifer Scott, CNM, Class 75, realized that she needed to take additional steps to keep her patients safe. We recently shared a spotlight story on Jennifer, whose patient base is largely from a local Mennonite community in the Finger Lakes region of central New York. As the pandemic rose in severity, Jennifer temporarily closed her clinic and began seeing patients in their homes.

“We have temporarily closed our clinic,” Jennifer said, noting that she’s unable to do telehealth visits because her patients don’t have computers or cell phones.

“We are doing home visits because it is easier to isolate and wipe down our equipment between homes. This also keeps our clients from congregating in the waiting room. Many women will make appointments on the same day and share a ride. We are also only seeing clients who are higher risk or near term. For example, we’ve spaced our four-week visits out to five weeks and are doing more phone calls.”

Jennifer is from the Finger Lakes region and, after working as a full-scope midwife in a community hospital for seven years, she joined other colleagues to open Community Midwives in 2019. She has retained admitting privileges at the hospital, though the Mennonite community prefers home births.

“The reasons are multifaceted,” Jennifer said, noting that she and her fellow nurse-midwife at Community Midwives attend six to 10 births per month in the community of approximately 600 families.

“Many are farmers, have large families and don’t drive cars. In order to have a hospital birth they would need someone to take care of the farm, watch the children and would have to hire a driver to take them to the hospital in labor, possibly in the middle of the night. The closest maternity hospital is 30 to 45 minutes by car. Some are put off by hospital costs and length of stay. Others like the comfort of their own home. They feel safer emotionally to give birth in their own surroundings.”

Making her patients feel safe has become an additional challenge amid the COVID-19 pandemic. While the pandemic impacts this somewhat isolated community differently than other parts of the country, the fears are the same. The closing of schools and churches has limited primary sources of socialization, entertainment and information. Because the Mennonite community does not watch TV or listen to music, Jennifer shares news about the pandemic with the families she serves, printing off the latest information from the county and state health departments.

“Like everyone, they are worried for their families, stressed by the social restrictions and having to homeschool their children,” Jennifer said.

“The Mennonite community is very self reliant. They have stocks of canned and frozen produce from their own gardens and bake their own bread. They have fresh eggs and milk also. They may only go once a month to Walmart for other supplies so they are not as exposed to as many crowds.”

Jennifer, whose husband is also battling the COVID-19 pandemic as a physician in a local hospital, said she hopes the pandemic inspires others to choose nursing and medicine, just as she was inspired by her experiences as a Frontier Nursing University (FNU) student.

“FNU taught me to grab my saddlebag, get on my horse and ride up that mountain,” Jennifer said.

“It taught me that my calling is to care for the underserved, the vulnerable families, without hesitation. I’ve always believed the education at FNU has prepared me for anything I encounter in the workplace. I remember Kitty Ernst giving a talk at Frontier Bound that I paraphrased as ‘We only educate the strongest, most resilient nurses’.”

Like so many other FNU graduates leading the fight against the pandemic, Scott demonstrates that strength and resiliency every day.

What is a Certified Nurse-Midwife (CNM)?

Alumni Spotlight: Nurse-Midwife Jennifer Scott Serves Local Mennonite Community

April 2, 2020 By Frontier Nursing University

Frontier Nursing University (FNU) alumna Jennifer Scott, CNM, recently left her hospital job to co-found a home birth practice in her local Old Order Mennonite community. Located in the Finger Lakes region of central New York, Jennifer and her colleagues opened Community Midwives in March of last year, filling a gap in maternity care in the area.

In a typical week at Community Midwives, Jennifer spends one day in an open clinic providing prenatal care and other services to the women who visit. She spends the rest of her week making postpartum home visits and being on call 24/7 to conduct home births.

According to Jennifer, the Mennonite women are not opposed to hospital care, but home birth is their preference. Without motor vehicles, the 45-60 minute distance from the Mennonite community to the nearest hospital presents a great challenge, so nurse-midwives are a cultural necessity.

Community Midwives is a simple, self-sufficient organization. They draw their own labs, book their own appointments, and spend their time on rural farms – but they are making an impact.

“I finally feel that I am answering the call!” Jennifer said.

Although Jennifer enjoyed her time working in a hospital and is grateful for the experience she gained, she admits it did not bring the same level of fulfillment that her current career holds.

“At Frontier, we were led by the example of Mary Breckinridge, who worked for the good of those in need rather than for fame or fortune,” Jennifer said.

The longer Jennifer and her colleagues work in the Mennonite community, the more they have come to understand the value in Mary Breckinridge’s career model.

“We came to help the Mennonite women without knowing how much we would learn,” Jennifer said. “The women I work with experience birth as I have always felt it should be; they have faith in their bodies and lack the fear of birth that most American women have. I love what I do because of the strong women I serve.”

A 2012 alumna, Jennifer built strong relationships with fellow FNU nurse-midwives she admires. The bonds she made with these “sisters” have lasted long past graduation.

“I am still friends with so many of my fellow alumni and we are always here to support one another. As we continue to expand Community Midwives, I hope some of my Frontier sisters will be interested in working with us in this region. FNU leads the way in how nurse-midwives are perceived in this country, and as long as they continue with their strong work, I will always be proud to be a Frontier alumna,” Jennifer said.

Thank you, Jennifer, for following the example of Mary Breckinridge and filling a gap of care in your community!

What is a Certified Nurse-Midwife (CNM)?