Building Leadership Skills Through a Doctor of Nursing Practice Degree

November 20, 2025 By Frontier Nursing University

As today’s healthcare professionals take on more responsibility and advocate for system-wide improvements, leadership development becomes a cornerstone of advanced nursing education. Earning a Doctor of Nursing Practice (DNP) degree is one of the most effective ways to build the leadership skills necessary to drive meaningful change in healthcare settings and beyond.

Wherever you are in your nursing journey, pursuing a DNP can equip you with the tools to step confidently into executive and educational roles.

Why Leadership Matters in Nursing

Leadership in nursing is more than just supervising others. It can include:

Guiding interdisciplinary teams
Shaping health policy
Improving clinical outcomes
Educating the next generation of nurses

Frontier Nursing University’s online DNP program is designed to prepare nurses for these roles through a combination of advanced coursework, clinical experience and scholarly projects.

Earn Your DNP at Frontier Nursing University

At Frontier Nursing University, leadership development is woven into the core of the Post-Master’s DNP curriculum. The program consists of 30 credit hours, including ten clinical credit hours, and is designed to strengthen both theoretical knowledge and practical leadership application skills. View the program of study here.

Flexibility with Frontier’s Online DNP Program

The online DNP program at Frontier Nursing University makes it easier than ever to balance school, work and day-to-day responsibilities while advancing your education. FNU’s program offers flexible learning models, allowing students to complete coursework while continuing to serve patients in their home communities.

Students begin Frontier’s DNP program with a three-day on-campus orientation experience where they meet and build a support network with their faculty and peers. Upon completion of didactic coursework, students collaborate with their chosen clinical site to lead a rapid cycle quality improvement project.

Gain Practical Experience Through Quality Improvement Project

At FNU, DNP students strengthen their leadership skills by organizing and leading quality improvement projects that directly address needs within their clinical sites. Working with faculty coaches, site mentors and site sponsors, students learn to translate evidence into practice through focused, rapid-cycle initiatives that are small in scope but big in impact. Students complete planned improvements using the Institute for Healthcare Improvement “Model for Improvement” over an eight-week period.

Dr. Nagavalli Thiruvalluvan

For instance, DNP graduate Dr. Nagavalli Thiruvalluvan developed a weight management program for her primary care clinic, where most patients were overweight or obese. Her project emphasized lifestyle modifications, resulting in improved comorbidities, enhanced body image, and reduced reliance on medications.

Dr. Julie Percefull

Likewise, fellow graduate Dr. Julie Percefull increased mammogram rates at her clinical site by 40 percent, introducing screening reminders, decision aids, and case management tools that boosted both patient engagement and quality of care.

Through projects like these, DNP students gain hands-on leadership experience while leaving a lasting impact on the organizations and communities they serve.

Ready to Lead with a DNP?

If you’re ready to take the next step in your nursing career and lead with confidence, a DNP degree could be the path for you. FNU’s Post-Master’s DNP program combines flexibility with rigor, equipping you with the leadership tools to improve care, empower teams, and inspire change.

To learn more about earning your online DNP through Frontier Nursing University, click here.

Faculty Spotlight: For Dr. Tanya Baca, Quality Care Begins with Cultural Competence

October 13, 2025 By Frontier Nursing University

At the heart of Frontier Nursing University is a talented community of students, alumni, faculty, staff, Couriers and preceptors. Spotlight blogs feature members of our FNU community that 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.

Tanya Baca, DNP, CNM, PMHNP-BC

FNU recognizes the rich histories, cultures, and contributions of Hispanic Americans. We are proud to highlight the stories of our community members who embody the values of resilience, service and leadership. One of those individuals is Tanya Baca, DNP, CNM, PMHNP-BC, who is both an FNU graduate and faculty member.

Dr. Baca’s path in healthcare began at just 15 years old, when a visit with her best friend’s mother, a nurse, sparked a passion for serving others.

“That moment, I knew I wanted to serve other human beings in a way that only some of the world’s population are called to do,” she said.

Soon after, Dr. Baca entered the nursing profession as a CNA in high school, and at just 17, became the youngest member of her LPN program.

“I come from a very underserved population and family,” she said. “I am the first and only member of my immediate and extended family to earn a doctorate degree.”

Her drive to learn and serve others never slowed. Over the years, she has worked in a wide variety of settings, including nursing homes, rehabilitation centers, ambulatory care, and several hospital departments. She has served as a charge nurse, Lead Midwife, and now operates a small LLC for her telehealth services as a psychiatric-mental health nurse practitioner (PMHNP).

Dr. Baca’s personal experience also shaped her path toward midwifery. She said after undergoing a postpartum hemorrhage when she had her first child, she realized how little she knew about her own body and pregnancy. Growing up in what she describes as a “very traditional Hispanic, Catholic family,” topics like menstruation and even breastfeeding were rarely discussed.

“So, in that moment, I knew I was not the only one out there who must have grown up this way, despite culture, race, and religion,” she said. “I knew I wanted to serve women and those who identify as female.”

Dr. Baca emphasized that continuing education and advancement are essential for medical professionals to stay sharp and gain a deeper understanding of policies and procedures. Her decision to pursue a DNP degree reflected her strong commitment to lifelong learning, and she encourages nursing professionals who aspire to teach to strongly consider earning a DNP.

“I wanted to be an educator at FNU to give back to students the way I was taken care of when I was a student at FNU,” she said. “I was challenged, but I was listened to. I felt like the faculty truly wanted us to be successful. That is why I knew that I wanted to have a place as a faculty member to guide and grow further practitioners.”

As a faculty member, she brings that same encouragement and guidance to her students.

“I remind myself that every student comes from a different walk of life, and my job is to help them see their own potential, even when they doubt themselves,” she said. “I use real-life experiences, not just textbooks, so they can see how what they’re learning applies at the bedside or in practice.”

For Dr. Baca, cultural competence is at the heart of quality care.

“Patients come with their own beliefs, values, and experiences, and if we don’t meet them where they are, we fail them,” she said. “Being able to speak their language, understand traditions, or even just show respect for their cultural differences builds trust. Trust is what leads to better outcomes because patients are more willing to open up, follow through, and feel safe in their care.”

Dr. Baca said her own cultural background has made her especially mindful of representation and respect in healthcare.

“I know firsthand what it feels like to not see yourself represented in healthcare, to have traditions misunderstood, or to feel overlooked,” she said. “That awareness makes me intentional about creating space for students and patients who may feel the same way.”

This awareness presents itself both in Dr. Baca’s role as a healthcare provider and in her role as an educator.

“As a provider, I slow down and ask questions that matter to them, not just what the chart asks for. As an educator, I push students to think outside the box, to consider how culture shapes health decisions, and to always approach care with humility and respect,” she said.

Outside of her professional endeavors, Dr. Baca is an avid runner, Peloton enthusiast, world traveler, beach-goer, and loves spending time with her three kids, three doodles, and husband.

Frontier Nursing University honors Dr. Baca’s contributions to nursing, education, and the broader community. Thank you, Dr. Baca, for reminding us that representation matters, cultural competence saves lives, and education has the power to transform not just one life, but many.

Graduate Spotlight: Karen Tepper’s family history inspires her focus on underserved populations

February 20, 2025 By Frontier Nursing University

At the heart of Frontier Nursing University is a talented community of students, alumni, faculty, staff, Couriers and preceptors. Spotlight blogs feature members of our FNU community that are focused on the mission of educating nurse-midwives and nurse practitioners to deliver quality health care to underserved and rural populations.

FNU graduate Karen Tepper, DNP, ANP-BC, HHCNS-BCN/A, has consistently dedicated her three-decade career in healthcare to the betterment of underserved communities. Based in Massachusetts, Dr. Tepper’s passion for improving healthcare access and outcomes is rooted in her own family’s history—her parents, both immigrants, endured immense challenges, including her mother’s survival of World War II and her father’s family fleeing oppression in Eastern Europe.

“I understand what it means to be underserved from that experience,” she said. “That led to my passion to work with those communities.”

As the Director of the VISN 1 Clinical Contact Center for the Veterans Health Administration, Dr. Tepper is responsible for the administrative, supervisory, and health care aspects of the center. Clinical Contact Centers provide patients 24/7 virtual access to dedicated staff, providers, and a range of clinical and administrative services, including RN clinical triage for evaluation of symptoms, disposition, and care coordination of health care concerns; virtual clinical visits with medical providers for acute, episodic, and exacerbation of chronic care needs; pharmacy services; and appointment scheduling.\

Dr. Tepper holds a Doctor of Nursing Practice (DNP) from FNU, which she earned in 2020. While writing a Request for Proposal (RFP) for a Nurse Practitioner Residency program, she recognized the need for additional education to effectively co-direct the program and lead broader initiatives. This realization inspired her to pursue her DNP. She was inspired to attend Frontier by a colleague’s recommendation and the university’s emphasis on underserved populations.

“I appreciated the focus on underserved populations, and the emphasis of ensuring students are successful,” she said.

In addition to her professional achievements, Dr. Tepper serves her community as Chair of the Massachusetts Board of Health. She has served as a member for 18 years. In addition, she has also served on the Board of Nurse Practitioner Associates for Continuing Education (NPACE) for the past nine years.

Recognizing her lifelong commitment to improving patient care, Dr. Tepper was recently honored with the 2024 Gerontological Advanced Practice Nurses Association (GAPNA) Excellence in Clinical Practice Award.

“Many nurses develop incredible programs that affect the lives of patients for the better. I am grateful and humbled to be selected for this award,” she said.

Reflecting on her journey, Dr. Tepper advises others to advocate for their communities actively.

“It is important to have a seat at the table at your organization and be politically active to achieve change for our communities,” she said.

Thank you, Karen, for your unwavering dedication to underserved communities and for embodying Frontier’s mission.

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

2024 Distinguished Preceptor Award Recipient: Sandi Mellor

October 30, 2024 By Frontier Nursing University

The Distinguished Preceptor Award recognizes a graduate providing long-standing support and commitment to the mission and work of Frontier Nursing Service and Frontier Nursing University through precepting students. The 2024 recipient of this award is Dr. Sandi Mellor, DNP, APRN, FNP.

Growing up in her hometown of Tulsa, Oklahoma, Dr. Sandi Mellor, DNP (Class 30), APRN, FNP-BC, knew at a young age that she wanted to pursue a career in healthcare so she could “help people get healthy and stay healthy.” Determined to do just that, she took a medical-surgical nursing class while still in high school. After high school, she worked towards her associate degree in nursing and worked as a nurse for three years for the National Health Authority in Bedford, England, where her husband was stationed as a member of the U.S. Air Force.

“I thought I wanted to be a physician, but after taking my first nursing medical-surgical class in high school, I fell in love with being with the patients,” said Mellor, who has worked as a nurse for almost thirty years.

Upon returning to the United States, she went back to school and earned a bachelor of science in nursing in 1998. While raising two sons, she worked in the cardiac intensive care unit, pediatric intensive care unit, and neonatal intensive care unit, as well as the trauma and emergency room. She recognized that many of these patients required not only emergency or urgent care but also primary care management of their comorbidities. Inspired to serve the underserved, she went back to school to become a family nurse practitioner. She earned her FNP in 2004, the same year she and her husband had a baby daughter.

They moved back to Tulsa in 2007, where Mellor began training internal medicine residents how to be providers. She also began precepting FNP students. She left the resident clinic setting in January 2010 to open her first family practice, where she found more opportunities to precept and teach BSN and FNP students while serving the underserved. At her clinic, Mellor accepts those on Medicaid or without insurance and has Spanish-speaking translators on staff to help make sure all are welcome. At the second clinic that she opened, Neighborhood Medical Clinic, Mellor provides both family and urgent care.

“I always wanted to serve the underserved and felt called to nursing,” Mellor said. “I can see the entire family and treat them, with or without insurance. I can give free care to families. I see one child that has strep throat, and I can see the other children in the family and the parents and do not have to charge each of them because I own the practice.”

Mellor’s practice not only provides essential service to the community but also serves as a training ground for others who follow in her footsteps. She is eager to precept students, including approximately a dozen from Frontier Nursing University, with a time commitment of nearly 600 hours per student.

“I decided to earn my DNP from Frontier Nursing University as I had precepted so many students from there and found it to be a very prestigious program,” said Mellor, who earned her DNP in 2019. “Their FNP students were prepared and knowledgeable. I also researched the DNP program, and it was and still is one of the top in the nation. (FNU Director of the Doctor of Nursing Practice Program) Dr. Khara’ Jefferson (DNP, APRN, FNP-C, CHC) was patient and guided me to “trust the process”, and I was able to complete a project I was truly proud of that is still in use today. I was able to make a change in a vulnerable population and serve the underserved. It has helped me guide Quality Improvement projects at my clinic, teach in the FNP/DNP programs, and always encourage others to maintain the highest standards of nursing by continuing their education.”

Not only has the passion that Mellor had for nursing and helping others as a child never waned, but it has grown stronger and deeper as she has seen the impact that she can have in her community and beyond.

“I enjoy teaching and precepting because I get to see the ‘aha’ moments where the theory/didactic and practice guidelines make sense in clinical practice,” Mellor said. “I get to see the growth of a student becoming what they dreamed of earning – their RN or FNP qualifications. I get to influence and help the next generation of nurse practitioners to maintain our high standards and continue to improve the quality of healthcare for all. I get to be part of the positive change in healthcare as NPs increase their presence and roles in providing care for everyone.”

In addition to teaching through precepting, Mellor also has ventured into course development and classroom teaching. She wrote the FNP courses and taught the first three graduating classes from the University of Tulsa FNP program. She has also worked with Oral Roberts University and the University of Oklahoma.

“It is a way to give back to the nursing profession that has given me so much and fulfilled my calling,” Mellor said. “I want to write a book about nurses, and I hope I can continue to work as a nurse practitioner, precept, and teach all levels of nursing as well. I am interested in earning my PMHNP certification as well as continuing to serve my community. I will continue to advocate for full-practice authority and showcase the benefits nurse practitioners bring to bridging the gap in healthcare.”

Her advocacy efforts have included volunteering for the American Nurses Credentialing Center (ANCC) FNP content expert panel. To date, she has served on the panel for six years, including two as the elected chair of the panel.

“Nurses have to be the change we need in healthcare,” Mellor said, explaining her interest in being an advocate. “We are the largest population and the most trusted for many reasons. So we must be the ones to lead those positive changes towards improvement.”

And to help people get healthy and stay healthy.

Graduate Spotlight: Cheyenne Allen pursued DNP to positively influence next generation of nurses

August 19, 2024 By Frontier Nursing University

At the heart of Frontier Nursing University is a talented and diverse community of students, alumni, 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 deliver quality healthcare to underserved and rural populations.

FNU graduate Dr. Cheyenne Allen, DNP, PMHNP-BC, serves as a Psychiatric-Mental Health Nurse Practitioner (PMHNP) in private practice while also lending her expertise as undergraduate nursing faculty at Pennsylvania Western University. Her dual role allows her to not only provide direct care, but also to mold the next generation of mental health nursing professionals.

In her practice, Dr. Allen serves rural and underserved populations, filling crucial gaps in mental health care access. In addition, her consultancy work reaches across multiple facilities to improve patient outcomes, including facilities that serve those with intellectual disabilities, geriatric needs and substance use issues.

Dr. Allen’s dedication to advancing mental health care is evident in her scholarly contributions. Her research, highlighted by her article “Improving Patient-Centered Care for Veterans with Treatment-Resistant Depression Using Shared Decision-Making Tools,” underscores her commitment to patient empowerment and holistic treatment approaches. The article was published in the Journal of the American Psychiatric Nurses Association in 2023, and she presented it at the American Psychiatric Nurses Association conference last October.

Reflecting on her journey, Dr. Allen said she sees her vision of success as a continuous pursuit of growth and service.

“My idea of success is to continue to learn, work, and evolve to be the best version of myself possible,” she said. “I want to be able to pass on this principle, so I pursued my Doctor of Nursing Practice (DNP) to be a positive influence on the next generation of nurses, my students!”

Dr. Allen’s path to mental health advocacy was serendipitous, shaped by the guidance of mentors and her own evolving interests. Initially drawn to obstetrics, she found her calling in psychiatry—a field she felt compelled to destigmatize and elevate through her work.

Her experience at Frontier, she notes, was transformative, characterized by a sense of community and personalized support—a culture she seeks to replicate in her own teaching approach.

“Frontier is much more of a community-based school than many of the larger schools my colleagues attended,” she said. “I had an opportunity to know my professors on a more personal level and I try to connect with my undergrad students in the same way, knowing how supported I felt.”

Beyond her professional endeavors, Dr. Allen finds solace in nature, tending to her hobby farm, exploring the outdoors, and enjoying activities such as gardening, camping and kayaking. She also enjoys attending dog shows.

Thank you, Cheyenne, for your unwavering commitment to advancing mental health services and for leaving an indelible mark on the future of nursing.

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

Learn more about advanced nursing degrees and specialties at Frontier Nursing University. Subscribe to our blog for the latest news and events at FNU and to get inspired with stories featuring our alumni, students, faculty, preceptors and staff!

Frontier Nursing University Offers  Course on Caring for Veterans
Frontier Nursing University has created a continuing education course to prepare healthcare professionals to provide culturally sensitive care to veterans within their community. Developed by military-connected faculty at FNU, the “Care of the Veteran” program is a self-paced module that will guide clinicians through understanding military culture, service-connected health concerns, and developing a plan of care utilizing military service benefits.

Dr. Francis Aho receives 2024 Distinguished Service to Society Award

July 22, 2024 By Frontier Nursing University

Sometimes, we wind up exactly where we are meant to be in life. For Dr. Francis Aho, DNP (Class 37), CNM, that place has been with Africa Mission Services (AMS) in Kenya since 2008. She recently opened the Africa Mission Services Women’s Health Center, an 11,000-square-foot building that includes both inpatient and outpatient services, as well as a labor and delivery wing. The birth center provides an extremely rural and underserved population with vital services that were previously administered as a small component of the AMS Community Health Clinic, which serves the Maasai tribe of the Maasai Mara National Reserve in Kenya.

“This is major for us,” Aho said. “We have an outpatient department, an inpatient maternity wing, and then an OB labor and delivery wing. We started out in a little clinic building with just an exam bed, no electricity, no running water.”

In 2016, Aho and her team renovated an area of the AMS Community Health Clinic to provide more space for maternal health services, but the need for a larger, dedicated space is evident. In 2023, Aho and her team of four Kenyan midwives delivered 612 babies in a community with an estimated population of 11,000.

“It is really hard to know the actual population,” Aho said. “We are on dirt roads. If you drive down the road, it looks like nobody is around here, but they are all in little huts and homes in the bush. We also have women from farther away who come for ultrasound or specialty care such as infertility.”

What might seem overwhelming to some is exactly the environment Aho craves. Born in Switzerland, she and her family came to the United States when she was 4, moving around a lot before settling in rural western Tennessee when she was 10. She grew up in a very religious family and often read about mission trips and mission work. Her passion for serving led her to become an ER nurse, where she found that she also thrived on the adrenaline rush of providing urgent care. She thought of becoming a flight nurse, which would be both exciting and fulfilling, but the idea of mission work was also in the back of her mind. She did some mission work in Honduras and sought a more permanent position. That’s when she found AMS. She moved to Kenya in 2008.

“At that time, there was a clinic – just a little building – and visiting doctors would open it up,” Aho said. “It would be open for a week and then shut down. I asked Africa Mission Services if I could come and open up the clinic full-time. I was 24 and thought I could change the world. A Kenyan provider, thank goodness, asked if he could help open it up. We came the same week. That was December 2008.”

Aho recalls losing a 5-year-old patient with malaria just three days into her time at the clinic and hiking into the village to treat pregnant women while the Kenyan provider treated the men.

“I was an ER nurse and knew nothing about women’s health,” Aho said. “I was just kind of feeling around their bellies and talking to them about nutrition. I had no clue what I was doing. That evening we delivered our first baby with a little mini Maglight. The girl who is now in charge of my office was holding the mini Maglight, and I delivered the baby.”

Despite the uneven start, Aho was hooked. Aside from a two-year hiatus from the clinic after the birth of her twins in 2014, she has remained at the clinic along with her husband, Andrew, who is the founder of AMS.

After the birth of her children, Aho’s awareness of the need for maternal care was heightened. She needed to learn more in order to better care for these women and their babies.

“I think my maternal instinct kicked in. I had to change things,” she said. “I ended up going to Frontier Nursing University and decided to become a midwife. We did a big fundraiser, got equipment, and renovated a whole area at the clinic, and that’s where we set up the birth center. I hired Kenyans who were more specialized midwives and knew maternity, and we became the Women’s Health Center.”

After earning her CNM at Frontier, Aho went on to get her DNP from Frontier as well. Her DNP project led to the establishment of a prenatal class at the clinic.

“I have learned basic OB ultrasound and taught two of my midwives,” she said. “As I was doing my DNP, I decided, as part of it, I would ultrasound all the women. I did ultrasounds on hundreds of women for my DNP project. That’s what made me learn OB ultrasound.”

Aho’s enrollment at FNU coincided with the university updating its policies to disallow clinicals being completed internationally. Aho feared she might not be able to continue.

“I was all gung-ho and ended up going to Frontier Bound that week they announced online that they were not allowing international clinical,” Aho said. “They worked with me. I went and did three months, then I flew back to Kenya for two months, and then I flew back and finished. I did my clinical in Chattanooga. For my DNP, they allowed me to do my project at my clinic. Being able to do it somewhere where I have autonomy and leadership, I was able to choose something that was very impactful for my population and clinic.”

Like many others, Aho was drawn to FNU’s mission to provide care to rural and underserved communities and populations.

“I chose Frontier because of their mission,” Aho said. “Their mission is really to give back to rural areas and underserved populations, and that really hit home with me.”

Without question, Aho certainly serves a rural and underserved area. Not only are healthcare services limited, but so are travel and overall access to care. AMS has modified a Landcruiser to serve as an ambulance able to traverse the rough and muddy dirt roads. It is over an hour’s drive to a facility that can perform a C-section and two-and-a-half hours to get to the nearest NICU.

“We are the first line for anything emergency-related in the area,” Aho said. “We deal with a lot higher risk than a birth center should, considering we don’t have C-sections, but we see patients that we will never see for prenatal care who will show up at our door ready to deliver. We have a population of HIV-positive moms, we deliver twins at least once a month. We have done triplets. We have done breach delivery. When we do an ultrasound and know that they are twins, we do the counseling and tell them they should go into town and deliver where there is a backup for C-section, but at the end of the day, they can afford to come to us, and they are going to show up.”

They can afford the care Aho and her time provide thanks to AMS being aligned with the Kenyan government’s insurance program. The government provides payment for rural women, even if they are uninsured.

“The majority of people don’t work, and they don’t have insurance,” Aho said. “They can come to our clinic, we sign them up, and then they get four prenatal care visits, the delivery, four well-baby checkups, and the immunizations that the government will pay us for. We get about $20 for the delivery. It’s not big money, but it’s more than we could charge the locals. It does help cover our payroll, but we haven’t been paid since March of 2023.”

AMS, which is a nonprofit with no religious affiliation, relies on donations, fundraisers, and volunteers to help serve its mission. Volunteer medical teams, construction teams, and even landscaping teams provide much-needed physical support.

“When I have a medical team, I will go out with them, and we will set up mobile clinics in the villages that don’t have a healthcare facility, and we do free clinics under a tree,” Aho said.

With the opening of the AMS Women’s Health Center, Aho will do so with a 12-person staff, including four midwives, a lab technician, a pharmacist, and social workers who are birth assistants. Together, they are committed to providing excellent healthcare while respecting the culture and values of their patient population.

“Having a birth here is a woman’s event completely,” Aho said. “They are polygamous in general, so they come either with a co-wife, a sister, mother, some other women – and we will often have a room full of women supporting one mother. We will let mothers come into the room if women are giving birth and they want their mom or another woman to give them strength. They have certain practices like blowing air into the mom’s mouth that give them strength, conveying strength from one to the other. I try as much as possible only to educate and change things that are not healthy for the baby or mom.”

“I don’t want them to feel judged when they are giving birth,” Aho said. “I feel like I empathize with the women here. They have a tough life, and if I can make their childbirth experience safer and give them a place where they can rest and feel treated with respect and their cultural values respected, it gives me a high sense of fulfillment.”

The opening of the Women’s Health Center this summer figures to be equally fulfilling. She hopes that it will grow beyond providing maternity care to addressing other needs, such as breast cancer and cervical cancer testing and treatment.

“I never came in with the idea that I could raise enough funds or start this big women’s health center,” Aho said. “My dream is that this women’s health center way outlasts me. I will feel like I have been successful if I have trained the locals to know what I know and if the center doesn’t shut down when I leave.”

Dr. Bradley Kuo: Thinking Ahead About Mental Healthcare

July 15, 2024 By Frontier Nursing University

Bradley Kuo, DNP (Class 33), M.Ed., APRN, FNP-BC, PMHNP-BC, CARN-NP

Ever since he graduated high school a year early, Bradley Kuo, DNP (Class 33), M.Ed., APRN, FNP-BC, PMHNP-BC, CARN- NP, has made being ahead of schedule the norm. He completed an accelerated master of nursing program at the University of Hawaii at Manoa and completed his DNP at Frontier Nursing University while working five jobs. He even started his mental telehealth practice – the first based in Hawaii – in 2018, two years before the pandemic drove other practices to start offering telehealth.

The reality is that Kuo hasn’t rushed through anything. Rather, he was making up for lost time after completing his undergraduate studies at St. Olaf College in Northfield, Minnesota, as a music major intending to become a high school choir director. He then earned a master’s of education in counseling with an emphasis in student affairs at Northern Arizona. A healthcare career was not yet on the horizon.

Kuo worked in higher education administration for several years with stops at Cal Poly Pomona, UC Berkeley, and finally, the University of Hawaii at Manoa, where he worked for three years.

“That last year, I started to complete the prerequisites to get into the master’s entry program in nursing at UH,” said Kuo, who grew up in Wisconsin and spent one year in Germany as a foreign exchange student. “In 2010, I did my pre-licensure year. What nurses would typically do in three years of education, I and my cohort had to get it done in one. It was very intense. As soon as we were done, we had to go right into the graduate program. After all that, I did graduate with a BSN and an MSN as an FNP and an advanced public health nurse. Over the course of those several years in the graduate program, I worked in long-term care and hospice. I really enjoyed that because it shapes how I have conversations with my patients now.”

Kuo and his husband, Erik, now own and operate Wellness Partners Hawaii, Inc., an online telemental health clinic. Wellness Partners Hawaii opened in 2018. In 2019, Kuo enrolled in the DNP program at Frontier. By then, he had a wealth of experience in nursing, including being a nurse practitioner for hospice, working in a pediatrics clinic, and working with the Honolulu Police Department in corrections as an independent contractor. Then, he began working at Queens Medical Center in Honolulu, Hawaii. In 2015, he enrolled at Johns Hopkins and earned his postgraduate certificate for psychiatric-mental health.

“While I was working at Queens, the thing about getting that DNP kept on nagging me,” Kuo said. “That’s when I decided it was time in 2019 to do the Frontier Nursing DNP program.”

Bradley (left) and his husband Erik

He approached the DNP the same way he had the rest of his academic and professional career, taking on multiple projects simultaneously.

“I needed a program that would allow me some flexibility because I was working full-time at the hospital,” Kuo said. “I was literally working five jobs while I was getting my DNP: Full time at the hospital, running my mental health business, my husband and I started a medical spa, I was working for the police department, and I held a couple of other smaller jobs. I was really busy while at the same time doing the work for the DNP. I decided I was going to torture myself and really stack up the classes. I did get my DNP done rather quickly, but it was intense. My faculty mentor, Ana Verzone (DNP, FNP, CNM, PMHNP), was amazing. She was instrumental in helping me move through my program.”

Even with his businesses and career already flourishing, Kuo believed in the value of the DNP. His experiences since then have validated his beliefs. Kuo has become an active leader in local and state healthcare policies, serving on a seemingly endless list of boards and committees.

“One of the things the DNP helped me achieve is that I am able to be a part of a lot more leadership roles,” Kuo said. “I am able to be a part of a lot more initiatives, and that is because of my completion of that degree. My ability to take on leadership roles has been a big piece of my work since I finished my degree at Frontier. People pointed at me, saying, “Well, you’ve got your DNP; you can manage this.” Other leadership roles were something that was asked of me. It also helped to get the attention of legislators. Using my academic title is important at times so that I can be heard in the work that we are doing.”

Kuo has served as the chair of the legislative committee for the Hawaii Association of Professional Nurses. Last year, he was selected by the governor for an interim appointment as the APRN representative for the Hawaii State Board of Nursing until the Senate is able to solidify that appointment during the next legislative session. Kuo is also the Chair of the Board of Directors for Mental Health Kokua, a non-profit organization founded in 1973 to assist those dealing with mental illness. He is the Hawaii liaison for the American Association of Nurse Practitioners and is on the Board of Directors for the National Alliance on Mental Illness-Hawaii.

“As APRNs and nurses, we actually have to take our seat at the table. We can’t wait for somebody to offer it to us,” Kuo said. “What that might look like is we might submit legislative testimony. That’s how we can take our seats. We can be very involved from a legislative perspective. If we wait for somebody to give us a seat at the table, it’s going to take a long time. I think there are ways to take our seat at the table that are not overbearing but can support the organizations’ or the state’s mission to move the healthcare needs forward.”

Much of Kuo’s committee work involves ensuring that APRNs are working within their scope of education, certification, and licensure. This, he says, ultimately leads to a better overall healthcare system.

“In the work that I do politically, it really is improving access to care for the people of Hawaii,” Kuo said. “If we’re not working outside of our scope, certain organizations in the country and this state have less of an argument to make when suggesting that we’re not properly trained and educated. Then we’re in a much better spot in being able to advocate for the patient care we are able to deliver. For that reason, the state of Hawaii put together the APRN Scope of Practice Algorithm to ensure APRNs can ask themselves if they are working within that scope. If the answer is no, they need to course correct.”

Other legislative issues that Kuo has addressed include financial concerns, such as increasing state-funded loan reimbursement and preceptor tax credits.

“Pay parity is a very difficult problem here,” Kuo said. “Hawaii is one of the lowest reimbursing states for care. I am envious of my colleagues in other states who get more money for the work that they do. The medicare reimbursement doesn’t meet what is needed to provide care here. I am part of a couple of groups that are working to lobby federal legislators to increase medicare reimbursement. Typically, an APRN throughout the country gets reimbursed 85% of what a physician does. We are already operating at a deficit in a state that makes it difficult for APRN-run and physician-run clinics to operate financially.”

Fortunately, Kuo’s Wellness Partners Hawaii is succeeding. The practice now includes 17 therapists and five subscribers and averages more than 100 new patients per month and 98 percent of all care is conducted via telehealth. Common presentations include PTSD, depression, anxiety, ADHD, trauma, and issues related to substance use. The only time in-person appointments are conducted is to meet DEA requirements to start a controlled substance.

“We have been focused on reaching the communities that have less access to care,” Kuo said. “We thought the best way for us to improve access to care is to use technology. We’ve been doing telehealth before it was even popular. During the pandemic, when everyone was trying to pivot how they deliver health care, we were already there.”

While Kuo has found the value in telehealth, he is no stranger to in-person mental health care. His interest in mental healthcare developed when he worked in student affairs at the University of Hawaii at Manoa. He found that helping first-year college students involved a significant mental health aspect.

“As I became more involved in the mental health world, I needed to make sure I had the education and training to back that up,” Kuo said. “That’s when I decided to go back to Johns Hopkins. Once I was done with that program, then my work in mental healthcare catapulted. I worked on ways to improve mental healthcare in the workplaces that I was in. I just grew to embrace mental healthcare.”

While fully invested in the care of his patients, his staff, and his legislative work, Kuo does so with an eye toward the future, where he hopes to see greater access to care for all Hawaii residents.

“We’re constantly working to improve access to care,” Kuo said. “Nurses and APRNs are trained differently, so how we deliver that care may be improved for certain members of the population. As we continue to evolve here in the state, I think nurses and nurse practitioners can have an even greater seat at the table.”

Dr. Tracy Hicks Puts Her Mind to Improving Access to Mental Care

July 11, 2024 By Frontier Nursing University

When you rank last in anything, there are two ways to respond: accept defeat or embrace the opportunity. After all, there is nowhere to go but up.

It is safe to say that the latter is the mindset that FNU alumnus Dr. Tracy Hicks DNP (Class 23), MBA, APRN, FNP-BC, PMHNP-BC, CARN-AP, FIAAN, FAANP, adopted when she opened C-Trilogy Comprehensive Clinical Care/C-Trilogy Outreach (C-Trilogy) in Longview, Texas. In 2022, Mental Health America, a nonprofit advocating for people with mental illness, ranked Texas 51st for mental health care access, behind every other state and Washington, D.C.*

That ranking came a full seven years after Hicks organized her practice, which officially opened in 2016. Since then, C-Trilogy has grown significantly with the intent of helping as many people as they can.

“I started in 2015 with myself and a front desk person,” Hicks said. “By 2020, I had a front desk person and a part-time nurse.”

Currently, the clinic has 12 staff members, including a psychiatrist/medical director, a physician assistant, a licensed master social worker, a licensed vocational nurse, a medical assistant, a licensed chemical dependency counselor, three psychiatric-mental health nurse practitioners, two patient navigators/crisis interventionalists, and a front desk manager/executive assistant and assistant clinical director. Incredible to think that this vitally important clinic almost never existed.

Hicks always wanted to be a nurse, but it wasn’t until she was in the family nurse practitioner (FNP) program at the University of Texas at Arlington that she was drawn to the possibility of being a psychiatric-mental health nurse practitioner.

“We had to take a full semester of psych with a 45-hour clinical rotation,” Hicks said. “The PMHNP Director at the time asked me if I would be interested in the PMHNP program because of my performance in didactic and clinical. I told her I wanted to complete the FNP program because I wanted to offer a holistic care model, but I promised her that I would take a semester off and return because I did love the psych rotation. I did just that, and my Program Director remains in my life today as a mentor and like a second mom.”

Hicks’ real mom was also a nurse but encouraged her to become a physician. “I told her I wanted to become a nurse because I had watched her and how her colleagues and patients loved her,” Hicks said. “She loved her work. She made me promise that if I wanted to be a nurse, I would go to the top and make an impact.”

Establishing a psychiatric-mental health clinic in the state with the lowest access to mental healthcare certainly makes an impact. Hicks credits FNU’s DNP program for helping prepare her to establish and manage her own practice.

“When I researched universities online, I was attracted to FNU's rural health focus,” said Hicks, who is also an associate professor in the College of Nursing at the University of North Texas Health Science Center. “I remember being inspired by Dr. Diane John. She was so helpful and supportive throughout my journey at FNU. I met Dr. Khara’ Jefferson toward the end of my journey, and she was instrumental in my grounding toward the end. Dr. Eileen Thrower taught the ‘nurse as an educator’ course, which solidified my interest in teaching at the graduate level. I also used some of my courses as a guide in setting up and refining my clinic.”

Part of refining her clinic to meet the community's needs included the establishment of C-Trilogy Outreach, a non-profit branch of C-Trilogy, in 2020. This came in response to a growing number of patients, both insured and uninsured, who were presenting with more complex issues during the pandemic.

“I established a non-profit in 2020 in hopes of securing funding to expand and transform the practice to meet the needs of the community,” Hicks said. “I researched and studied the Certified Community Behavioral Health Clinic (CCBHC) model and met with stakeholders, including the local mental health authority. I applied for grant funding through SAMHSA and was blessed to receive funding in 2022 for the planning, development, and implementation of a CCHBC Certified Community Behavioral Health Clinic Planning, Development, and Implementation Grant.”

The CCBHC model ensures access to coordinated comprehensive behavioral health care and serves those who request mental health or substance use care. C-Trilogy has established relationships with the Harris County Jail System and the Jim Meyer Comprehensive Health Center, which is partially funded by the Ryan White HIV/AIDS Program.

“We used to have contracts with them, but now we work collaboratively referring patients between organizations when needed,” Hicks said.

Understanding that C-Trilogy cannot fix the state’s mental healthcare needs alone, Hicks has become a vocal leader in advocating for increased awareness and funding. As a presenter and speaker, she addresses the importance of the social determinants of health in providing individualized and holistic care on a broader scale.

“My motto is ‘restricted NP practice anywhere is restricted access to care everywhere,’” Hicks said. “Increasing access to mental health services is key. We have to take a more proactive approach versus a reactive approach. Mental healthcare tends to get more attention when there a tragic events such as mass shootings and the pandemic, which highlighted health inequality. Issues such as this wreak havoc on the population's mental health. We need to continue to be proactive and promote and cultivate crucial and fierce conversations on the state of mental health and the solutions that are needed. We need all healthcare providers to practice to the fullest extent of their education without unnecessary barriers and restrictions.”

Balancing her duties as a clinician, educator, and advocate might seem daunting to most, but to Hicks, it is the most effective way for her to serve her community and her state.

“I plan to continue work as an educator and clinic owner/entrepreneur while being an exemplary leader and addressing the needs of underserved populations,” she said. “I hope to expand my clinic model into Full Practice States. I intend to continue to support Texas Nurse Practitioners and the American Association of Nurse Practitioners as we work with legislators to secure Full Practice Authority in Texas and across the nation.”