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.”

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 and staff!

Student Spotlight: Mara-Joanne Derinor aims to improve clinical education with DNP

March 9, 2023 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.

The schedule of a healthcare professional can be challenging to navigate. Yet, Mara-Joanne Derinor manages to work as a psychiatric-mental health nurse practitioner (PMHNP) while pursuing her Doctor of Nursing Practice (DNP), authoring books and more.

Derinor, a resident of Kissimmee, Florida, completed her Master of Science in Nursing (MSN) in the PMHNP FNU program last year and is a member of DNP Class 48, on track to earn her Doctor of Nursing Practice this year.

Through her work as a PMHNP, Derinor evaluates and assesses patients for mental health conditions, prescribes medications, provides education about mental health, and provides therapy and counseling. She works with an underserved population, and many of her patients do not speak English or are bilingual.

“I provide culturally competent care for my community,” she said.

Pursuing a DNP at FNU

Derinor was motivated to pursue her DNP in an effort to improve clinical education. She feels that too often nursing students are not given adequate encouragement in their education.

“I want to be the change that I want to see,” she said. “I remember when my very own nursing professor told me I would not pass my NCLEX. That was very discouraging. I passed my NCLEX on the first try. I want to encourage and motivate future clinical students. I also want to make new discoveries in clinical research.”

Derinor is working on her DNP Quality Initiative which is focused on improving clinical workflow and patient satisfaction.

“I hope to improve quality care and patient satisfaction,” Derinor said.

So far, Derinor said her favorite course in the online DNP program has been the Nurse as Educator course (PC711).

“This is the most interesting course because it was informative and provided opportunities for students to improve their skills as a nurse educator,” she said. “My professor was very supportive of me as a learner. This class allowed me to be creative and explore ways to improve my skills as a nurse educator.”

Derinor said she initially decided to study at FNU after researching universities and online programs. She was impressed by FNU’s reputation. Since then, she said she has enjoyed a welcoming and engaging experience fostered by FNU faculty and peers.

“One of the best decisions ever,” she said.

Outside of her work and studies, Derinor is an author, motivational speaker, dancer, and director.

She has published four books, including three children’s books and one book of poetry, and has participated in poetry competitions nationwide. In her free time, she enjoys cooking, traveling, and going to the beach.

“I started a book reading program in 2020 where I partner with schools, after school programs, and summer programs to read to the children and educate the children about mental health and the writing process,” said Derinor.

Thank you, Mara-Joanne, for choosing FNU in your path to improve clinical education and provide mental health care for underserved populations.

Meet the Program Director: Dr. Khara’ Jefferson, DNP Program Director

February 10, 2023 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 that are focused on the mission of educating nurse-midwives and nurse practitioners to deliver quality healthcare to underserved and rural populations.

Throughout her time working with FNU, Khara’ Jefferson, DNP, APRN, FNP-C, CHC has been a champion for higher education among nurses. As Director of the university’s Doctor of Nursing Practice (DNP) program, she provides essential support to students in the program.

Dr. Jefferson knows first-hand the benefits that come from earning a DNP degree through FNU, as she earned her degree from the university in 2017. She is a certified Family Nurse Practitioner through the American Association of Nurse Practitioners and before earning her DNP, she practiced in urgent care centers, telehealth, and emergency departments.

Dr. Jefferson earned her DNP at the encouragement of Dr. Amber Littlefield, a colleague in emergency medicine and urgent care who now serves as a faculty member at FNU.

“I loved it because it was a good conglomeration of everything that I was already doing, because I was already doing some quality improvement work,” Dr. Jefferson said. “I just wasn’t calling it quality improvement or quality assurance, but that’s really what I was already doing at some of these sites. So it all just came together.”

After earning her degree, Dr. Jefferson began working with the course faculty in the DNP Program at FNU before becoming an assistant professor. She took on the role of DNP Program Director in 2021.

A native of Louisiana, Dr. Jefferson moved around in her early life due to her father’s career with ExxonMobil. She spent seven years living in Malaysia, attending the International School of Kuala Lumpur.

Before taking on a career in healthcare, Dr. Jefferson worked as a seventh-grade science teacher. She has a Bachelor of Science in Biology and a Bachelor of Science in Nursing from the University of Louisiana at Lafayette, and worked as a Registered Nurse in an emergency department for several years before obtaining her Master of Science in Nursing degree from the University of South Alabama in 2011.

Learn More About FNU’s Online Doctor of Nursing Practice Program

Through her current role at FNU, Dr. Jefferson helps prepare future advanced practice registered nurse (APRN) leaders to provide evidence-based care as they earn their DNP degrees. FNU’s DNP program is designed to improve healthcare outcomes and the delivery of primary health through enhanced nursing leadership.

Students in the program complete 30 credit hours in 18 months, lead a rapid cycle quality improvement project in collaboration with a chosen clinical site, and participate in a three-day campus immersion experience. FNU’s online DNP program,a focused practice doctorate that centers on improving patient outcomes, helps nurse practitioners take their career, leadership skills, and clinical expertise to the next level.

”FNU’s DNP program is designed to improve healthcare outcomes and the delivery of primary health through enhanced nursing leadership…I think you really become part of a family, part of a community when you come to Frontier.”
– Khara’ Jefferson, DNP, APRN, FNP-C, CHC, DNP Program Director

Dr. Jefferson said the DNP Project FNU students lead truly makes the program stand out. Projects are small in scope and need to be appropriate for implementation within three months of the student and sponsor deciding on the clinical topic. Through their project, students are guided through the process of working within a healthcare delivery system to translate evidence into practice, and are introduced to quality improvement theories, processes, and programs.

“They are seeing all the gaps that are actually around them in their site, and meeting with people on their leadership team to decide which one of those they can realistically tackle in this small amount of time,” Dr. Jefferson said.

Projects pursued by DNP students follow guidelines and standards provided by the Institute for Healthcare Improvement (IHI). Students also have the opportunity to present their project at the annual IHI National Forum in Orlando, Florida.

The Culture of Caring Within the DNP Program

Dr. Jefferson said another aspect of the DNP program that makes it stand apart is FNU’s Culture of Caring, which reinforces a committed and loyal community where all members feel valued, confident, empowered and accepted by embracing Professionalism, Inclusivity, Respect, Positive Communication and Mutual Support.

“I think you really become part of a family, part of a community when you come to Frontier,” she said.

This connection, Dr. Jefferson said, is one of her favorite things about her career at FNU.

“Because we have these live sessions and because we have these one-on-one meetings, I get to know people for who they are, not just their DNP project,” she said. “A lot of times I know their family, because there’s somebody who’s cheering them on in the background that they’re telling me about. So that’s what makes it really special. It’s just being able to connect with people on a different level.”

Dr. Jefferson said when it comes to those who are considering entering the DNP program at FNU, students should expect to welcome feedback about their project and be open and curious.

”We’re looking for people who want to be the next APRN leaders who really want to change healthcare in a meaningful way and still serve their communities.”
– Khara’ Jefferson, DNP, APRN, FNP-C, CHC, DNP Program Director

“We’re looking for people who want to be the next APRN leaders who really want to change healthcare in a meaningful way and still serve their communities,” she said.

Dr. Jefferson is married and has one son. In her free time, she enjoys adrenaline-raising activities such as sky-diving and bungee jumping. She also serves as CEO of a health and wellness consultation business, KAJ Wellness.

Thank you, Khara’, for your dedication to DNP students at FNU and for your commitment to helping FNU further its mission of educating nurse-midwives and nurse practitioners to deliver quality healthcare to underserved and rural populations.

Do you think FNU’s DNP program is for you? To learn more about FNU’s online DNP program, fill out the form below.

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Russian-Born Viktoriya Kashin’s Mission to Aid Ukrainians

September 20, 2022 By Frontier Nursing University

When Russia began its attack on Ukraine in February, the images were shocking and terrifying. The heartbreaking scenes of devastation and destruction impacted everyone, but it was all particularly impactful to Frontier Nursing University (FNU) alumna Viktoriya Kashin, DNP, FNP, who was born in Russia. Her family immigrated to the United States in 1994 when she was 8. She traveled to Russia and Ukraine several times, staying connected to her homeland through friends and family. As the war began and casualties mounted, she knew she had to find a way to help. As a family nurse practitioner, Dr. Kashin, of course, is uniquely qualified to provide medical aid, and her knowledge and experience were needed in the war-torn country.

“The reason I became a nurse was because of my high school teacher,” said Dr. Kashin, who attended high school in Tennessee. “I was a senior in high school and didn’t know what I was going to do. I took a health science class. It was just basic things – taking blood pressure and learning about the human body. One day my teacher said, ‘You would make a great nurse.’ Two of my friends wanted to be nurses, and my mom also encouraged me to go into the medical field. She was sick a lot off and on, and she passed away while I was in nursing school. This devastated me, but she inspired me to live for others. Seeing her care at the hospital and the difference nurses made motivated me to become a nurse, and then later a nurse practitioner.”

Dr. Kashin, who completed a Bachelor of Science in Nursing at the University of Tennessee in Chattanooga, realized that she had the potential to do more for her patients but that she would need to expand her training and education to do so.

“I felt I was restricted as a nurse because my knowledge base was limited,” Dr. Kashin said. “In 2014, my dad had a pulmonary embolism. Being in a room with him and unable to help him felt horrible, so I decided to go back to school, and I applied to Frontier.”

“I loved Frontier,” said Dr. Kashin, who now works in maternal-fetal medicine (MFM) at the University of Florida Health Hospital in Gainesville, Florida. “Going back to school as an adult is a completely different experience. I wanted to learn, and I really loved it. The Frontier faculty and staff were extremely invested in my success and very supportive. I struggled in undergrad so much that I never thought I could do well in a doctorate program, but I graduated with a 4.0. Frontier had a lot of emphasis on rural medicine and helping underserved people. This lines up exactly with my life’s vision. I was always interested in working with the marginalized and poor. I think it is because I know what it is like to live on the other side of the railroad tracks and have very little. Even now, I work with a population that does not have regular access to medical care, many do not have insurance unless they are pregnant. Frontier helped frame my thinking and opened my eyes to many health care disparities, and is why I did not go into private practice.”

“The Frontier faculty and staff were extremely invested in my success and very supportive…Frontier had a lot of emphasis on rural medicine and helping underserved people. This lines up exactly with my life’s vision…Frontier helped frame my thinking and opened my eyes to many health care disparities, and is why I did not go into private practice.”
– Viktoriya Kashin, DNP, FNP, FNU Alumnus

In her first three years in MFM, Dr. Kashin worked outpatient, but a year ago, she switched to inpatient care. Among the conditions that she helps treat are patients with premature rupture of membranes (PROM). These patients’ water ruptures early, and they are hospitalized to help prevent them from delivering too early. The MFM team also treats preeclampsia, which is high blood pressure during pregnancy. Those with severe cases of preeclampsia are hospitalized and treated to help them remain pregnant as long as possible while preventing seizures or other complications. Other conditions treated include diabetes, multiple gestations, fetal anomalies, and infections.

The high-risk and labor halls are all closely connected, as is the tight-knit staff. A typical shift consists of 12 nurses and three residents, including a general attending, an MFM attending, a nurse practitioner, or a certified nurse-midwife.

“We share a workspace and often help each other out,” Dr. Kashin said.

That level of support came into full view when Dr. Kashin answered the call to go on a mission trip to help the people of Ukraine. Her hospital was no stranger to the nursing shortage prevalent throughout the country, yet her request was met with nothing but support.

“I told my boss I needed 3 weeks off, and he said, ‘What can I say? It’s for humanity,’” said Dr. Kashin, who created a fundraiser to help pay for the mission trip. “Many people had to step up and cover for me at work. My co-workers even organized a bake sale, collecting thousands of dollars. They also put out a department-wide email with my fundraiser links, and many donations came from the faculty and staff at the University of Florida. They were immeasurably kind and supportive.”

Dr. Kashin had always thought about going on a medical mission. She just didn’t think it would be such a personal trip.

“When the war broke out, I really wanted to help but didn’t know how. A few days after the war started, my childhood friend Natasha sent me a message stating that they need Russian-speaking female medical professionals (because most of the refugees were women),” Dr. Kashin said. “All that matched up with me. It was like an answer to prayer. At that point, I knew I had to go.”

Along with her coworkers, Dr. Kashin received tremendous support from her community, who supported her GoFundMe campaign. Her brother, Oleg, also went on the trip, and her church paid for their tickets to and from Ukraine. Overall, they raised over $20,000, which they were able to give to people in Ukraine to help with food and other supplies.

Her mission trip, which lasted 20 days and was organized through Crisis Response International, began by flying into Krakow, Poland, and then driving to Ukraine.

“We stayed in a small city an hour away from Poland,” Dr. Kashin said. “It was an old hospital that was only functioning on the first floor. The other levels were empty for decades, and that is where the refugees moved in. Our team, however, rented a couple of rooms in a gym and stayed on the top floor. We just had two rooms – one for the guys, one for the girls. We didn’t always have hot water. The heat wasn’t working. There wasn’t a stove or kitchen. We were definitely roughing it.”

Dr. Viktoriya Kashin with her brother, Oleg, outside of the refugee center.

The refugee center was organized by a husband and wife who had a long-standing connection to local orphanages. The husband himself was an orphan growing up, and the couple had also adopted two orphans.

“They got in touch with the orphanages and brought the orphans from all over Ukraine to the refugee center,” Dr. Kashin said. “From there, the orphans were sent to Austria and Germany. Every day there would be a bus full of kids leaving and going elsewhere. That’s how they started the refugee center. They had a chef that was a refugee herself who volunteered her services. They would cook three meals every day. There was a little office that we made into a clinic. It was easier just to show up with a stethoscope around your neck than to make appointments. The refugees would just stop you in the hall and tell you whatever ailed them, often inviting us into their rooms. Every day I would go in and see patients. I had a couple of pregnant patients and a couple of newborn babies. We also went to train stations and gave out goodie bags full of supplies. One day we met a pregnant woman that didn’t have anywhere to go. She and her family were able to come to the refugee center that same night to have a place to stay.”

Dr. Kashin explained that drivers would take vans into the ravaged areas and pick people up and get them out. Some of the money that Dr. Kashin and her brother raised helped repair the vans and protect the drivers, who were frequently under fire.

Even in the relative safety of the refugee center, however, there was an element of constant threat and danger.

“Every day, the bomb sirens would go off,” Dr. Kashin said. “Many people at the refugee center had PTSD (post-traumatic stress disorder). Every time a door slammed, they would jump.”

Despite the constant reminders of the violence all around them, the volunteers did their best to make the refugee center as comfortable and welcoming as they could. In addition to the meals, room to sleep, and access to medical care, a hairstylist gave haircuts, and other women offered massages. Often, the refugees just wanted someone to talk to.

A new father feeds his baby in the hospital where Dr. Kashin and her mission group delivered medical supplies.

Dr. Kashin stands in front of the refugee center’s makeshift medicine cabinet.

“They just wanted to tell you where they came from, their pets they left behind, their husband or brother or father who is fighting,” Dr. Kashin said. “We just sat with them and listened and offered encouragement and tried to give them any help we could. I held back a lot of tears.”

In addition to the supplies they brought with them, the refugee center regularly received shipments of humanitarian aid from the U.S. and other European countries, including diapers and formula (before the formula shortage), warm clothes, and medications.

“The airline didn’t charge us for extra bags because it was humanitarian aid,” Dr. Kashin said. “It was really neat to see how the U.S. and the whole world responded to Ukraine.”

After 20 days, Dr. Kashin returned to the U.S., but her brother remained in Ukraine, continuing to forge relationships and deliver supplies.

“It was hard coming back. I had a little bit of survivor’s guilt,” Dr. Kashin said. “This is pretty much home country. If I didn’t come to the U.S. as a child, what would my life be? I could be one of those women that were raped and killed. It is horrendous to think about.”

Activities for the refugee children included making arts and crafts.

She intends to return to Ukraine at some point. In the meantime, she continues to raise funds for supplies and remains in contact with many of the people she met there. More difficult, however, is communicating with her Russian family. The topic of “war” is completely off-limits.

Beyond a return trip to Ukraine, Dr. Kashin’s plans are wide open, thanks to MFM being such a large field. She can continue or perhaps select something new.

“I really love women’s health she said. “There is so much to learn in this field. I would like to do more medical mission work in the future. For now, I am happy where I’m at.”

One thing she does know is that the people of Ukraine will persevere.

“They are running out of gas, and they have nothing to fight with. But they are a very resilient people,” she said. “Even though the war is still going, certain parts of Ukraine are being rebuilt already. I’m very thankful for everyone who has shown support with money, encouragement, and prayer.”

National Academies of Practice Inducts Dr. Vicky Stone-Gale as a Distinguished 2022 Fellow

June 27, 2022 By frontieredu

The National Academies of Practice (NAP) recently announced the election of Dr. Vicky Stone-Gale, DNP, APRN, FNP-BC, FAANP, FNAP, as a Distinguished 2022 Fellow. Class of 2022 Fellows were welcomed into the National Academies of Practice during the awards and induction ceremony in San Diego, California, on March 5, 2022.

In the fall of 2020, Dr. Stone-Gale and her daughter Jennifer Stone, DNP, APRN, FNP-BC, became the first APRNs licensed as autonomous advanced practice registered nurses in the state of Florida. They received the good news after a house bill permitting select APRNs to practice in primary care was signed into law by the Florida governor earlier that year. The Autonomous Nurse Practitioner practices in primary care settings permitting the APRN to be independent of physician general supervision to provide care throughout Florida.

“To be elected by my peers as a Fellow of the National Academies of Practice is truly an honor,” Dr. Stone-Gale said. “This organization works toward the common goal of working with all professions to advocate for quality healthcare for all individuals. This will only improve the outcomes of our patients, which is what is needed for everyone.”

Founded in 1981, NAP is an interprofessional, nonprofit organization with membership representing a range of healthcare professions willing to serve as distinguished advisors to healthcare policymakers in Congress and elsewhere. The mission of the National Academies of Practice is to serve as distinguished professionals advancing interprofessional healthcare by fostering collaboration and advocating policies in the best interest of individuals and communities.

The academies within the National Academies of Practice include Allopathic and Osteopathic Medicine, Athletic Training, Audiology, Dentistry, Nursing, Occupational Therapy, Optometry, Pharmacy, Physical Therapy, Podiatric Medicine, Psychology, Social Work, Speech-Language Pathology, and Veterinary Medicine.

Fellowship in the National Academies of Practice is an honor extended to those who have excelled in their profession and are dedicated to furthering interprofessional practice, scholarship, and policy in support of interprofessional care. The central purpose of NAP is to advise public policymakers on health care issues using NAP’s unique perspective — that of expert practitioners and scholars joined in interprofessional dialogue and advocacy.

To learn more about Dr. Stone-Gale and her work in advocacy, listen to our podcast.

Faculty Spotlight: Dr. Kristin Gianelis Recognized with Circle of Caring Award

June 16, 2022 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 that are focused on the mission of educating nurse-midwives and nurse practitioners to deliver quality health care to underserved and rural populations.

Frontier Nursing University (FNU) is proud to recognize faculty member Kristin Gianelis, DNP, APRN, ANP, WHNP, who was one of the recipients of the Winter 2021 Circle of Caring Award.

A resident of Barrington, Rhode Island, Gianelis serves as a Doctor of Nursing Practice (DNP) faculty member for FNU. Through this role, she mentors DNP students to become agents of change in their communities. Outside of her work with the university, she also works in a clinical setting and dedicates her time to improving healthcare access for underserved populations.

“If I can provide patient-centered care to even a few individuals who wouldn’t have been able to receive healthcare otherwise, I consider my work a success,” she said. “I walk into each clinical day not knowing what I will encounter, but with only the intention of providing each person dignity, respect and the opportunity to have their individual needs met.”

Over the last 17 years, Gianelis has worked in a variety of settings as a dual-certified Women’s Health and Adult Nurse Practitioner. She currently works for an urban Federally Qualified Health Center (FQHC) and provides OB/GYN care for a gender-diverse and largely undocumented immigrant population.

Gianelis said her initial inspiration to pursue nursing was to help women and families navigate normal life changes, but her scope of perspective has changed throughout her career.

“As I have developed a more broad understanding of gender and sexuality, I would now say that I recognized the importance of this aspect of our beings and honor the unique path to sexual wellness for each individual,” she said. “It is my honor to give voice to all individuals and provide patient-centered sexual health care across the lifespan.”

Before receiving her bachelor’s degree from Wheaton College in Norton, Massachusetts, Gianelis applied for immediate direct entry into a Master of Science in Nursing (MSN) program.

“I finished my bachelor’s on a Saturday and started my master’s on the following Monday,” she said.

Gianelis earned her MSN in 2005 after taking a break to work as a Registered Nurse (RN). She worked as a Nurse Practitioner (NP) for 13 years before earning her Doctor of Nursing Practice (DNP) from FNU.

“Obtaining my doctoral degree taught me to think differently,” she said. “It opened my eyes to quality improvement, developed leadership skills and gave me the confidence to be an agent of change in my community.”

After earning her DNP from FNU, Gianelis decided to stay with the university as a faculty member.

“I chose to work at Frontier because I firmly believe in the mission of this institution. I believe that health equity starts with educating a strong healthcare workforce for the entire country, especially those areas that are underserved.”
– Kristin Gianelis, DNP, APRN, ANP, WHNP

“I chose to work at Frontier because I firmly believe in the mission of this institution,” she said. “I believe that health equity starts with educating a strong healthcare workforce for the entire country, especially those areas that are underserved.”

Gianelis said she embraces FNU’s Culture of Caring, not only when interacting with fellow faculty members, but also with students.

“Working in the DNP program, I have the opportunity to mentor students longitudinally during their clinical quality initiative,” she said. “While they are my students, they are also my colleagues – fellow APRNs working in other parts of the country. Through our interactions, I have the opportunity to understand how practice and policy differs nationwide, while also expanding on my own narrow experience of life in the northeast. Not only does this enrich my life intellectually, but I am embraced by each students’ warmth and openness to share their experiences and unique points of view.”

The Culture of Caring also is important in the context of Diversity, Equity and Inclusion (DEI) work at FNU, Gianelis said.

“I am here to amplify marginalized voices, shelter those who need rest, and support diversity in all its beauty,” she said.

Gianelis is married to her husband Steve, and has two children and a dog. She enjoys traveling, boating, cooking and reading.

Thank you, Kristin, for your dedication to providing healthcare access to underserved populations and for living out our Culture of Caring!

If you know an FNU staff or faculty member that goes above and beyond, nominate them now for the Circle of Caring Award!

Boston Midwife Prepares to Open Alabama’s First Birth Center

June 14, 2022 By Frontier Nursing University

To the casual observer, opening Birth Sanctuary Gainesville might not make a lot of sense. First, Gainesville is a rural town in Alabama with a population of less than 200. Second, because of state regulations that severely restrict the scope of care nurse-midwives can provide, there are no birth centers in the entire state. That is about to change because FNU alumni Dr. Stephanie Mitchell, DNP, CNM, CPM, plans to open Birth Sanctuary Gainesville later this year. While the uncertainties are many, Mitchell insists, “It will get done.”

Mitchell is the sort of person who finds ways to get things done. Barriers represent an opportunity rather than a permanent roadblock. Even her road to becoming a nurse-midwife was a circuitous one. Where others might have given up and changed course, Mitchell never wavered from her plan.

Growing up in urban Boston, Massachusetts, in the 1980s, Mitchell’s first thoughts of pursuing a medical career began by watching The Cosby Show.

“My very first exposure to childbirth was on television,” Mitchell said of The Cosby Show. “It was very shocking to me because the family would have mirrored my family, except that they were completely different echelons of human society. We were struggling along in the hood, the ghetto, dealing with all the things that 1980s Boston brought for a low-income black family. It was the opposite on TV. The father was an obstetrician, and the mother was a lawyer. That was my first exposure to pregnancy, and the healthy dynamic of that family really appealed to me and stuck with me.”

Her second exposure to pregnancy and her first to obstetrics came a few years later when she was 16 and pregnant. She had collaborative care with an obstetrician and a midwife.

“The way my body was honored during that process of pregnancy is really cemented into my mind,” she said. “I figured out that the word wasn’t ‘obstetrician’ or ‘obstetrics’ – it was ‘midwife’. I thought, ‘How do I do that?’”

She did that by having her baby, finishing high school, attending community college, and going on to earn her BSN from Curry College. She knew she wanted to be a midwife and wanted to attend Frontier Nursing University. She also knew that she needed to gain experience, preferably in labor and delivery. She worked in pediatrics for about six years before getting into a labor and delivery unit, where she worked for six years before applying to Frontier. She continued working in labor and delivery while she earned her MSN and DNP from FNU, the latter in 2019.

“The hospital I worked at was a lovely place in the backdrop of my neighborhood in Boston. I learned so much and have deep respect for my colleagues there,” Mitchell said. “But it was shocking to me to get to the labor and delivery unit and realize that the medical staff was not reflective of the community. I had come from the Boston Children’s Hospital, and we had a very diverse staff. I got to the labor and delivery unit, and it was shocking to be one of three black nurses on a staff of 120 in that unit. That was difficult because there are so many stark cultural differences between the care providers and those that they are caring for.”

Mitchell had learned the importance of diversity at an early age when she was part of a busing program aimed at addressing segregation in the city. She attended school in a predominantly white school system.

“You learn to interact with people who are definitely not from your community,” she said. “To have experience with individuals that don’t look like you, don’t talk like you, don’t have the same cultural norms as you, provides exposure that’s valuable in life. Midwives and advanced nurse practitioners are not always going to be black or people of color or LGBTQ, but you have to have people in place who are truly antiracist and empathetic.”

Mitchell was also concerned about what she termed “the conveyor belt of care” that sometimes persists in hospitals with high volumes of patients. She wanted to practice in a different setting, where more time could be spent with the patients in a less frantic environment. She wanted to open a birth center and started looking into the prospects in Boston. She soon realized that funding would be a problem, as would the significant amount of competition. She shelved the idea temporarily until she and her husband Jamie moved to Gainesville, Alabama, where Jamie had family.

Jamie is a successful pitmaster who got into the catering business. When the catering business became overwhelming, the Mitchells realized that a restaurant would be the better option. Starting a restaurant in Boston would not only be expensive but also involve a great deal of competition.

“He wanted to get rid of the landlord and the competition, so we came down here to Gainesville and built a restaurant,” Mitchell said. The Alabama Rib Shack is open Friday through Sunday, with the capacity to cater as needed.

As they prepared to move, Mitchell began researching places where she might be able to work. She soon found that there are no birth centers in the state. Further, in Gainesville and the surrounding area, there is no access to family planning services, midwifery care, or obstetric care.

“If you’re pregnant, it’s a desert,” Mitchell said. The nearest options are approximately 45 miles away in Tuscaloosa or across the state line into Mississippi.

It didn’t take long for Mitchell to think about opening her own birth center in Alabama. Not only did she need it as a source of income, but the community needed it as well.

“I’ve always valued the low volume, slower-paced care that can be offered through midwifery,” Mitchell said. “I had a good amount of surface information to build on what it would mean to build a birth center in Alabama. It was important to me to work in the black and not be in a situation where I am over my head and sink myself before I get started. Kitty Ernst wisely once reminded me to follow the money. I followed the business model that my husband has followed for years – eliminate the competition and eliminate the landlord. There is no competition in Alabama, and people deserve to have options. To not have it as an option is unconscionable.”

While many would agree with that, few have been as determined as Mitchell to bring about the necessary changes. One of the primary barriers created by the state’s legislation and regulation of midwives is the prevention of independent practice. Mitchell sought out physicians with whom she could partner to provide collaborative care but found none.

Midwives who attended out-of-hospital births in Alabama were jailed until 2019 when the state began issuing midwifery licenses for Certified Professional Midwives (CPM) for the first time since 1976. Contrary to Certified Nurse-Midwives (CNM), who have nursing degrees, CPMs are not required to have a nursing degree. Despite being a CNM, Mitchell had to get a CPM license so she could practice in Alabama.

“I was annoyed that I had to be a CPM because it prevents me from offering those full range of comprehensive health services,” Mitchell said. “ I see the value in being a Certified Nurse-Midwife. I see the value of being able to provide that umbrella of comprehensive care. Why would anyone ever specifically go the path of CNM only to be boxed in a corner to be a CPM? Prescriptive authority, billing insurance, access medications, full-scope care – it’s all gone. Especially in a healthcare desert like Alabama, it doesn’t make any sense. I’m still fighting that battle. It will take a while. But it’s not, ‘we can’t do it,’ it’s ‘we haven’t done it yet.’”

Mitchell says that the Alabama Birth Center Coalition, Alabama Midwife’s Association, the Alabama Board of Midwifery, and the Alabama chapter of the American College of Nurse-Midwives are all lobbying for change. In the meantime, she is pressing forward with Birth Sanctuary Gainesville. For years on their visits to Alabama, Mitchell had admired an old two-story home in Gainesville. Built in 1835, it is a registered historic landmark. It sat empty for years until, shortly after they moved, Mitchell saw that it was for sale. The Mitchells bought it and began renovation and construction to convert it into a birth center.

The roof, soffits, plumbing, electrical, and HVAC all had to be replaced or updated, but the structure was good, and the price and location were right. An exam room and a bathroom have been added, and the work continues with hopes of opening later this year.

“My first goal is to get this birth center opened this year and have our first birth here this year,” Mitchell said.

Grassroots efforts have provided the majority of the funding for the construction of the birth center. One fundraiser is a legacy walkway campaign in which people can purchase bricks and inscribe their own messages. Another fundraiser included the creation of three $5,000 scholarships that will go to BIPOC (Black, Indigenous, and people of color) midwifery students.

“This grassroots effort is a constant return back into the systems we’re working in,” Mitchell said. “It’s been overwhelming. I’ve been filled with gratitude, and I remain so humble about this project, reminding myself that this isn’t a ‘me project.’ This is a project that will impact so many families just to be able to have that access to care.”

Mitchell hopes to continue to give back to the nurse-midwifery profession by precepting students. She knows drawing them to rural Alabama might be difficult so that the birth center will include a special space for students. Mitchell describes it as a calm room where students will be able to rest or sleep in their own private space.

Until the birth center is ready to open, Mitchell is operating as an LLC and providing home birth services as a CPM. She plans to continue to offer home births even after Birth Sanctuary Gainesville is fully operational. She is also working with the University of Alabama-Birmingham’s midwifery program, assisting with course development and serving as an adjunct professor.

“I have been delighted to take part in that program,” she said. “I believe that’s the solution. UAB is a stronghold for the state. They are highly influential, and what better investment into the future of maternal healthcare and pregnancy healthcare than having a school that is going to be educating the midwives? That will lay the groundwork for accessibility in ways that we haven’t even thought about in this state.”

Mitchell has successfully managed to fund the birth center to this point and continues to advocate for more access to nurse-midwifery care in the state. She has overcome many obstacles and knows many more loom ahead, not the least of which is the potential patient population.

“It doesn’t make any sense to build a birth center here,” she said. “The same thing about my husband having a restaurant here. It seems highly unlikely and improbable. But what he has learned is that people will travel for quality. They will do it in Alabama for barbecue in a minute. There is the same sort of model in terms of accessibility. We’re talking zero freestanding birth centers in the state. It becomes a question of, ‘Do you want to travel to get care?’”

Mitchell said that, in order to help with that, they are even considering providing space for families who make the journey with their loved ones. It’s true that travel is a potential hurdle, but true to her nature, Mitchell sees not only the barrier but also the potential solution. In the end, it all makes perfect sense.

Are you interested in learning more about Certified Nurse-Midwives? Learn about the care they provide.

Editor’s Note:
Dr. Mitchell wishes to acknowledge her husband, Jamie. “Making the journey into midwifery with a family could have been my insurmountable obstacle. He’s been my stronghold for the last 20-plus years.” She also expressed her gratitude for the support of her children, Jasmyn, Jaymie, Jayar, and Jesse, and wished to acknowledge former FNU Academic Advisor and current Clinical Advisor Carisa Lipp. “I loved so many of the faculty, but none so much as Carisa. She was the constant person of contact at FNU as I made my way through each term. I can’t say how much her guidance meant. Funny that it wasn’t a midwife who I’d describe as most impactful, but that just goes to show that one’s biggest support can come from unexpected places if you keep your eyes peeled and your heart open!”

Student Spotlight: Carrie Baker uses nursing experience to advocate for public health

May 12, 2022 By Frontier Nursing University

Frontier Nursing University (FNU) student Carrie Baker, MSN, FNP, PMHNP, is utilizing her experience as a nurse practitioner to advocate for the health of her community. Baker is pursuing a Post-Master’s Doctor of Nursing Practice (DNP) at FNU (Class 40) and is set to graduate this year.

A former U.S. Army officer, Baker lives on a Marine Corps housing installation in Hawaii with her two children and her spouse, who is an active member of the U.S. military. There, she serves as a psychiatric-mental health nurse practitioner (PMHNP) for a local nurse practitioner-owned telepsychiatry practice and as a Periodic Health Assessment provider.

Baker’s patient base is wide-ranging, including urban and rural, male and female and local and military. By completing psychological evaluations and medical management via telehealth, Baker is able to reach patients through most of Hawaii’s chain of islands.

Recently, Baker has served as an advocate for the public health and safety of her community. On Nov. 20, 2021, 14,000 gallons of jet fuel spilled at the Red Hill Bulk Fuel Storage Facility, a military storage facility in Hawaii that is operated by the U.S. Navy. As a result, the Navy’s water distribution system, which Baker’s community uses, became contaminated. Soon, residents began complaining of a visible oil sheen on the water, odor and a variety of illnesses.

Seeking accountability and solutions from local leaders, Baker co-organized a community town hall meeting.

“Due to a lack of acknowledgement, validation and communication, our community has taken a stand to be heard,” Baker said. “Somehow, I have found myself at the forefront of this.”

Several key stakeholders were invited to the meeting, including the Naval Facilities Engineering Systems Command Hawaii, Marine Corps Base Hawaii, local housing leadership, local water board personnel and members of the media. During the meeting, community members were given the opportunity to ask questions to leadership personnel.

Baker said some key takeaways from the meeting included increased communication, further water testing, flushing of the community water system, entitlements (such as funds for hotel lodging until the issue is resolved) and continued water points on the installation for retrieval of clean water.

“We are far from having this situation resolved, but we now have the attention of those leaders who matter,” Baker said. “There is still some discord between the community and the leadership in that we still have not been acknowledged as affected.”

Baker said her experience as a nurse practitioner gave her the confidence to advocate for the health of her community. To that end, she said she has decided to earn her DNP to gain confidence in being a leader and advocate for her patients and the community. She said FNU was the right choice in her pursuit of this goal.

“I decided to become a DNP to gain confidence in being a leader and advocate for my patients and community.”
– Carrie Baker, MSN, FNP, PMHNP