Since its foundation in 1939, Frontier Nursing University (FNU) has adopted a mission of reaching rural, diverse and underserved populations. This mission is still being lived out today, where more than 80 FNU alumni are answering the call in Alaska. In the coming months, we will be highlighting several of these alumni who serve in our country’s most remote and unforgiving state.
Holly Fisk, MSN, FNP, ONC, Class 142 is a family nurse practitioner in Anchorage, Alaska where she was born and raised. On November 30, 2018, when a magnitude 7.1 earthquake hit south-central Alaska, her center’s lobby became a triage center.
“That’s the Alaskan way,” Holly said of the center’s care for the earthquake victims. “The emphasis FNU places on rural and underserved communities has been helpful for me in this role. We really take care of one another. In rural areas, you have to pull together and have teamwork.”
Holly and her team at Southcentral Foundation’s Anchorage Native Primary Care Center helped care for the earthquake victims, but additional challenges came in the form of extensive damage to Glenn Highway, one of only two roads out of Anchorage. While Anchorage itself isn’t rural, with a metro population of approximately 300,000, Holly’s clinic serves patients from extremely remote areas, some of which are only accessible by plane. Community health aides in those areas help treat basic conditions and triage those who need to be transported to larger healthcare facilities.
Southcentral Foundation is part of the Alaska Native Tribal Health System, which works in conjunction with Alaska Native Tribes and Tribal organizations to provide comprehensive health services to more than 160,000 Alaska Native people. The health care provided at Holly’s clinic is prepaid via this system.
“We call our patients ‘customer-owners’,” Holly said, noting that essentially all of the patients seen at the clinic are Alaska Native or American Indian people. The clinic serves a population of about 65,000 customer-owners in the Anchorage area.
To meet the needs of those patients, the Anchorage Native Primary Care Center is divided into seven distinct smaller clinics. Each clinic has an integrated care team. Holly serves as her clinic’s only nurse practitioner and is joined by two medical doctors, three physician’s assistants, a doctor of osteopathic medicine, an internal medicine physician, pain management, behavioral health consultants and a nurse-midwife.
Holly, whose preceptor Christopher Haupt-Chronister, MSN, FNP, Class 71, also works at the clinic, says that while the clinic offers every kind of specialty, the access is limited.
“There is not enough access to specialized care,” Holly said. “We have every specialty, but they might come in from another city once a month.”
The lack of access to specialty care often results in exorbitant costs of care, which acts as a barrier for many. Some patients go to Seattle instead, finding it more affordable even with flight and hotel costs.
According to Holly, her time studying at FNU helped prepare her for the challenges of working with a rural and remote population. FNU’s curriculum includes instruction on dealing with complex patients in rural communities where access to specialists may be sparse.
“Our graduates are well-prepared clinicians who are improving healthcare around the country and the world,” said FNU Associate Dean for Family Nursing Lisa Chappell, Ph.D., FNP-BC. “As a Frontier student, you will get to know the needs of your community.”
One of those needs for Anchorage patients is mental healthcare.
“The biggest need is behavioral health services,” Holly said. “It’s a three-month wait right now for intake. We have behavioral health consultants who bridge the gap until the patient can be seen by a psychiatrist.”
Holly notes that the clinic has seen a significant uptick in the number of patients coming in with anxiety, depression and PTSD since the earthquake. The clinic’s behavioral health consultants assist with that, and they have started offering extended appointment times.
“Alaskan Native people emphasize relationships, so we provide very relationship-based care,” Holly said. “Most appointment times are 30 minutes. I love that about this place.”
Holly’s experience with FNU played a significant role in preparing her for her current career. “FNU did a great job in preparing me for the more holistic and relationship-based kind of care that we do here,” she said.
Holly enjoys preventative care and educating her patients while she takes the time to talk to them and to understand their particular needs. Still, when the time comes for more urgent care, the clinic responds quickly to those in need.
“We have excellent same-day access,” Holly said. “We keep appointment times open for those types of urgent situations. That’s what we do. It’s the Alaskan spirit.”