2018 Frontier Nursing University President's Report

Answering the Call.

President’s 2018 Annual Report

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Frontier Nursing University: Founded in 1939, FNU seeks to meet the needs of prospective nurse-midwives and nurse practitioners who want to remain in their home communities while studying to obtain a graduate education to fulfill their professional goals. Students start by completing webbased didactic coursework with the encouragement and support of academic advisers, classmates, a strong curriculum, and active and engaged faculty. Working with clinics, hospitals, and preceptors in their own communities, students gain the hands-on clinical experience required for these exciting health care professions. FNU’s more than 100 faculty members, who are located all over the country, are national leaders in advanced practice nursing and midwifery education.

More about FNU: •

80 years of experience in graduate nursing and nurse-midwifery education

• Offers the oldest and largest continually operating nurse-midwifery education program in the United States • Offered the first family nurse practitioner program in the United States • More than 6,000 alumni • Current enrollment of more than 2,300 students • Students and alumni represent every U.S. state and many foreign countries • 33.84% of our enrolled students are from federally designated rural areas • 73.17% live in health professional shortage areas (HPSA)

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ACCESSIBLE PREPARE FNU Vision:

Answering the Call. ETHICAL COMPETENT To continually improve our status as a center of excellence for midwifery and nurse practitioner education.

FNU Mission:

To provide accessible nurse-midwifery and nurse practitioner education to prepare competent, entrepreneurial, ethical, and compassionate leaders in primary care to serve all individuals with an emphasis on women and families in diverse, rural, and underserved populations.

ENTREPRENEURIAL

COMPASSIONATE LEADERS WOMEN FNU’s Culture of Caring: Professionalism Inclusivity Respect

Positive Communications Mutual Support

FNU’s Culture of Caring initiative drives these values into our talented and diverse community of students, alumni, faculty, staff, couriers, and preceptors. We are inspired by a culture of caring among all members of our university community and it strengthens our focus on our mission of educating nursemidwives and nurse practitioners to deliver quality health care to underserved and rural populations.

FAMILIES DIVERSE UNDERSERVED POPULATIONS 2018 President’s Report | 1

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Contents

Letter from FNU President Dr. Susan Stone . . . . . . . . . . . . . . 3 Letter from FNU Board Chair Dr. Michael Carter . . . . . . . . . . 4 FNU Adopts an Updated Mission Statement . . . . . . . . . . . . . 5 Psychiatric Mental Health Nurse Practitioner Program Addresses Mental Healthcare Shortages. . . . . . . . . 6 The Case for More Nurse-Midwives . . . . . . . . . . . . . . . . . . . 8 FNU Launches Quality Enhancement Plan to Improve Patient Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . 10 FNU Graduates Address Lack of Primary Care Providers in Rural Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 The Road to the Doctor of Nursing Practice . . . . . . . . . . . . 12 Frontier Innovation: The Path to Clinical Practicum . . . . . . 14 Focus on Diversity and Inclusion Yields Positive Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Celebrating Achievements . . . . . . . . . . . . . . . . . . . . . . . . . 17 Accolades . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 FNU At A Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

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Dear Friends, The past year has been filled with change, growth, challenges, and opportunity at Frontier Nursing University. Guiding us every step of the way is our mission and vision. We are determined to provide accessible nursemidwifery and nurse practitioner education that prepares our graduates to make a difference in their communities, particularly serving diverse, rural, and underserved populations.

Letter from the President

In this annual report, you will read about many of the programs, initiatives, events, and accomplishments that shaped a very exciting and busy year. Each and every step we took in 2018 was guided by our mission. On page 5, you can read more about FNU’s mission and the small but significant changes that we adopted in 2018.

This report explores some of the healthcare issues in our country, such as mental health, maternal mortality, and access to primary care. The report also demonstrates that graduates from each of our degree programs are prepared to impact positive change. We invite you to read about the growth of our programs, our emphasis on diversity and inclusion, and the impact of the FNU Community on our nation’s healthcare.

Much like our new campus that is currently being constructed in Versailles, Ky., in the past year, we have continued to build the foundation, enhance the design, and expand the impact of the work we do every day at FNU. It is a slow and steady process, but the vision and goals remain clear.

We are thankful that supporters and friends like you share those visions and goals and see the value of our efforts. We hope that you find this report informative and inspiring, and we thank you for all you do to support FNU.

Susan Stone, CNM, DNSc., FACNM, FAAN

Susan E. Stone, DNSc, CNM, FAAN, FACNM President

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Dear Friends, The Board of Directors is pleased to share this annual report with you.

Letter from the Board Chair

As you will see, lots of things have happened over the past year but we still have many things to do. Opening the new campus and better managing our other properties takes a good deal of our time. The real focus of our work, however, is to provide the very best education for nurse-midwives and nurse practitioners that we can and to do this at an affordable price. Our graduates are the key health care providers for hundreds of communities and families, many who live with poverty and in rural or underserved locations.

We think that Mrs. Breckinridge would be pleased with our achievements but would push to do more. America still has one of the deadliest maternity systems in the world and it is particularly so for women of color. None of us can rest or remain silent until this is corrected. Our faculty and our students continue to lead many of the required changes to improve care.

We thank you for your continued support of the university as we continue to keep alive the spirit and vision of Mrs. Breckinridge.

Michael Carter, DNSc, DNP, FAAN, FNP/GNP-BC Chair, Board of Directors

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FNU Adopts an Updated Mission Statement In 2018, the FNU community of leaders, including the Board of Directors, Leadership Council, Trustees, and several members of the faculty and staff, met to discuss FNU’s mission and philosophy. The purpose of the discussion was to ensure that FNU’s mission statement was an accurate reflection of the university’s purpose and direction. FNU has a strong commitment to diversity and inclusion (see page 15 for more), which led the mission and philosophy committee to suggest language that directly addressed that commitment. The discussion led to small but significant changes. The revised mission statement was voted on unanimously approved by the committee and FNU’s Board of Directors.

“We felt it was very important to make sure that our mission statement accurately reflected the true mission and purpose of Frontier Nursing University,” said FNU President Dr. Susan Stone. “We received input from not only our Board of Directors, but also our Trustees, Leadership Council, faculty, and staff. It was a collaborative effort that has resulted in a more inclusive mission statement.”

Our mission is to provide accessible nurse-midwifery and nurse practitioner education to prepare competent, entrepreneurial, ethical, and compassionate leaders in primary care to serve all individuals with an emphasis on women and families in diverse, rural, and underserved populations.

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Psychiatric-Mental Health Nurse P Mental Health c Access to Care In October 2018, the National Council for Behavioral Health released the results of a study which indicated that lack of access was the root cause for the mental health crisis in America*. The study revealed that 56 percent of Americans are seeking mental health services for themselves or loved ones. The study found that 96 million Americans have had to wait longer than a week for mental health treatments. In addition, 46 percent of those seeking mental health treatment have had to drive more than an hour round-trip to receive treatment.

The Opioid Epidemic The opioid epidemic is contributing to the mental health crisis in America. A report issued by the U.S. Department of Health and Human Services revealed that in 2017, 11.4 million Americans misused prescription opioids and two million people misused prescription opioids for the first time†.

The number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was six times higher than in 1999.

Class 155, FNU’s first PMHNP class.

The opioid epidemic has become a public health crisis with devastating consequences including increases in opioid misuse and related overdoses, as well as the rising incidence of neonatal abstinence syndrome due to opioid use and misuse during pregnancy. Use of opioids during pregnancy can result in a drug withdrawal syndrome in newborns called neonatal abstinence syndrome or neonatal opioid withdrawal syndrome‡.

The mental health aspect of the opioid epidemic is revealed in the data as well. Among adults who misused prescription tranquilizers at least once in the past year, the most common reasons for the last misuse were to relax or relieve tension (46.2 percent§).

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e Practitioner Program Addresses h care Shortages FNU’s Contribution to the Solution FNU launched its Psychiatric-Mental Health Nurse Practitioner (PMHNP) program in January of 2017 and proudly presented Kelly England, DNP, FNP-C, PMHNP, and Lisa Uribe, MSN, FNP-BC, PMHNP, as the first two graduates of the program in 2018.

The January 2017 class started with 19 students and FNU is now accepting 40 students into the program per each quarterly term.

“It has been an absolute pleasure to guide and educate our PMHNP students,” said FNU faculty member Dr. Tracy Hicks, APRN, FNP-BC, PMHNP-BC, CARN-AP. “The program is well structured with a wealth of information accessible to the students.

The hands-on involvement with clinical sites is an asset to the program. I have learned a great deal in working with this diverse group of students who have much to offer to the psychiatric mental health community.”

“I am more confident in my ability to care for patients with mental illness after taking the core courses,” said Rachel Houser, a graduate of the program. “I have learned valuable tools in this program that I plan on incorporating into practice to provide quality care for clients with serious mental illness.”

In January 2019, FNU named Jess Calohan, DNP, PMHNP-BC, as the new director of the PMHNP program. A retired Lieutenant

“I have learned valuable tools in this program that I plan on incorporating into practice to provide quality care for clients with serious mental illness.”

Rachel Houser

Colonel in the United States Army, Calohan served the military in a variety of medical positions for 20 years. Most recently, he was the Program Chair and Assistant Professor of the PMHNP program in the Graduate School of Nursing at Uniformed Services University of the Health Sciences in Bethesda, Md., from 2013-2017. His distinguished military record includes a long Jess Calohan, DNP, PMHNP- list of awards, including a Bronze BC, became the director of Star, the Defense Meritorious FNU’s PMHNP program in Service Medal, two Meritorious January 2019.

Service Medals, and eight Army Commendation Medals. His professional activities include memberships in the American Association for Men in Nursing, the American Psychiatric Nurses’ Association, and the American Association of Nurse Practitioners.

“I am honored to accept the PMHNP director position at FNU,” Dr. Calohan said. “I have long been impressed by FNU’s organizational values, model, and the success of its programs.

I am excited to lead this program and continue FNU’s legacy of preparing outstanding students to provide excellent healthcare in their communities.”

PMHNP faculty member Dr. Hedy Rougeau, DNP, said the program will continue to grow and improve with the leadership of Dr. Calohan, the expertise of the faculty, and the dedication of the students. “The PMHNP program at FNU prepares students very well to become PMHNPs,” Rougeau said. “I appreciate how integrated the primary care mental health model is part of this PMHNP program.”

*Wood, Paul, et al. New Study Reveals a Lack of Access as Root Cause for Mental Health Crisis in America. 2018/10/10, National Council for Behavioral Health, https:// www.thenationalcouncil.org/press-releases/new-study-reveals-lack-of-access-as-root-cause-for-mental-health-crisis-in-america/ †HHS.GOV/OPIODS. The Opioid Epidemic by the Numbers. Jan. 2017, https://www.hhs.gov/opioids/sites/default/files/2019-01/opioids-infographic_1.pdf ‡National Institute on Drug Abuse. Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome. Jan. 2019, https://www.drugabuse.gov/related-topics/ trends-statistics/infographics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome §Rachel Lipari, et al. Why Do Adults Misuse Prescription Drugs? Substance Abuse and Mental Health Services Administration. 2017/07/27, https://www.samhsa.gov/data/ sites/default/files/report_3210/ShortReport-3210.html

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The Case for More N The Maternal Mortality Crisis

Why More Midwives are Needed

Maternal mortality has become a hot-button political topic, and with good reason. According to the United Health Foundation, the 2018 maternal mortality rate in the U.S. was 20.7 deaths per 100,000 births from any cause related to or aggravated by pregnancy, excluding accidents*. The U.S. is the only industrialized nation with a rising maternal mortality rate, and between 2000 and 2014, there was a 26% increase in the maternal mortality rate †.

Data suggests that nurse-midwives could help dramatically improve the nation’s maternal mortality crisis. The Lancet Series on Midwifery§ found that midwives are linked to higher rates of physiologic birth and fewer adverse neonatal outcomes. The report noted that approximately 10 percent of U.S. births are attended by nurse-midwives, compared to 50-75 percent in other high-resource countries.

Increasing access to nurse-midwives starts by increasing the number of nurse-midwives. FNU is helping to meet the demand by increasing the numbers of nurse-midwives graduating each year.

Many chronic conditions and diseases are associated with pregnancy complications. A study by the United Health Foundation reported that rising rates of chronic disease such as obesity, hypertension, and cardiovascular disease have contributed to the rise in maternal deaths†.

The numbers are even more alarming for women of color.

According to the Centers for Disease Control and Prevention‡, black women are three to four times more likely than white women to die from pregnancy-related complications.

Contributing factors to these disparities in healthcare are financial, bureaucratic, transportation, language barriers, and care that is not consistently culturally appropriate or respectful.

FNU alumna Kristina Amundson, DNP, CNM, moved to Fairbanks, Alaska, in 2009. She is a nurse-midwife at Interior Women’s Health in Fairbanks and attends 60-70 births per year.

Amundson is just one of seven FNU nurse-midwife alumni in Fairbanks.

FNU Nurse-Midwifery Graduates, 2013-2018 300

“[The new regulations] significantly changed the landscape of birth centers here in Colorado, and it’s had a positive impact on the community as more have opened.”

285 236

200 179

174

2013

2014

210

210

2015

2016

100

Aubre Tompkins

0 2017

2018

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e Nurse-Midwives “I think FNU has touched this community in a positive way,” Amundson said.

“We have more midwives than obstetricians. If we didn’t have the ability to go to FNU and have distance learning, that wouldn’t be the case here.”

While FNU’s distance learning helped Amundson and her colleagues in Alaska, other FNU graduates have benefited from FNU’s focus on leadership. For instance, some nursemidwives face state regulations that limit their opportunity to practice, thus reducing the number of healthcare providers available to address maternal mortality issues.

Kristina Amundson is a nurse-midwife at Interior Women’s Health in Fairbanks, Alaska.

“I think FNU has touched this community in a positive way,” Kristina Amundson

FNU alumna Aubre Tompkins, BSN, RN, MSN, CNM, is a nurse-midwife at Women’s Health Group in Thornton, Colo.

Prior to her work there, she worked at Mountain Midwifery Center in Englewood, Colo. Confronted by outdated state regulations and licensing for birth centers, Mountain Midwifery joined Aubre Tompkins helped challenge outdated with three other state regulations in Colorado. birth centers to form the Colorado Birth Center Coalition and filed a petition to review the regulations.

“It was a grueling, eye-opening process,” said Tompkins, noting that new regulations were signed into law in 2017. “I will always be proud of that as I look back on my career. It significantly changed the landscape of birth centers here in Colorado, and it’s had a positive impact on the community as more have opened.”

FNU is very proud of graduates like Tompkins and Amundson.

They are certified nurse-midwives who are serving their communities and effecting lasting change. They exemplify the impact that nurse-midwives can have as we address the maternal mortality crisis in the U.S.

*United Health Foundation, AmericasHealthRankings.org. Maternal Mortality. Accessed May 2019, https://www.americashealthrankings.org/explore/health-of-women-andchildren/measure/maternal_mortality †Source: MacDorman, M., Declercq, E., Cabral, H., Morton, C., “Is the United States Maternal Mortality Rate Increasing? Disentangling trends from measurement issues: Short title: U.S. Maternal Mortality Trends.” Obstet Gynecol. 2016 Sep; 128(3):447-55. ‡Eleni Tsigas, et al. Meeting the challenges of Measuring and Preventing Maternal Mortality in the United States. 2017/11/14, https://www.cdc.gov/grand-rounds/ pp/2017/20171114-maternal-mortality.html §The Lancet. Midwifery: An Executive Summary for The Lance’s Series. June 2014, https://www.thelancet.com/pb/assets/raw/Lancet/stories/series/midwifery/midwifery_ exec_summ.pdf

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FNU Launches

Quality Enhancement Plan to Improve Patient Outcomes From its founding, FNU has a history of responding to the needs of the community and addressing healthcare gaps. For example, FNU’s education model enables students to learn while practicing in the communities in which they serve, thus helping to address healthcare gaps in rural, diverse, and underserved populations.

Similarly, in response to the shortage of access to mental healthcare, FNU launched its Psychiatric Mental Health Nurse Practitioner (PMHNP) program in 2017 (see page 6 for more about PMHNP).

environment by utilizing the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) framework developed by the Agency for Healthcare Research and Quality (AHRQ). The vision of this QEP aims to broaden and enhance healthcare team communication and teamwork skills by focusing on four specific aims:

Another initiative now underway at FNU is in response to national data that shows that communication between healthcare providers as well as communication between providers and their patients is a critical safety problem in our healthcare system. It is estimated that 80 percent of serious medical errors involve miscommunication. A 2016 study by Johns Hopkins claimed that more than 250,000 people in the U.S. die every year from medical errors*.

• Apply principles of healthcare team leadership

Interdisciplinary education has been the focus of discussion at the Institute of Medicine (IOM), now renamed the National Academy of Medicine, for over 40 years. The IOM found that patients received safer, high-quality care when health care professionals worked effectively in a team, communicated productively, and understood each other’s roles. When all clinical and nonclinical staff collaborate effectively, healthcare teams can improve patient outcomes, prevent medical errors, improve efficiency, and increase patient satisfaction.

Accordingly, FNU’s latest Quality Enhancement Plan (QEP) is focused on improving interprofessional and intraprofessional communication and other teamwork skills in the healthcare

• Demonstrate an understanding of healthcare team communication

• Recognize healthcare team situation monitoring • Examine strategies for healthcare team mutual support “We know that if we can improve teamwork and communication, we will improve healthcare outcomes,” said FNU Associate Dean and Associate Professor Tonya Nicholson, DNP, CNM, WHNP-BC, CNE, FACNM. “This is especially critical in points of transition, meaning when a patient’s care is handed off from one provider to another, when a patient is transferred from one unit to another, or when moving from one hospital to a tertiary care center where a higher level of care is more appropriate.”

Accordingly, TeamSTEPPS experiences will focus on the care of the people FNU graduates serve, regardless of the student’s clinical setting. Educational activities will build on foundational information to allow students to apply their knowledge to solve problems, improve communication, and create team-based plans of care. Student learning outcomes will be based on nationally accepted competency domains to ensure that students truly learn how to work in the healthcare team environment. The courses with integrated content will enhance student capabilities to utilize TeamSTEPPS, and the assessment data will be measured institutionally to assure positive impact on student learning.

FNU is excited to launch this QEP, to better train our students to be exceptional healthcare leaders in the communities in which they serve across the globe.

* Daniel, M. Study Suggests Medical Errors Now Third Leading Cause of Death in the US. 2016/05/03, Johns Hopkins Medicine Current News Releases, https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us[d]

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FNU Graduates Address Lack of Primary Care Providers in Rural Areas According to a report by Becker’s Hospital Review, the ratio of physicians to patients in rural areas in the United States is 1 to 2,500*. That means that 60 million Americans are impacted by limited access to primary care providers. According to a study published by Health Affairs, because many physicians are now choosing specialties rather than primary care careers, the number of new primary care physicians is not sufficient to replace those who are retiring. In rural communities, the net loss of even one primary care physician can have a significant impact on access to care†.

While the primary care physician numbers are dropping, the number of nurse practitioners continues to grow. According to the Health Affairs study, the number of primary care practices including nurse practitioners increased from 35 percent in 2008 to 45.5 percent in 2016. In rural practices during that time span, the presence of physicians dropped from 69.4 percent to 60.5 percent while the presence of nurse practitioners increased from 17.6 percent to 25.2 percent.

In addition to his work in McCreary County, Ky., James Corder recently went on a medical mission trip to Africa.

A report entitled “Nurse Practitioner Cost Effectiveness,” published by the American Association of Nurse Practitioners, stated, “There is a solid body of evidence demonstrating that NPs have consistently proven to be cost-effective providers of highquality care for almost 50 years‡.”

FNU is at the forefront of this shift in primary care, preparing highly trained graduates via the Family Nurse Practitioner, Women’s Health Nurse Practitioner, Community-based Family Nurse Practitioner, and Psychiatric Mental Health Nurse Practitioner degree tracks. In 2018 alone, FNU awarded degrees to 324 Nurse Practitioner students, 22 Women’s Health Nurse Practitioners, 30 Psychiatric Mental Health Nurse Practitioners, and 27 Community-Based Women’s Health Care Nurse Practitioners.

FNU graduate James Corder, DNP, APRN, FNP-C, DNP, practices in McCreary County, Ky., where the nearest hospital is 30 miles away. Furthermore, there are no physicians at his practice. For that reason, Corder said nurse practitioners in McCreary County are relied upon to do more.

“In general, we must do more than what an NP would do in traditional primary care practice,” Corder said. “We rely more on our clinical skills than a clinic where we might have access to a hospital. At Frontier, students are ready to just dive in and see whatever the preceptor is seeing because they have completed their didactic coursework up front.”

FNU takes pride in educating and training nurse practitioners who are ready to hit the ground running and take on new challenges.

Our graduates are demonstrating that nurse practitioners are a viable part of the solution to the dwindling number of primary care physicians in rural areas.

* Brock Slabach. Fixing the Medical Staff Shortage Problem in Rural Areas. Becker’s Hospital Review, 2018/06/20, https://www.beckershospitalreview.com/populationhealth/fixing-the-medical-staff-shortage-problem-in-rural-areas.html † Hilary Barnes, et al. “Rural and Nonrural Primary Care Physician Practices Increasingly Rely on Nurse Practitioners.” Health Affairs, June 2018, https://www.healthaffairs. org/doi/pdf/10.1377/hlthaff.2017.1158 ‡American Association of Nurse Practitioners. “Nurse Practitioner Cost Effectiveness”. 2013 “https://www.aanp.org/advocacy/advocacy-resource/position-statements/ position-statements

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The Road to the Docto FNU celebrated its 10-year anniversary of the Doctor of Nursing Practice (DNP) program in 2018. The program was established with the intent to prepare a new generation of leaders in healthcare.

“The DNP is different because all of the students are already educated as APRNs,” said Deborah Karsnitz, DNP, CNM, FACNM, who served as FNU’s Deborah Karsnitz, DNP, DNP Interim Program Director. Jane Houston, DNP, CNM, MSN, FACNM, CNM, FACNM, served was named to the position in April as FNU’s DNP Interim 2019. “Also, the degree of experience Program Director in is different,” Karsnitz continued.

2018.

“DNP students bring a wide variety of experience from new APRNs to APRNs that have been in practice 30 years. Additionally, students within the DNP program hold a variety of specialty certifications.

Because our students bring diverse experience to the program, students benefit greatly learning from each other and forming strong relationships. This experience can translate into further opportunities for consulting, collaborating on new projects or dissemination, sharing knowledge, and forming lifelong relationships.”

What sets the DNP apart from other degree programs is that it prepares students to be influencers within healthcare professions and organizations.

“The DNP APRN graduate is prepared as a leader in healthcare, and is poised to improve the quality of healthcare by initiating change and utilizing tools to translate evidence-based practice at the community and systems level,” Karsnitz said.

Azam Tayyebi, DNP, FNP-BC, APRN, exemplifies this level of leadership. She was recently named one of 57 healthcare “Innovators Who Are Making Healthcare Better, Faster” by CareZooming*. Tayyebi, who works at Elmhurst Wound Care Clinic in Elmhurst, Illinois, a suburb of Chicago, led a Quality Improvement Project, as a part of her DNP program, to improve outcomes for patients with diabetic foot ulcers. Each DNP student is required to complete a Quality Improvement Project to improve the care of their patients. Tayyebi was advised on her project by FNU Dean of Nursing Joan Slager, CNM, DNP, FACNM, and FNU faculty member Niessa Meier, DNP, CNM. Via the project, a standardized method was developed for identifying abnormal diabetic foot exams, improving the quality of patients’ overall care, and promoting more expedient referrals to different podiatry or vascular services. As a result of this project, the diabetic foot exam became standardized in this practice, which improved the clinicians’ detection skills. The program also facilitated communication between interprofessional providers, including daily huddles and team meetings that fostered shared decision making, teamwork, and communication.

Prior to the DNP, there were few ways for nurse clinicians and others to expand their expertise in the practice environment to the doctoral level; PhDs were the domain of researchers and academicians. Today, the DNP establishes a higher level of skill for nurses with aspirations of translating evidence-based care into practice and improving systems of care. “So often we see advanced practice nurses with a desire to change the healthcare environment, and the DNP gives you the tools to do that,” Meier said.

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tor of Nursing Practice A 2018 article published in Medical Research Archives† entitled “The Impact of the Role of Doctor of Nursing Practice Nurses on Healthcare and Leadership” concluded, “The DNP nurse impacts other areas of healthcare including health economics, health insurance, administration, and information technology. Some examples of the impact that are already occurring: DNPs hold administrative positions in the health insurance industry and can influence the financing of healthcare. They utilize electronic health records (EHRs) to collect and extract data in order to improve patient processes, influence patient outcomes, and contribute to the optimization of EHRs. The future of the impact DNPs can have on healthcare is endless and many more areas of impact are still to be discovered.”

FNU’s DNP program is an example of the ultimate practicefocused degree. It is awarded to nurses who want to achieve the highest level of proficiency in the delivery of complex care over the lifespan of the patient. It is also for those seeking to positively influence healthcare in roles that don’t involve direct patient care, such as administrators, executive leaders, informaticists, health policy specialists, public health advocates, nurse educators and more.

“The DNP APRN graduate is prepared as a leader in healthcare, and is poised to improve the quality of healthcare by initiating change and utilizing tools to translate evidence-based practice at the community and systems level.”

- Deborah Karsnitz

“We have a DNP program that is specifically designed to prepare APRNs for leadership roles in health care quality improvement,” Karsnitz said. “Our rigorous program prepares students to work within their organization to identify needs, translate evidence, plan, implement and analyze quality improvement projects.”

*Azam Tayyebi. Improving Timely Referrals via Implementation of Lower Extremity Amputation Prevention (LEAP) Tool @ Suburban Wound Care Clinic. CareZooming, Accessed May 2019, https://www.carezooming.com/recipes/573/ †Nancy Edwards, et al. “The Impact of the Role of Doctor of Nursing Practice Nurses on Healthcare and Leadership.” Medical Research Archives, vol. 6, no. 4. 2018, https:// journals.ke-i.org/index.php/mra/article/view/1734

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Frontier Innovation: The Path to Clinical Practicum

Susy Furr, FNP, (left) with preceptee Beth Morrell, FNP

“I have learned so much more than skills. I am learning true patient-centered care,” said FNU student Michelle Gragg, CNM, regarding her clinical practicum experience with preceptor Cheyenne Brown, CNM.

The relationship between FNU students, preceptors, and our Regional Clinical Faculty (RCF) is a vital element in every FNU student’s success. FNU’s distance education model allows students to complete their didactic coursework in their home community. The web-based course of study is completed in 11-week terms, during which students interact regularly with faculty and fellow students via email, phone, online forums, and web-based face-to-face sessions.

Students also receive guidance and support from their academic advisor, program director, clinical director, and associate dean.

The commitment to helping students learn and practice in their own communities helped lead FNU to be awarded the Advanced Nursing Education Workforce (ANEW) grant from the Health Resources and Michelle Gragg, CNM, (left) with Services Administration preceptor Cheyenne Brown, APRN, CNM (HRSA). The grant totals $1,376,800 in funding from 2018-2020, including $600,000 in student scholarships.

“We are honored to receive the ANEW grant and excited for the opportunities it creates,” said FNU president Dr. Susan Stone. “Since its founding, Frontier Nursing University has been committed to filling the gaps in quality healthcare available in rural and underserved populations. This grant will enable us to expand our impact and improve our ability to address healthcare disparities in communities across the country.”

The overall goal of the FNU ANEW program is to formalize FNU’s academic-practice partnerships to improve the preparation Amanda Dozier, FNP, (left) with preceptor and prevalence of APRNs and nurseDr. Cherese Severson midwives practicing in rural settings. As part of the program, FNU has established five partnerships at rural clinical sites across the country: That’s when the work with the preceptor and RCF begins. The • Cherokee Nation Hastings Hospital (Tahlequah, Okla.) clinical practicum is a minimum of 675 hours in which students provide nurse practitioner or nurse-midwifery services in their • Summit Pacific Healthcare Clinic (Elma, Wash.) home community for an average of six to 10 months under the guidance of a master’s prepared clinical preceptor. An RCF • Tuba City Regional Health Care (Tuba City, Ariz.) member provides guidance and instruction during the practicum.

RCFs are responsible for the evaluation of the student, the clinical • United Memorial Women’s Care Center, United Memorial site, and the preceptor.

Medical Center (Batavia, N.Y.) Upon completion of the web-based coursework, students return to campus for Clinical Bound, a five-day experience in which students participate in demonstrations, simulations, and assessments to ensure their preparation to enter a clinical site.

To assist students with identifying appropriate preceptors and clinical sites, FNU recently formed a Clinical Outreach and Placement (COP) Services department. Via the COP, Clinical Advisors will provide support to students during the process to ensure a successful placement, enabling students to complete their clinical practicum in or near their home community.

• White House Clinics (Richmond, Ky.) By continuing to expand the distance education model and opportunities for FNU students to train at clinical sites close to their home communities, FNU hopes to identify the specific needs of rural practitioners that can be integrated into the curriculum.

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Focus on Diversity and Inclusion Yields Positive Results On page ten of this report, we shared the genesis of FNU’s Quality Enhancement Project in response to national data showing the significant impact of miscommunication in the healthcare system. While that data is specific to miscommunication between healthcare providers, there is also growing evidence of the importance of communication between provider and patient.

The National Institutes of Health (NIH) identifies cultural respect as an essential factor in reducing healthcare disparities and improving access to high-quality healthcare for a diverse group of patients. A report by Georgetown University’s Health Policy Institute states that a lack of effective communication can lead to patient dissatisfaction and lower quality of care*. For example, the study found that Spanish-speaking patients report being less satisfied with their care and more likely to report problems with their care than English-speaking patients.

According to maternal mortality data from the CDC in 2017†, African-American women are three to four times more likely to die of pregnancy complications than white women. Contributing factors to these disparities in healthcare are financial, bureaucratic, transportation, language barriers, and care that is not consistently culturally appropriate or respectful.

As FNU has done throughout its history, the university recognized the need for change. In 2010, FNU launched its Diversity Impact Program (formerly known as PRIDE, which stood for Promoting Recruitment and Retention to Increase Diversity in NurseMidwifery and Nurse Practitioner Education), intent on increasing the diversity of the student body. That percentage of students of color was 9 percent in 2009. By 2018, that number had grown to 23 percent.

Not coincidentally, in October 2018, FNU was officially named a recipient of the prestigious Health Professions Higher Education Excellence in Diversity (HEED Award from INSIGHT Into Diversity magazine). The HEED Award is a national honor recognizing U.S. medical, dental, pharmacy, osteopathic, nursing, veterinary, allied health, and other health schools and centers that demonstrate an outstanding commitment to diversity and inclusion.

“We take a detailed approach to review each application in deciding who will be named a Health Professions HEED Award recipient. Our standards are high, and we look for schools where diversity and inclusion are woven into the work being accomplished every day across their campus,” said Lenore Pearlstein, publisher of INSIGHT Into Diversity magazine.

Diversity and Inclusion

FNU’s Diversity Impact Student Conference has been held annually since 2011.

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The HEED Award is a validation of the efforts FNU has made to increase the diversity of its faculty, staff, and student body.

“We believe in the benefits of a diverse university and in the positive impacts our diverse graduates can make in communities across the country,” said FNU President Dr. Susan Stone. “Our graduates serve people of all races and cultures and are increasingly coming from diverse backgrounds.

It is imperative that our students, faculty, and staff have cultural awareness and competency in order to effectively advance our mission of servant leadership.”

FNU’s diversity and inclusion efforts are led by Dr. Maria ValentinWelch, who was named Chief Diversity and Inclusion Officer in 2017. Dr. Valentin-Welch was named one of the Top 25 Women in Higher Education by Diverse Magazine in 2018. In addition to the recruitment and retention of students of color, Dr. ValentinWelch has directed initiatives to increase faculty and staff diversity training. She also oversees FNU’s annual Diversity Impact

Student Conference. The purpose of the Diversity Impact Student Conference is to ensure that nurse practitioners and nursemidwives understand the challenges and opportunities offered by diversity in rural and underserved healthcare systems.

Recognized as a leader in helping reduce those health disparities, FNU was awarded the Nursing Workforce Diversity grant from the Health Resources and Services Administration (HRSA) in 2017.

The $1,998,000 grant funds a four-year project that is being led

by FNU with assistance from several key partner organizations.

The goal of the Nursing Workforce Diversity (NWD) program is to increase access to high quality, culturally aligned advanced practice nurses and midwives that reflect the diversity of the communities in which they serve.

Progress made via the NWD grant through 2018 includes the establishment of a three-person Diversity Office, the duties of which include oversight of FNU’s Diversity Impact Program and the annual Diversity Impact Student Conference. Additionally in 2018, 30 NWD student scholarships were awarded. The purpose of these scholarships is to recruit, retain, and graduate more advanced practice nurses from disadvantaged backgrounds.

In 2018, FNU also implemented NWD tutoring, mentoring, professional development, and writing assistance programs.

“We believe in the benefits of a diverse university and in the positive impacts our diverse graduates can make in communities across the country.”

FNU President Dr. Susan Stone

* Health Policy Institute. “Cultural Competence in Health Care: Is It Important for People with Chronic Conditions?” Issue Briefs on Challenges for the 21st Century. Accessed May 2019, https://hpi.georgetown.edu/cultural/ †Centers for Disease Control and Prevention. “Meeting the Challenges of Measuring and Preventing Maternal Mortality in the United States.” Public Health Grand Rounds.

2017/11/14, https://www.cdc.gov/grand-rounds/pp/2017/20171114-maternal-mortality.html

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Celebrating Achievements The year 2018 was filled with amazing accomplishments by our students, alumni, faculty, and staff. There isn’t room in these pages to list them all, but we would like to share just a few of the memorable moments that filled us with pride this year.

FNU Awards Degrees to More Than 800 Graduates FNU held its 2018 commencement ceremony on Saturday, October 20, at the Nixon Center in Hyden, Ky. More than 1,800 guests and friends of FNU gathered for the commencement activities honoring more than 800 nurse-midwives and nurse practitioners. These graduates represent 47 states and three countries with 45 graduates being from Kentucky. Of these graduates, 227 attended the ceremony in Hyden on October 20th.

FNU President Dr. Susan Stone presided over the commencement ceremony and degrees were conferred on graduates of FNU’s Doctor of Nursing Practice (DNP) and Master of Science in Nursing (MSN) programs. Dr. Holly Powell Kennedy, Ph.D., CNM, FACNM, FAAN, the Helen Varney Professor of Midwifery at the Yale School of Nursing, was the keynote speaker during the ceremony.

Students and their families celebrated the many milestones and achievements of the graduates. Many of the graduates were

participants in the Student Council, scholarship recipient winners, and Wide Neighborhoods Ambassadors.

Leadership awards were announced to recognize students who demonstrated exceptional leadership. The Kitty Ernst Leadership Award was awarded to Deborah Alba, MSN, Nurse-Midwifery, Class 139; the Nurse Practitioner Leadership Award was presented to Bree Ferrin, MSN, FNP, DNP Class 32; and the DNP Leadership Award went to Janette Bowers, DNP Class 27. Current faculty member Ana Verzone, DNP Class 24, was presented with the DNP Quality Improvement Project Award, for her DNP project which focused on improving communications during transports from Nepalese rural clinics to emergency departments. Joanne Keefe, DNP, MPH, FNP-C, received the Course Faculty Award and Audra Cave, DNP, FNP-BC, received the Regional Clinical Faculty award, recognizing their commitment to students and the lasting impact they have on the student educational experience.

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Edith B. Wonnell Presented Honorary Doctorate Edith B. Wonnell was presented the Doctor of Humane Letters, honoris causa, during FNU’s commencement ceremonies. This in honor of her development of freestanding birth centers and her extraordinary lifelong dedication to the midwifery profession.

Edie’s entrepreneurial drive led her to open the Bryn Mawr Birth Center in 1978 and The Birth Center in Wilmington, Delaware, in 1982. Today, both birth centers operate at full capacity. Simply put, she developed the entrepreneurial model that has played a major role in offering an alternative to the not-for-profit birth center model.

Annual Awards Highlight FNU Homecoming 2018 On October 5, 2018, alumni, family, and friends gathered at Wendover for FNU’s annual Homecoming celebration. Held at the beautiful Wendover Bed & Breakfast and Retreat Center, the weekend festivities included a reception, cookout, award ceremony and many opportunities to network with present and former FNU students.

2018 award winners: Distinguished Service to Alma Mater, Nurse-Midwife: Susan Clapp, CNM, Class 81 Distinguished Service to Society, Nurse-Midwife: Francie Likis, CNM, NP, Class 40 Distinguished Service to Alma Mater, Nurse-Practitioner: Estella Wetzel, FNP, Class 78 Distinguished Service to Society Alumni, Nurse Practitioner: Elena Prendergast, DNP, Companion DNP 4 Mary Breckinridge Lifetime Service Award: Berea College Appalachian Fund Courier Unbridled Service Award: Julia Breckinridge Davis, Courier, 1967-69

“Spending time at Frontier with friends on the mountain gives you the time you need to recharge and reconnect,” said Susan Clapp, CNM, Class 81.

Homecoming participants spent Saturday at the annual Mary Breckinridge Festival and parade.

Winner of the Courier Unbridled Service Award, Julia Breckinridge Davis, great-niece of Mary Breckinridge, led the parade with the traditional riderless horse.

The traditional bell ringing concluded homecoming weekend, and participants caravanned to the new Versailles campus for a tour of the exciting renovations.

“Every once in a while, I need to go back to ‘the mountain’ to reaffirm my commitment to this profession/calling, to draw strength and courage from those who went before me. Homecoming provided that opportunity for fellowship and inspiration,” said Lisa Pontious CNM, CNEP, Class 82.

FNU Homecoming award winners, l to r: David Cooke on behalf of the Berea College Appalachian Fund; Julia Breckinridge Davis: Susan Clapp; Francie Likis; Estella Wetzel. Not pictured: Elena Prendergast.

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FNU Student Pass Rates Exceed National Averages Over the past few months, FNU has received pass rates from the American Association of Nurse Practitioners (AANP) and the American Midwifery Certification Board (AMCB). FNU students continue to perform well above the average. We are proud of our outstanding students and our excellent faculty who have prepared them. FNU takes pride in preparing our students not only to excel on these exams but more importantly, to provide excellent healthcare to those in their communities.

FNU Nurse-Midwifery, Nurse Practitioner, and Women’s Health Specialty Track Programs National Board Examination Pass Rates 2014

2015

2016

2017

2018

FNU Nurse-Midwifery Graduates

94%

97%

98%

95%

86%

National Nurse-Midwifery Graduates

92%

94%

94%

92%

83%

FNU Nurse Practitioner Graduates

97%

93%

100%

100%

N/A

National Nurse Practitioner Graduates

79%

75%

82%

83%

N/A

FNU Nurse Practitioner Graduates

94%

94%

95%

95%

98%

National Nurse Practitioner Graduates

88%

88%

81%

80%

85%

FNU Women’s Health Nurse Practitioner Graduates

94%

100%

100%

98%

100%

National Women’s Health Nurse Practitioner Graduates

87%

87%

89%

90%

92%

American Midwifery Certification Board

American Nursing Credentialing Center

American Academy of Nurse Practitioners

National Certification Corporation

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Accolades

In 2018, the leadership of FNU was increasingly recognized nationally as voices of expertise, direction, and change.

In the following pages, we highlight just a few of the many accolades they received throughout the year.

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Dr. Susan Stone Inducted as President of American College of Nurse-Midwives FNU President Dr. Susan Stone was inducted as the president of the American College of Nurse-Midwives (ACNM) during the ACNM’s annual meeting in May 2018.

ACNM is the professional association that represents certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. With roots dating to 1929, ACNM is the oldest women’s health care organization in the United States.

The organization’s elected leaders play an important role in guiding the midwifery profession.

“Susan brings expertise and vision to this role, particularly in the areas of Board management and strategic financial development which will serve the members of ACNM very well,” said past-ACNM President Lisa Kane Low, Ph.D., CNM, FACNM, FAAN.“ We are fortunate to have her.”

“To make the necessary changes, we need to not just be present but leading in all venues where decisions are being made,” Stone said. “We must be participating in legislative agenda, mortality/ morbidity review committees, and planning and constructing the health care systems of the future.

Midwives must be central in the decision-making process. We are the experts at helping women become healthy and remain healthy. We are the teachers, the care providers, and the advocates who can change this picture. Working together in interprofessional teams, we can make a difference.”

FNU Names Dr. Joan Slager Dean of Nursing Dr. Joan Slager, CNM, DNP, FACNM, was named FNU’s Dean of Nursing in August 2018.

Slager previously served as the program director for FNU’s Post-Master’s Doctor of Nursing Practice.

Slager graduated from the Frontier School of Midwifery and Family Nursing in 1991 and completed her Master of Science in Nursing at Case Western University in 1993.

She graduated from Oakland University in Rochester, Mich., with a Doctor in Nursing Practice in Dec. 2008. In 1993, she helped to establish Bronson Women’s Service in Kalamazoo, Mich., which is now Michigan’s largest midwifery service with 14 midwives.

Dr. Slager practiced full-scope midwifery in this hospital-based collaborative practice and served as the practice director from 1995 through December 2016.

“We are very proud to announce Dr. Slager as our Dean of Nursing,” said FNU President Susan Stone. “We have benefited from her leadership and expertise in the past and are excited to see her influence and impact in this position.“ Slager served two terms as Chair of the Business Section of the Division of Standards and Practice for the American College of Nurse-Midwives (ACNM) and four years as the Division Chair. She is currently serving a second term as the Treasurer on the ACNM Board of Directors.

“I am honored to be a part of this pivotal time in the long and proud history of Frontier Nursing University,” Slager said. “Our strategic growth is vital as we work toward fulfilling our mission. We are striving to address healthcare gaps in our communities by educating nurse-midwives and nurse practitioners to serve all individuals and all communities, with an emphasis on diverse, rural and underserved populations.”

Slager’s many accolades include being honored as the Dorothea Lang Pioneer Award recipient from the American College of Nurse-Midwives Foundation in 2008 and the Distinguished Service to Alma Mater Award winner from FNU in 2015.

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Emma Metcalf Joins FNU Board of Directors In April 2018, FNU officially welcomed Emma Metcalf, MSN, to its Board of Directors. Metcalf brings with her a wealth of experience and knowledge, adding significantly to the Board’s capacity to continue to lead FNU’s ongoing mission.

FNU’s Board of Directors is comprised of 15 individuals who are invested in the success and growth of FNU. Metcalf serves as the treasurer. The Board is chaired by Michael Carter, DNSc, DNP, FAAN, FNP/GNP-BC. Wallace Campbell, Ph.D., is the secretary, and Mike Rust serves as Vice Chair.

Recently retired, Metcalf served as the Director of the Lexington, Ky., Veterans Affairs Medical Center, a dual division with four community-based outpatient clinics. She was responsible for the day-to-day operations of the medical center as well as its overall clinical performance. She provided executive leadership, budgetary and operations oversight, and collaborated with other VISN 9 Medical Center Directors in the formulation of budget, policy, and strategic business planning at the network level.

Her VA career included positions as Director of the VA Illiana Health Care System; Chief Operating Officer, Alvin C. York Campus of the VA Tennessee Valley Healthcare System; Chief, Strategic Management Service, VAMC in Louisville, Kentucky where she also held the position of Administrative Officer for Associate Director of Operations; and Compliance Officer at the Central Arkansas Veterans Healthcare System.

Metcalf received her Master’s Degree in Nursing in 1985 from Bellarmine College in Louisville, Ky. She received her Associate Degree in Nursing from Jefferson Community College in 1981 and a Baccalaureate of Science in Community Health from the University of Kentucky in 1979. Metcalf is a Certified Case Manager in the Case Management Society of America and a Certified Professional in Healthcare Quality. She is a graduate of Leadership VA (2000); the Executive Career Development Program (2002); Senior Executive Service Candidate Development Program (2009); and is a Certified VHA Fellow Mentor (2010). She is also a member of the College of Health Care Executives.

Dr. Maria Valentin-Welch Named One of Top 25 Women in Higher Education FNU’s Chief Diversity and Inclusion Officer, Dr. Maria Valentin-Welch, DNP, MPH, APRN, CDP, CNM, FACNM, was selected as one of the Top 25 Women in Higher Education by Diverse Magazine.

Named FNU’s CDIO in 2017, Valentin-Welch has led FNU’s diversity and inclusion efforts, including targeted student recruitment, mentoring and tutoring programs to improve retention, and diversity and inclusion curriculum for students, faculty and staff.

“I am humbled and honored to be FNU’s first Chief Diversity and Inclusion Officer,” Valentin-Welch said. “Together, hand in hand, we will bring our FNU Community to higher heights.”

Dr. Valentin-Welch has more than 30 years of teaching experience, including her role at Frontier as an assistant professor since 2013. Through extensive work with marginalized and underserved populations, Maria has garnered several awards and accolades. She completed her Doctor of Nursing Practice (DNP) at FNU in 2015. Her DNP capstone project was a national online tutorial pilot program for ethnically diverse student nurse-midwives.

“My love for education has influenced my passion for diversity and inclusion,” Valentin-Welch said. “I have always been a teacher in my heart. I have taught and precepted many students. Teaching is in my blood.”

Read more about Valentin-Welch’s impact on FNU’s diversity and inclusion efforts on page 15 of this report.

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FNU AT A GLANCE Total Students Served, 2013-2018

Graduates by Specialty Track, 2013-2018 0

Total Served 1000

2000

3000 NurseMidwifery

2037

2013 723

718

Family Nurse Practitioner 2037

2015

755

2017

Women’s Health

894 2573

210 210 236 285 253 242 241 203 246 324 40 43 24 28 28 22

1080

1162

Women’s Health Certificates for CNEP Grads

2013 2014 2015 2016 2017 2018

PsychiatricMental Health Nurse Practitioner

2013 2014 2015 2016 2017 2018

2859 2018

174

2013 2014 2015 2016 2017 2018

2200 2016

300

179

2013 2014 2015 2016 2017 2018

2032 2014

200

Total Admitted 2013 2014 2015 2016 2017 2018

0

100

14 10 10 16 16 27

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FNU AT A GLANCE Degrees Awarded, 2013-2018 0

2013 2014 2015 2016 2017 2018

Companion DNP

2013 2014 2015 2016 2017 2018

PostMaster’s DNP

2013 2014 2015 2016 2017 2018

PostGraduate Certification

2013 2014 2015 2016 2017 2018

Master of Science in Nursing

200

400

600

454 440 460 437 489 616 40 32 27 24 39 74 39 56 73 74 63 63

10 48 63

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Answering the Call.

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Campus: 195 School Street P.O. Box 528 Hyden, KY 41749 FNU@frontier.edu 606.672.2312 Frontier.edu Wendover: 132 FNS Drive Wendover, KY 41775

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