xt7h707wnd12 https://exploreuk.uky.edu/dips/xt7h707wnd12/data/mets.xml The Frontier Nursing Service, Inc. 1989 bulletins  English The Frontier Nursing Service, Inc. Contact the Special Collections Research Center for information regarding rights and use of this collection. Frontier Nursing Service Quarterly Bulletins Frontier Nursing Service Quarterly Bulletin, Vol. 64, No. 4, Spring 1989 text Frontier Nursing Service Quarterly Bulletin, Vol. 64, No. 4, Spring 1989 1989 2014 true xt7h707wnd12 section xt7h707wnd12 v4Ul§;~
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  y A   ···»   nm,
  Early in the School's history, midwifery students traveled with instructors to
l; patients' homes to provide prenatal care.
‘i . . . . .
kl beginmngs, the FNS School was emerging as a nationally respected leader in
.; nurse-midwifery education.
In 1970, thirty-one years after its founding, the Frontier School added a
li family nurse-practitioner (FNP) certificate program. The first class entered in
June of that year, and the school changed its name to the Frontier School of
. Midwifery and Family Nursing (FSMFN) to reflect its broadening educational
l role.
i_ The basic philosophy behind the new course, as quoted from FSMFN’s
l

 4 FRONTIER NURSING SERVICE
catalogue, was that the   would be a blending of nursing with selected V
medical and public health functions...a broadening of the traditional nursing role g
to include basic diagnostic, treatment, and preventive skills...so that FNP’s  
would be able to provide assistance to families, whether they be living in Ap- *
palachia, inner cities, or developing countries..." {
Such national and intemational utilization of midwifery and FNP skills
has always been the motivational force behind FNS’s very existence. Mrs.
Breckinridge had always envisioned the nurse as playing a more vital role in ’_
preventive medicine. In fact, FNS has the only program in existence that A
combines the FNP certification with the nurse-midwifery education. This {
enables a student to be certified as a family nurse—midwife. Just as FNS has {F
always seen itself as a model for providing rural healthcare, the Frontier School ,
has advanced the expanded role of training nurse-midwives and family nurse {
practitioners to provide care in varied settings, all over the world. To date, FNS E
has graduated a combined total of approximately 700 practitioners. These f
graduates are currently practicing in 47 states in the USA and more than 50
foreign countries.
However, the number of graduating nurse-midwives is not keeping pace
with the national demand. Indeed, studies show that enrollment in basic
midwifery programs has declined in recent years. The Dean of the Frontier
School, Nancy Clark, Ph.D., notes, "For every nurse—midwife who graduates it
    `* W — 5 at   .     -..·     ii
gg U 5;     ·     5, 7% tg; i
  ...» ‘ t   t I   i    
A  'y`
.  ·     F X   · __
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......   _, M I , ._.·  *?" e‘i*   » ·    it
.   S    _, p   i    
eg    `I   In ,l Q r     V
FNP Instructor, Debbie Browning (right) works with a student in 2-1  
classroom at the Frontier School.  

 1
  QUARTERLY BULLETIN 5
  from our program, there are at least 6-7 jobs available for them to choose  
lp Recently the Office of Technology Assessment, in a report to the Senate
g Committee on Appropriation noted, "historically certified nurse-midwives
gg (CNM’s) must be credited with improving the geographic distribution of care
;» .. .increasing access to primary care ...providin g effective low cost maternity care
Q; and ...providin g care where quality is equivalent to that of care provided by phy-
sicians."
, Concurrently, the Institute of Medicine issued a report stating that "[the
V ‘ current] maternity care system is fundamentally flawed, fragmented and overly
i complex." They urged that a " new system be established, based on a wide area
Q of providers, including both physicians and CNM's...each of whom may practice
* in a variety of settings and within a variety of systems. Such a system, if
  implemented, would have to rely heavily on the use of FNP‘s, CNM's and other
  mid-level practitioners."
  The call for greater utilization of advanced nursing skills is also heard
U more and more frequently from groups studying the status of infant mortality and
Q prenatal care in the USA. This, combined with the decreasing enrollment in basic
` midwifery programs, has created an unprecedented market demand for mid-
  wifery skills. With the same determinination that FNS faced its midwifery
  shortage in 1939, the FSMFN has assumed a leadership role in finding new,
§” innovative ways to address the current health care crisis, and make midwifery
  training more accessible.
  Expansion of the school’s existing programs was the most obvious first
`, step in a multifaceted effort to increase the number of practicing midwives.
  However, Hyden, the town where the School is located, doesn’t have the
_ population base necessary to provide clinical experience for large numbers of
midwifery students. So, the decision was made in the late l970’s to establish off-
; campus clinical bases with on-site preceptors to monitor students. "Students
* , must have access to an adequate clinical base," notes Dr. Clark. "This expansion
_‘   into a variety of settings has had the benefit of not only enabling us to accept more
3 gt students into the program, but also of increasing student flexibility and affording
  them an opportunity to experience different practices, organizations and set-
lg tings." FNS currently has arrangements with over 40 clinics, hospitals, and
` birthing centers, throughout the United States where it can send students (often
  with their families along) for hands-on clinical experience.
é Another need being addressed by the FNS School is the demand for
’ graduate prepared FNP's and CNM's. FSMFN has had a formal and mutually
— beneficial affiliation with the University of Kentucky College of Nursing since
T 1977 and with Bellarmine College of Louisville, and the Frances Payne Bolton
5 School of Nursing at Case Westem Resereve University (CWRU) of Cleveland,
i q Ohio, since 1985. Through these affiliations, students from the Frontier School
 a3

 6 FRONTIER NURSING SERVICE
are able to earn graduate credit for courses taken at FNS and apply them towards K
a Masters Degree in Nursing at these institutions. As the need for CNM's grows,  i
these Masters prepared nurse—midwives can serve as faculty and future leaders.  
The 1980‘s brought another challenge for the Frontier School. Since the  
addition of the FNP program to the School in the l970`s, FNS had received grant  1
funds from the U.S. Department of Health and Human Service's Division of j
Nursing (DON). With the govemmental budgetcutbacks ofthe '80s, the Frontier L
School faced severe funding reductions. However, through the generous support  
of numerous FNS friends, a $3 million dollar endowment fund was established   h
to supplement the reduced DON funds. Further, FNS's National Chairman, Kate  
Ireland, and Honorary National Chairman, Mrs. Jefferson (Marvin Breckin- E
ridge) Patterson, established the first endowed faculty chair of midwifery in the   V
nation. Mrs. Ruth Coates Beeman was the first to hold this chair. When she ‘
retired in 1987 she was succeeded by the School's current Dean, Dr. Nancy Clark. I
These endowment funds, together with the reduced DON grant funds, f
have enabled FSMFN to expand its original programs and take steps towards  
establishing new, pilot projects that move FNS further towards the goal of ad-  I
dressing the serious shortage of midwives.  
In March 1988, FSMFN began the only American "Refresher Course" for l
non-practicin g or foreign-trained nurse-midwives who wish to hone their skills,  
become certified by the American College of Nurse-Midwives (ACNM), and re- A
tum to practice in the US A.
This Precertification Pro-   V;       ._.,_._,   ._,·,g   _.._ . _ . .,   1
gram can be completed in   f   {2;   ij; ‘.‘` .         T
just 4 months at a much    _Q ij     · _ `   Qf I
lower cost to the student ' /5 E      gp   f  ,
than the full 20 month     A   i‘'..      if  . { A  
course required for basic .;   g§`C’jiV ·A_. `     g
midwiter trainin . Ms.   .».  ,    *· e.,,     ...,    .
Wendy Wagers, gFSMFN     U ·  
Education Coordinator  ig ‘S*$·;`i¥Q:`%`·’i§"§ Y   ` "
_ _ {lie  wifi. »   . ,
states, "Without doing any   ,.:» 2
formal advertising the 4     -·¤  4,
School received over one I   _   'VC` ji
hundred inquiries about    K    °  
theprogram; and within the * eg   .  I,  
last year FSMFN has admit-     .·    
ted close to 20 applicants to T   Q., ..-· __ ·  
the pre-cert program." "A       A i`
future goal of the School," i · `V   ~ \   H
adds MS- W"g°“· "‘S *0 FSMFN Dean, or. Nancy clark .

 QUARTERLY BULLETIN 7
2 expand this program to serve even more students...as soon as sufficient funding
  and faculty are available."
I The Frontier School's newest pilot project is the Community Based
I Nurse-Midwifery Educational Program (CNEP). This program is being jointly
  sponsored by FNS, Case Westem Reserve University, the Matemity Center
I  Association in New York and the National Association of Childbearing Centers
A`  in Pennsylvania. While the Dean of the Frontier School heads the program, the
yi day-to—day operation is directed by Kitty Emst, Assistant Dean of CNEP, and
  a graduate of FSMFN. "This program offers greater flexibility in graduate
i‘ education to people who prefer independent study or, who are unable to relocate
1 to existing midwifery schools," explains Dr. Clark. The program may take
{V between 18 months and two years to complete, depending on the pace decided
 i by the student. About 1/3 of the student’s time will be spent in self-study, the
·’ other 2/3 will be spent at clinical sites in or near the student’s home community.
t Dr. Clark adds, "One of the most frequently mentioned hardships of attending
_- midwifery schools is that the student has to leave her home and family to relocate
I for at least a year, sometimes longer. This new program addresses this concem
I and for the first time, offers a viable solution." CNEP began its first class in April,
and already has close to 20 students, with hopes of expanding to at least 30 in
· the coming months.
While national support has increased since Mary Breckinridge’s incep-
tion of the school in 1939, schools and universities haven’t kept pace with the
rising demand for trained midwives. Indeed, today there are still only 24
W midwifery training programs in operation that are accredited by the ACNM.
When Mary Breckinridge opened her midwifery school she noted that...
"We [FNS] opened our first post-graduate course for American
nurses in midwifery and frontier technique with two pupil nurse-
Q midwives ..... although this course is set up primarily to meet our
  acute emergency caused by the war, it is also part of our perma-
5 nent program. When our emergency has been met, we will be
  able at last to respond to the calls to provide frontier nurses for
  American outposts from the Caribbean to Alaska."
.` Mrs. Breckinridge’s dream reached out beyond the mountains. Her vision was
j of leadership in providing nurse-midwives to a critically failing health care
delivery system. Today, 50 years later, the demand for nurse-midwives is para-
p mount; the requests for graduates unprecedented. The Frontier School must con-
tinue with Mrs. Breckinridge’s vision and utilize the resources of FN S in the most
efficient way. The challenge is ours .....
— Sheila Allen

 8 FRONTIER NURSING SERVICE  
Kate Ireland Elected  it
Treasurer of Foundation Board ‘
for Hospice and Homecare
    {
T `:  in ., »... > J .'
 C    ·“i‘ i    l_ M ¢_`¤ to
    q ii ié _ .    I
`     `‘.i   ***2     v``· ·. .--t·’‘     ,
  K    3 I   ga  ·- .....   _A - _,  » I
      `   ~ »—·=~».   V ` · g
      ’
r   a asr     .    I
Miss Kate Ireland, FNS National Chairman  y
Kate Ireland of Leslie County, Kentucky, has been elected Treasurer of the  
Board of Directors of the Foundation for Hospice and Homecare. The Founda— ,;
tion, which is located in Washington, D.C., serves the dying, the disabled, and  
the disadvantaged through a broad range of programs.
The Foundation promotes the humane alternatives of hospice and home ; 4,
care, trains caregivers, and educates consumers. Among its most visible  f
activities are the Caring Awards, a national program designed to identify,  .
recognize, and reinforce the activities of "the most caring people in America."  I
Miss Ireland is Chairman of the National HomeCaring Council in
Washington, D.C. , National Chairman of Frontier Nursing Service in Wendover, A
Kentucky and Chairman of the Board of Berea College, Kentucky. The  `
Foundation is chaired by former S enator Frank E. Moss of Utah. Former Senator  .
Charles Percy of Illinois is Vice Chairman.  ?

   QUARTERLY BULLETIN 9
‘ Illinois Health Care Officials Visit FNS
 I
* ¢‘‘‘iE ‘ ”* » »< ~   it‘V-  W" M _A__ ;   l··~··——~·"`
I   I   I     s i» — ~,i,   °   i  I  F   ‘ §;·*‘*°i    .   =. ·
.'  {  Q I     I ``“_     F  I          » , a I   ¥
tri as t     ~       il. e   li i t   E .
z   `   WF     a»..`~   `‘—’ T E   [  " » :; ` 'JIJA   * »
It   `\ I n   tf ft *        ·  
  ` li;  _~ { . X { ., /
  _ {. 2* ._ [   I   V X X QA
Ft?  { gig   .     g
The Frontier Nursing Service (FNS) welcomed six visitors from Illinois this
 . spring who came to talk with personnel from the Mary Breckinridge Hospital
_, (MBI-I) and the four district clinics. Pictured from left to right: George Wyatt,
  MBH Administrator and David Hatfield, President of FNS, their hosts here in
i Kentucky. Larry Ramsey, Chief Financial Officer, Massac Memorial Hospital;
 é Barbara Dallas, Executive Director of Small and Rural Hospital Section at the
  Illinois Hospital Association; Al Grant, Special Assistant to the Director of
V.; Public Health, State of Illinois; Loren Erwin, Chief Executive Officer, Massac
, Memorial Hospital; J ack Taylor, Chairman of the Board, Massac Memorial
Hospital; and Christopher West, Senior Vice—President of NKC Management of
¤ i Louisville, Kentucky. Their goal was to study the effectiveness of FNS’s decen-
 I tralized model of health care in order to determine if such a system could be an
 = effective means of providing health care in rural areas of Illinois.
& FNS welcomes health professionals from numerous states and foreign
; countries each year. Their common goal is to leam about the organization and
I return home with new ideas and approaches to the provision of health care.
 ‘· - Sheila Allen
»

 10 FRONTIER NURSING SERVICE .
District Doctor Makes a Difference
Family Practitioner/General Practitioner/Pediatrician - S
Needed to work with a unique, internationally renowned  N
rural health care system network in Kentucky, which in- A
cludes a hospital, satellite clinics, a home health agency and j
a school of advanced nursing. Physicians and advanced  ,
registered nurse practitioners work in joint practice teams; ,
interaction with students is encouraged. The rural population  
presents a wide range and intensity of medical problems...  
In November, 1987, a young general practitioner working in Memphis re-  
sponded to the above ad that appeared in the American Public Health t
Association’s joumal. Frontier Nursing Service (FNS) was looking for a doctor  ‘i
to work in rural southeastem Kentucky to service its four outlying district ’
nursing clinics. "It pushed all my buttons," explained Dr. Tim Todd. "The op- =
portunity to work with nurse-practitioners and home health nurses and to do
some teaching was very appealing. It was an opportunity to get out of the urban .
rat race." E
After visiting FNS the following January with his wife and two 4
children, Dr. Todd could see that health care providers were really needed in the S
area, "Because neither my wife norl had ever lived in a rural area we had some  
concerns. In fact, my wife had lived in London, Chicago, and New York and {
when she moved to Memphis thought she was relocating to a small town! I, on  {
the other hand, was bom and raised in Tennessee. I completed my undergraduate  
work at the University of Tennessee (U .T.), Knoxville and my medical training  .
at U.T. Memphis. Still, we both felt we were meant to come here - and our two ~
young children confirmed it by pleading with us to move!" By March 7th the
family had sold their house in Memphis, packed up and relocated to Hyden.  I
In the four years since finishing his medical training Dr. Todd found  i_
an awareness growing in him, "My calling in life is to bring compassionate and  (
competent care to people who, for whatever reason, have little or no access to  
health care." Before joining FNS, Dr. Todd had worked in urban health clinics l §
with nurse practitioners. "I fully support the concept of joint-practice with nurse .  
practitioners. So many segments of the population don’t have a doctor or can’t  ii
afford to see one. I see nurse practitioners as an excellent solution to the problem.  t
They can provide so many of the services that doctors traditionally have §
provided, and do it in a much more cost effective way. Nurse practitioners see < l
the patient as a whole individual, not a collection of diseased organ systems.  g
Nursing training includes formal education on how to talk to people and stresses  _·
the importance of caring and treating patients with dignity - something you don’t
get in medical school. I have leamed a great deal about the humanistic approach _‘

 QUARTERLY BULLETIN ll
y ‘   .
  i  A   .,       .   ;’‘   ..  
    .     V   ·  Y,,VV    
  tt t` *  ~ .       "   if
l· · `¥· :»J     .   A ‘·E”‘  
 ` _vv '  V r   ih `          I;.   _ V.  
  L.A ,. 4   r A ,g,   , V ·»    ·T~vT ; T,, .V t       ·,R‘’’ f
I   fi ff  y   g      · TJT-,   -  Q?    
    VVV:     { ,’,/   »    ·   ’ i'  L ·‘···=—»» ,     J'; 
r       T‘‘’‘’’     _  
Dr. Todd consults with nurse practitioner, Sr. Joan Gripshover, on the care of a
clinic patient.
to patients from watching the nurse practitioners."
Before starting his day as district physician at the FNS outpost clinics
I Dr. Todd sees his patients at the Mary Breckinridge Hospital. His first clinic
patient is usually scheduled for 10:O0a.m., and more often than not he is late! "I
I may have had a patient admitted to the hospital the night before or, I get tied up
` in the emergency room. It is becoming more and more common for me to have
patients in the hospital," he explained. However, the clinic patients that are kept
3 waiting don’t seem to mind. "I am told my patients understand when I am
detained and see it as a reflection of my being a good doctor," smiles Dr. Todd.
 (  He spends one day a week at each clinic (Monday-Wooton; Tuesday-Pine Moun-
> t tain; Wednesday-Community Health Center; Thursday-Beechfork). Friday
r   momings are split between the two busiest clinics and the afternoons altemate
  between the Home Health Agency and administrative meetings.
- l Providing physician service to six nurse—practitioners at four different
·· FNS sites makes it possible for Dr. Todd to deliver health care, directly and
 p indirectly, to far more people than he could were he based at just one site. "I may
 i see 10 or 11 patients a day and spend as much time again on the phone doing
consults with the nurse-practitioners at other clinics." Before Dr. Todd's arrival
the clinics had to rely on coverage from a hospital-based physician. "The clinics
had to schedule patients at a time when it was convenient for the physician to

 [f
12 FRONTIER NURSING SERVICE {
drive out from the hospital. This arrangement provided little consistency of care !
for the clinic patients," explained Sister Joan Gripshover the project director at  
FNS’s Wooton Clinic. "Now with Dr. Todd making regular visits our clients 2
have greater continuity of care and we are able to consult with a physician who I
knows the patient’s case history." [
By law, or protocol (the medical directives that define a nurse practi—  
tioners scope of practice), the nurse practitioners have to consult with Dr. Todd t
when the patient’s condition is no longer within their scope of practice. "I do have I g
a series of five to ten minute sermonettes on pathophysiology or pharmacology C
that I tend to ‘spit out’ on cue when asked about particular problems," explains i
Dr. Todd, "even though they have probably heard the same lecture four or five  
times the nurse practitioners are very responsive and polite enough not to tell me g 
I am being boring or obnoxious!" When operating in a joint-practice situation it
the nurse practitioner often simply consults with the physician, and sometimes
they co—manage a case for a period of time. However, when it is required the
patient is referred to the physician for as long as is necessary. i
Since the nurse practitioners see patients tive days a week in their own
clinics they select those patients who need the expertise unique to a physician. -
Dr. Todd spends most of his time seeing patients with chronic illnesses and the p
elderly who have multiple diseases involving different organ systems. High -
blood pressure, diabetes, coronary artery disease, thyroid disease and depression ,
are some of the most common problems Dr. Todd encounters. "Of course,
pulmonary and lung problems are top of the list," he adds. "Because of the ‘
prevalence of coal-mining in the area and the high incidence of cigarette
smoking, these particular patients tend to become more susceptible to illness i
than anyone else. One of the doctors practicing in the area before me was quoted
as saying he had never seen anybody who had black lung who wasn’t a smoker." .
Dr. Todd went on to say, "Research published in preventive medicine t
literature states that three-quarters of all human illness is either influenced or p
directly caused by lifestyle. lt is extraordinarily difficult to get people to change “ q
their lifestyle and good communication is essential. The challenge is to be  i`
successful in obtaining the patient’s compliance without coming across in a  q
dictatorial manner. It is important to establish rapport with your patients to let t {
them know the value of changing certain habits such as - giving up smoking, I ‘
moderating use of alcohol, exercising, and losing weight. I try to let them know j
I care about them even if they are not always successful." (
When the nurses make a diagnosis that requires a specific medication  
they must consult with Dr. Todd by calling the clinic he is assigned to on that day. 2
After obtaining his approval, the prescription can then be called to a pharmacy. 3
Dr. Todd feels it is unfortunate that in Kentucky nurse practitioners are not J
allowed to write prescriptions under any circumstances. There are twenty-three ‘_ 

 l
I
!
i QUARTERLY BULLETIN 13
i
i states where nurse practitioners can prescribe medications within the scope of
i their practice. However, in Kentucky only physicians, osteopaths, veterinarians
and, in a limited way, dentists are allowed prescriptive authority.
Since the clinics have had consistent physician back-up they have seen
I an increase in patient visits. This places more demand on an already burdened
i staff as they now see 30% more people. "In my own small way I try to convey
j to all the clinic staff mem