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Health & Nutrition - Commitment to the Rural Way of Life

The Family Nurse Practitioner Program focuses on the underserved in Maine communities

Pam Slaven

UMaine students focus on the healthcare concerns they're likely to see in rural settings, including conditions brought on by isolation and the "culture of community" that often dictates how patients view healthcare and live their lives.

Nancy Putnam had been a registered nurse for more than two decades when she took a two-year leave of absence from Houlton Regional Hospital. Her decision to make a career change was followed closely–and with genuine concern–by many residents in her rural Maine community near the Canadian border.

“How much longer are you going to be in school?” townspeople asked when they saw Putnam in the local grocery store on weekends. “How are you doing in school? Do you like your courses and the professors?”

The impromptu conversations epitomized the encouragement and support Putnam experienced from her hometown while she was doing her graduate work in the Rural Family Nurse Practitioner Program at the University of Maine. People in Houlton knew and respected the work Putnam did as one of the healthcare providers in their area. Perhaps most important, they understood that she shared their commitment to a rural way of life, and would bring her training back to the community to provide needed services.

“I wanted to work one-on-one with people and promote healthy lifestyles,” says Putnam, a family nurse practitioner for the past seven years and one of three primary care providers at Houlton Family Practice. “The hospital offered interesting, fast-paced work and I loved it, but that setting is a very small part of people’s total lives.”

In primary care nursing, people are not seen as isolated but as “living connected to families and communities in which their health is inseparable,” she says. “It has to do with physical and emotional health, and their community interaction.”

Putnam is one of 85 family nurse practitioners who received their advanced training at the University of Maine. Today, when a UMaine nursing student does his or her clinicals at one of more than 100 sites in the state, it’s likely that the on-site instructor or preceptor is a graduate of the program, says family nurse practitioner Nancy Fishwick, an associate professor in the university’s School of Nursing.

“There’s a cadre of nurse practitioners now in rural Maine like Nancy Putnam who are alumni and who are teaching the next generation,” Fishwick says.

UMaine’s Rural Family Nurse Practitioner Program was one of three in the country, and the first in the state, when it was established in 1991 with the help of a more than $670,000 grant from the U.S. Department of Health and Human Services. The first five students graduated in 1994.

Most students graduating with master’s degrees in nursing from UMaine have trained to be family nurse practitioners. In addition, some recent graduates have focused on nursing education, administration and other advanced role options.

The emphasis at the School of Nursing is on increasing access to higher education for nurses, thereby increasing access to healthcare in rural areas. A Family Nurse Practitioner Program can put primary care providers into rural communities that may not be able to support a doctor or that simply want to expand healthcare provider options.

Family nurse practitioners are “a virtual gateway” between patients–newborn to geriatric–and other care providers, says Carol Wood, the graduate program coordinator in the School of Nursing. In some areas, there is only one clinic for many miles around. With a rural family nurse practitioner in such a community, people don’t have to go to different places seeking healthcare for family members. The family nurse practitioner has the ability to provide a full scope of healthcare to address common illnesses and to provide health promotion measures. In addition, the family nurse practitioner has a professional relationship with other medical personnel for consultation and referral.

“Some of our graduates head toward more isolated areas in the state where they may be the only or preferred care provider,” says Associate Professor of Nursing and family nurse practitioner Judy Kuhns-Hastings. “Often these are positions that are not entirely attractive to a physician. Family nurse practitioners who are educated in the state have a commitment to that community and to improving the healthcare in that particular area.”

Ellen Pileski of Franklin is one of those family nurse practitioners trained to provide holistic patient care, looking at the effect of illness not only on the patient but the family. Pileski had been a nurse for nearly 20 years when she decided to return to school to study geriatric care. But in UMaine’s Rural Family Nurse Practitioner Program, she also discovered a love of pediatrics and women’s health, and a desire to “find out what people need in the environment in which they live.”

“It opened new perspectives,” says Pileski, who graduates next year. “I will stay in Maine to practice; I wouldn’t think of being anywhere else. I would love to own my own clinic with more of an old fashioned, door-to-door practice because in Franklin, whether you’re younger or older, transportation is a big issue.”

In their clinical training, UMaine students focus on the healthcare concerns they’re likely to see in rural settings, including conditions brought on by isolation and the “culture of community” that often dictates how patients view healthcare and live their lives. In parts of Maine, many people have no health insurance and will often not seek regular treatment, or will only seek medical attention when health problems have reached a crisis.

Today, there still are rural Maine areas underserved by healthcare, and the demographics are dramatically ratcheting up the need. Central and northern Maine have a disproportionately elderly population, says Fishwick. Older adults tend to have one or more chronic health problems, some that could be prevented.

Many times, the common denominator among the nurses returning for graduate degrees is their desire to prevent illness rather than just treat very sick patients. One of them is Lisa Starkweather, who was a cardiac nurse for nine years. She was looking for a way to continue to work with patients and be more autonomous in her healthcare role.

“Working in acute care, I’d see people coming in with preventable risk factors, like smoking and obesity. That’s when I decided I’d like to get into the community more and pursue more preventative care,” says Starkweather, who received her master’s degree this past May and was cited as the most outstanding student in her graduating class of nurses.As if she needed further incentive to make a career change, Starkweather was inspired by her 90-year-old grandfather.

“He’s one of the greatest role models,” she says. “I looked at what preventative care has done for him and knew it was the place for me. My grandmother passed away in her 50s. They never went to a doctor. When my grandfather finally went in for a physical, it showed he had high blood pressure and was headed for a stroke. It’s because of preventative care that he’s now in great health and traveling the world.

“I see so many older adults debilitated. Some of that’s genetic, but much of it is preventable or can be brought under control.”

Teaching is a big component of a family nurse practitioner’s job, says Linda Wentworth, a nurse in the intensive care unit of Penobscot Bay Medical Center who received her bachelor’s degree from UMaine. “I strongly feel that if people have a good understanding of their disease process, it increases their compliance with the treatment regime.”

Even before she graduated this past spring, Wentworth knew what difference a family nurse practitioner can make, even far from home.

“The driving force for me to get my FNP was missionary trips to Honduras that I participated in,” she says. “I’ve done six so far and wanted to be able to do more for the Hondurans.”

During her most recent trip last October, Wentworth accompanied a family practice physician to a remote village. “It was the most incredible experience,” she says. “A lot of the Hondurans appreciated the explanations of their disease processes. They said it would be easier to deal with the disease with knowledge of how the disease process works and why they have the symptoms they do.”

As Nancy Putnam sees it, “rural people are the same, whether in a lumbering community in western Maine or in an agricultural community” in Aroostook County.

“They depend on one another for their needs. They are family-centered and create their own community,” she says. “You find that even the people at the rural health centers are that way. From the receptionist to the people in the business office to the nurses and healthcare providers, they are supportive and committed to keeping healthcare available in the town.”

by Margaret Nagle

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