Distance learning addresses lack of primary healthcare providers in rural Ky.

By James Kelsey

During the COVID-19 pandemic, limitations have been a common story line. Healthcare professionals have dealt with limited supplies of personal protective equipment, limited space in which to house and care for patients, insufficient testing supplies and limited workforce.

Limitations in healthcare are not new to rural southeastern Kentucky, where most counties are designated as medically underserved areas (MUAs). Despite its beauty, the region’s remote locations and rural clinics and hospitals struggle to attract primary healthcare providers from larger cities and communities.

The problem is magnified by a lack of specialized healthcare providers in these rural and underserved areas. A 2018 study published in the American Journal of Preventative Medicine[1]  found that 65 percent of non-metropolitan counties in the United States lacked a psychiatrist.

Kevin Scalf is a psychiatric-mental health nurse practitioner at Hazard Appalachian Regional Healthcare Psychiatric Center in Hazard, Ky. Originally from nearby Manchester, Kentucky. Scalf is also a Regional Clinical Faculty member at Frontier Nursing University (FNU). He has been a Psychiatric and Mental Health Nurse Practitioner (PMHNP) since 2011 and a registered nurse for 24 years.

“I serve a population of adults that struggle with psychiatric illness in rural southeastern Kentucky,” Scalf said. “The residents of this region have limited support systems and significant economic challenges while living with persistent mental illness. As a result of these limited support systems and economic struggles, they often find it challenging to make healthy decisions and follow up with their primary care providers on a routine basis. The healthcare gaps include a shortage of mental health providers, which is especially true for patients suffering from conditions such as autism spectrum disorder, intellectual disabilities and substance abuse.”

These issues existed before the pandemic. Now, for many in the region, COVID-19 has added another component to their mental health struggles.

“COVID-19 has increased isolation among our population. Isolation is a risk factor for mental health destabilization,” Scalf said, noting that many patients in the area lack the mechanisms to attend virtual appointments. “Patients who suffer from anxiety and fear related to COVID-19 can sometimes be afraid to go to their primary care provider, resulting in decreased follow-up visits. This can be a significant risk factor for acute exacerbations of mental illness.”

Distance Learning Model

Scalf’s presence as a mental health provider in the area is an example of the impact that Frontier Nursing University’s (FNU) unique distance-learning model can have within rural and underserved populations.

Founded in Hyden, Kentucky by Mary Breckinridge as the Frontier Graduate School of Midwifery in 1939, FNU offered the first distance learning nurse-midwifery program in 1989. Because FNU’s students are already nurses, the distance-learning model allows them to continue to work while they pursue their advanced practice degrees.

In addition to maintaining his practice and teaching students, Scalf is also attending FNU as a student on track to earn his Doctorate of Nursing Practice this spring. With an enrollment of more than 2,300 students representing all 50 states, FNU students like Scalf are working and serving their communities while they continue their studies.

“We work every day to address healthcare shortages, particularly in rural and underserved populations,” said FNU president Dr. Susan Stone. “Our unique distance-learning model allows and, in fact, encourages students to continue their education in the same communities where they practice. Our students are not pulled to larger cities to be able to attend classes. They can remain in their local communities and continue to work and serve there while attending classes on a flexible schedule.”

More than 180 FNU graduates practice in southeastern Kentucky, representing a large percentage of the area’s healthcare providers. For example, in many of these counties, 50 percent or more of the Family Nurse Practitioners are FNU graduates.

“FNU has given me additional education, tools and skills that I can take into the world and use to bring about meaningful change in our region,” Scalf said. “As healthcare becomes more complex, it is important to have the ability to translate evidence-based strategies into individualized practice interventions.”

FNU’s model has also allowed the university to adjust to COVID-19 with no interruptions in classes. The university has remained open throughout, continuing to enroll new students while keeping current students on track to complete their degrees. Students have been allowed to take an academic hiatus as needed, and FNU has an emergency student fund to assist students with financial hardships brought on by the pandemic or other emergencies.

“FNU has been helpful in staying current on the latest COVID-19 updates,” Scalf said. “FNU has offered faculty, staff and student support sessions that have helped us draw strength from one another. These sessions not only demonstrate FNU’s culture of caring but also help us realize that social distancing does not always mean social isolation.”

-James Kelsey is with Frontier Nursing University in Versailles, Ky.


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