On a Mission

Among the procession of professional degree programs Francis Marion University has rolled out the past few decades, none has been clearer in purpose or sharper in focus than advanced practice nursing. 

The program, which educates nurse practitioners and now, doctors of nursing practice, was an obvious accompaniment to FMU’s acclaimed nursing program. And it met the most critical of needs in the region and state the university serves — improving the health of its people. The Pee Dee Region, particularly its poorest, most rural areas, has long struggled to find the resources needed — first-rate practitioners in particular — to deliver high quality healthcare. 

“There’s nothing more important to the health of a community than healthcare,” says Dr. Fred Carter, FMU’s president. “That may seem obvious, and it is, but it is a vital concern that still doesn’t receive the attention it needs and deserves. Since I’ve been here, one of FMU’s primary missions has been improving the health of the community, to the extent that it’s become a part of the very fabric of this place and what it does.” 

FMU, and its partners in the legislature and in the community, have poured resources into healthcare programs. FMU now offers 13 different degree programs across six specialties. 

None has had more impact than advanced practice nursing. As the program nears its 15th anniversary, it will soon celebrate its 300th graduate. Those professionals have fanned out across clinics and hospitals and other institutions across the Pee Dee, improving outcomes and raising hope in that most vital of spheres, life itself. 

“It’s nice to look back and see all the wonderful people who have come through our program,” says Dr. Deborah Hopla, the director of the program since it began. “It’s really amazing to think back to when I came on board and there were four nurse practitioners in the Pee Dee area, including me. Now they’re everywhere around here and so many of them are our grads. This has really made a big difference.” 

ON THE RECRUITING TRAIL 

Hopla is a pioneer in nursing practice. She was in the first wave of nurse practitioners in the state of South Carolina, and is a longtime advocate for the profession. She was already well-known in the state, and in the Florence area, and was a practicing nurse practitioner in Timmonsville, S.C., when Carter tapped her to build FMU’s program. Such was Hopla’s reputation that her mere presence as the new program head was enough to bring some early students into the fold. 

“My wife was a (nurse practitioner) and I was working in nursing, and I was thinking about doing it, too, when FMU picked up the ball and started a program,” says Darren Smith, a member of the first FNP class at FMU. “But when we heard Dr. Hopla was going to lead it — everybody knew who she was — I was almost compelled to enter the program.” 

Plenty of hard work was still required. Hopla says for several years she “went everywhere, talked to anyone willing to listen — doctor’s offices, clinics, nursing meetings, hospitals, the state medical association — to build support for the program. 

“You know, there was just so much to do,” she says. “We had to obtain practice partners for clinical experience. We needed faculty. And, of course, we wanted prospective students to know what we were doing. One positive was I had worked at McLeod (Medical Center) and at the old Bruce Hospital. I knew the medical community. And, for the most part, everybody was on board. We were able to get the people we needed, create the necessary partnerships, and of course, Dr. Carter provided tremendous support. It wasn’t easy, but we got off to a good start.” 

EIGHT TIL EIGHT 

The program started a few years before online education really took off across the nation. Hence, the program began with 100 percent in-person instruction. To accommodate working schedules — both for the students and the faculty, all of whom continued to practice medicine — Hopla and company set up a bruising all day regimen. 

“What I remember mostly from FMU was being in class for one long day,” says Dr. Krystal Cooley, who graduated in the first class of nurse practitioners then later obtained her doctorate in nursing practice. “We were there from 8 a.m. to 8 p.m. It was one class after another, or one lab after another. Most of us would go out to lunch together in the middle of the day at this diner down the road (from FMU’s main campus). … 

“… Because of all that, we formed a bond,” says Cooley. “It was a very tight-knit group. I still keep up with many of them.” 

Says Smith, “It was a very, very long day — for us and for the professors. We would see some of the same professors throughout the day — they often taught more than one class. We were stressed. I think the profs were, too. There was some shock value. A fair amount of us (in the class) were in our 40s and in grad school. I know I’d gone from being sort of an expert (in his nursing position) to being a new student who didn’t know anything. But what the heck — we all volunteered for this and it turned out great.” 

The program began with high standards, a certain connection to FMU’s baccalaureate degree program in nursing which began a decade before. Accreditations by industry-leading organizations were meticulously maintained and additional credentials were added when appropriate. For instance, FMU has been named a Center of Excellence in Pedagogical Expertise by the National League of Nursing for 10 years running. 

The program exuded pride in the profession, and from the beginning, its leaders were looking toward the future. They anticipated the addition of a doctoral program that would bring high-level research, and still higher standards, to the program. 

Hopla and university leaders insisted that faculty be both superb teachers and skilled, active practitioners in the field. Everyone who taught was a nurse practitioner who worked, at least parttime, in frontline healthcare. That’s still the standard today. Even Hopla, who, theoretically at least, is nearing retirement, practices one day a week at HopeHealth. 

“You can’t put a value on that experience, on staying active,” says Hopla. “Our students see it. It’s a model for them. And it keeps us going as well.” 

Four years in, FMU added the doctorate of nursing practice (DNP) program, the first doctoral degree in university history. The new degree, which equipped nurse practitioners to work in research, executive positions, and to teach at the highest level, was developed to meet changing industry standards. It was clear, says Hopla, that the field of nursing practice was headed in the direction of a doctorate becoming the standard for a terminal degree. But it also made sense for students. 

“It really caps your education,” says Hopla. “It puts you in a place where you have a different perspective, a broader view. It makes all the difference.” 

Advanced practice nursing at FMU now encompasses six different tracks: a master’s to doctorate program, a bachelor’s to doctorate program, a bachelor’s to psychiatric/mental health DNP degree, a masters in psychiatric/mental health practice, a post-masters psychiatric/mental health certificate, and master’s for nurse educators. 

A FLEXIBLE WORLD 

Just a few words into any career conversation with a nurse practitioner will produce a reference — several usually — to the word “flexibility.” NPs practice across a variety of healthcare disciplines and work every imaginable shift. Most are full-time, but part-time employment is always available for professionals seeking to accommodate different phases of their personal lives, so great is the demand for NPs. 

Krystal Cooley, for example, has worked as a hospitalist, as an occupational health provider, and now as provider at a geriatric center, in the less-than-a-decade since she graduated. During that same period, she and her husband, David, have also started a family. And more new experiences are on the way. She obtained her doctorate several years ago with the idea of teaching somewhere, some day, at the top of her mind. 

“It’s not the right time for (teaching) now,” says Cooley, “but someday, I will do that. And that’s the beauty of this (profession). It’s so flexible. You can do almost anything you want, and as far as I can tell, the need will always be there.” That is a bit different from when Cooley first graduated. She says she experienced a brief panic attack upon graduation because there didn’t appear to be any jobs for nurse practitioners in Florence. 

“But that was mostly because there weren’t any nurse practitioners around,” says Cooley. “You just had to look, to ask a few questions. Employers were eager to hire as soon as they found out we existed. It fills a real need.” 

Nurse practitioners are one of the fastest-growing fields according to the Bureau of Labor Statistics, with a projected increase of 135,000 jobs nationwide by 2033. There are currently about 285,000 active nurse practitioners in the United States, or not quite three times the number there were when FMU’s program began. 

Median pay in the profession has climbed too, to more than $125,000 per year, and it was recently ranked as the best job for the future by Money Magazine because of the remuneration and projected job stability. 

Hopla thinks the picture will continue to improve as the profession grows and gains more autonomy. By law, nurse practitioners practice under the direction of a medical doctor, but 28 states allow complete, or some additional autonomy for NPs who have 2,000 hours (about a year’s worth) of clinical practice under their belt. 

Hopla has been one of the chief voices advocating for a similar standard to South Carolina, frequently testifying before legislative committees on the matter. It just makes sense, she says, both for the profession and the state of healthcare in South Carolina, which still lags most of the country in practitioners of all kinds per capita. 

“It would allow nurse practitioners to go out into rural areas without having doctor oversight, places where it is so hard to find doctors to go and practice,” she says. “I don’t know what people are afraid of. Look, here’s the thing I know — nobody (in healthcare) works in a vacuum. When my husband (Dan Hopla, a noted otolaryngologist in Florence) was at his (ear, nose, and throat) practice, if someone came in with a lung lesion, he called a pulmonologist. No one works by themselves anymore. No one practices in a vacuum. Nurse practitioners wouldn’t either.” 

EXECUTIVES & ENTREPRENEURS 

Like the leaders of many academic departments, Hopla enjoys graduation day, the joy, the emotion, the once-in-a-lifetime family moments. But she says there’s a greater sense of accomplishment when she takes a moment to consider all the nurse practitioners FMU has produced and where they have gone. 

She tracks them closely. Of the almost 300 grads, she says, none have left the profession and all but 12 have remained in the state of South Carolina to practice. That’s important because the program’s mission, from day one, was to prepare healthcare professionals to stay in the region or state, in a place, in other words, where they were desperately needed. 

“Our program does attract students from other places, other states, and that’s great,” says Hopla, “but our mission statement is to provide this education to serve this area. I’m so happy we’ve done that, and continue to do that. 

“I look around and there are students from our program everywhere,” she says. “A family nurse practitioner can really care for any population, from cradle to grave, and that’s what you see our graduates doing. They’re in every kind of setting you can imagine, from schools, to nursing homes, to prisons, to factories. … We have graduates who have gone out and started their own businesses (see “A Sweet Idea” page 22) and who have hired other graduates to form new practices. It’s great to see and to feel that impact on the community, on people. 

That impact, and those people, includes the students Hopla and others taught — students like Darren Smith, the son of a sharecropper from Dillon County who now travels across the southeast, providing quality emergency room services where needed. 

He and his wife, also a nurse practitioner, have a son who’s about to go to med school, and other close relatives who are already doctors. The whole long story is all but unbelievable to Smith, considering where he started. 

“It’s been an amazing journey and I couldn’t have done it without FMU,” says Smith. “The university took that impoverished, poor kid from Dillon County and helped him secure a comfortable, purposeful life.” 

“Hey, I’m on the positive side of the statistical ledger now and this education …that’s what put me there.”