LYNN Ellen (Van Riper) HARTZ
• Healthcare Policy
LYNN Ellen (Van Riper) HARTZ
Lynn (Van Riper) Hartz was born the oldest of four siblings to a military family and spent many of her early years moving to Navy bases around the country. During her high school years, she lived in Ventura County, California. While in her Junior year in high school, her program offered coursework in different fields where she could work in a volunteer capacity. She chose to work as a nurses’ aide at a long-term care facility. That was a pivotal time for her, and she knew that nursing would be her chosen profession. In fact, she was so enamored with the role that she dropped out of her regular high school so that she could continue working at that facility as a nurses’ aide during the day while completing her last year in high school going to night school.
This was the start of a long and illustrious career in nursing. Hartz began her nursing education in an associate degree program and began working as a staff nurse at UCLA/UCSF and finally a small hospital in Santa Rosa, CA. It did not take her employers long to recognize her abilities and she was offered a role as the first director of in-service and employee health. This position was the first of many firsts for Hartz. While she was in this position, she was recruited to develop a coordinated diabetes program at the hospital. After she created the very successful program, it was shared and used by other hospitals in the area. During this time, Hartz, who was not one to miss an opportunity, continued her education and achieved a bachelor’s degree in nursing as an advanced nurse practitioner (ANP), family nurse practitioner. Her next position was in a mobile family planning clinic in California where she found her passion in providing services for women’s health, an area where she has continued to develop expertise throughout her career.
Her move to Alaska came after an early visit to the state with her husband, Jack. They were taken with the beauty of the country and when Jack was offered a job in Alaska, they immediately moved to Anchorage. Hartz began working at the Municipality of Anchorage Department of Health and Social Services Family Planning Clinic where she met Kay Lahdenpera, her supervisor, who became a significant mentor for her. It was Lahdenpera who suggested that she apply for a nursing position on the Alaska Board of Nursing (BON) and supported her in her successful bid for the position. At the same time, Hartz knew within herself that she had abilities that could affect the significant changes that needed to be made to allow nurses to practice to the full extent of their abilities and education. It was here that she truly came to embrace the vision of the nursing profession’s ability to take on new roles and accomplish significant improvements in health care through nursing.
Hartz was the first ANP appointed to the Alaska Board of Nursing in 1983. The ANP profession within the nursing profession was a new arena for nurses with advanced degrees. She described a situation that helped her to clarify the role of nurses in advanced practice when she attended her first Board of Nursing meeting. A physician came to testify about the BON working on new regulations for the ANPs. He said that NPs were practicing medicine and as such, needed to be supervised by a physician as nurses were incompetent to work independently.
“I sat struck and silent with the onslaught, unprepared with a well thought out argument. After going home, I dug deep and thought out a framework of ideas that would make a logical and strong argument against the idea that ANPs practice medicine. If I had not felt so terrible about not having an answer to that physician, I don’t know how long it would have taken me to have a ready answer.”
Later, she attended the Medical and Pharmacy Board as well as meeting with the President of the Alaska Medical Association. Now that she was ‘armed’ she could discuss the issue with those who may disagree, but at least they would understand ANPs had a solid base upon which to assert they practice nursing and as such, have no need to be supervised by someone in a different profession.
Though the number of ANPs in Alaska was small at the time (documented 32 ANP applications in 1980), Hartz had the background and understanding of the depth and breadth of ANPs’ abilities to improve health care in Alaska. It was her vision that ANPs could play a significant role to help fill a well-documented gap in primary care throughout the state of Alaska. Her work on the Alaska BON to craft regulations allowed for a strong foundation and structure for ANPs to set up independent practices that have resulted in increased access to care throughout the state. Those regulations, which went into effect in 1984, have continued to inform the practices of ANPs in Alaska for over 35 years. There are currently 1,568 ANPs licensed in Alaska. Hartz’s work had great positive impact in communities and cities throughout the state, with much of that impact being realized in documented underserved communities in rural and isolated areas of the state.
Hartz’s work to develop regulations has had significant impact for other states as ANPs nationally have worked to change their advanced practices laws and regulations. The regulations Hartz developed have been used as a model for other states and are regarded in national publications as an example of progressive health care policy.
Hartz took a bit of a detour when her husband was reassigned to San Francisco and then Houston for work. She, once again, took change as an opportunity and completed her master’s degree in women’s health while in Houston. While working on her degree, her faculty once again recognized her unique abilities and offered her an opportunity to contribute to the body of knowledge on feminine hygiene practices to better inform NASA of the unique needs of women astronauts. She did a pilot study, then completed her master’s thesis on this topic which she presented to NASA. She was recognized by her professors with the Harris County Medical Society Clinical Excellence Award.
Hartz and her husband moved back to Alaska and she worked again at the Municipality of Anchorage Department of Health and Social Services Family Planning Clinic Anchorage. Lahdenpera again saw her potential and asked her to develop a new federally funded program at the clinic and encouraged Hartz to take on a new role which she embraced. Hartz, in another first, was a pioneer in the development of a federally funded Colposcopy Project to detect and prevent cervical cancer in low-income women that was developed and managed by an ANP and also staffed by ANPs. Her clinic also provided many enriching educational clinical experiences to nursing students, medical students, and other health professionals including public health nurses. She was one of the first to measure and compare the quality of care of ANPs versus physicians who had long been the sole providers of colposcopy services. Her original research based on clinical outcomes was published in a national medical journal, Obstetrics & Gynecology, a journal that publishes only approximately 30% of submissions of original research, most of which are authored by physicians. In addition, she wrote a Colposcopy Clinic Manual that was used as a basis for those clinics wishing to develop their own Colposcopy Clinics.
The program is still servicing patients today (over 30 years later) and is based at the Municipal Reproductive Health Clinic in Anchorage. Hundreds of women have been served by this clinic which has expanded services to include incarcerated women at Hiland Mountain Correctional Center in Eagle River.
The Colposcopy Project which Hartz created has had and continues to have a significant impact on the health of women in and outside Alaska through the clinicians trained in the clinic. By conducting research on the clinic and successfully publishing the results, the Colposcopy Project has demonstrably had impact internationally, providing evidence that ANPs have the expertise in a highly technical skill that can detect and prevent cervical cancer. In cultures where women may refuse to see a male physician, or cannot access a female physician, the research Hartz conducted demonstrates that ANPs can take on this role thus saving lives.
Hartz has been very active in developing health policy within the profession of nursing in her many leadership roles throughout the years. Along with her extensive work on the Alaska BON, serving under two governors (Governor Sheffield 1983-84, and Governor Knowles in 1999-2003), she was a founding co-chair of the Advanced Practice Registered Nurse Alliance (another first), steering committee member of the Alaska Nursing Coalition, and executive board member of the Alaska Nurse Practitioner Association. She has remained heavily involved with advanced nursing organizations that deal with health issues throughout the state of Alaska and has strongly influenced policy change recommendations that have improved the health of all Alaskans.
Woven into her many years of leadership and pioneering activities has been what Hartz described as her single most overarching goal, to provide nursing care to people, particularly women, and make a difference in their lives. She maintained a clinical practice throughout her 47 years in the profession, and that has been her greatest love. She practiced in women’s health care for many years with a physician, Dr. George Stransky, who became a mentor for her. He always referred to her as a colleague, not an employee, and encouraged her to push the envelope to take on new opportunities to make her goals become reality. He describes Hartz as “a professional, but warm and welcoming; she organizes people by seeking common goals; and she has been a best friend.” Stransky’s support included volunteering many hours to precept ANPs in colposcopy and providing graphics for many colposcopy presentations.
Hartz has a love of writing that has played well in her career. She has authored many publications. She became editor of the one newsletter distributed to all nurses in Alaska beginning 2004. This newsletter was published quarterly and was a lifeline especially for nurses in rural and remote areas of the state. Burnout among nurses, especially those who are isolated from their professional colleagues because of distance and remoteness, has been a huge issue in Alaska. There is a very high turnover rate of nurses in our rural areas. Hartz was responsible for providing nurses throughout the state with up to date and pertinent information on what was happening in the field of nursing and health care both locally, regionally, and nationally. She gathered articles, and authored articles, researched information to assure credibility and provided a lifeline to over 12,000 nurses that offered views on health care and policy that impacted both nurses and their clients. She mentored graduate students at the University of Alaska Anchorage who were working on health policy projects and published their work in the newsletter. She updated nurses on regulation and health policy changes that could impact their ability to practice. She did all this with care, clarity, and impartiality.
Hartz has had an illustrious career as a nurse practitioner, and as a pioneer in pursuing nursing activism to better the quality and accessibility of health care in Alaska. She has been the recipient of many awards. She and her husband have a son, daughter-in-law, and two grandsons who are clearly significant forces in her life. Hartz has had personal challenges with two episodes of breast cancer: the first, 30 years ago, and the last within this past year, 2020. Her will to overcome these obstacles speak to her inner strength and ability to overcome adversity. Neither of these episodes has derailed her for long. Her latest project is to assure that the history of the growth of nurse practitioners in Alaska is well documented. She has worked on obtaining and organizing the work of nurse practitioners throughout over 50 years of activity in Alaska and is archiving her findings at the library of the University of Alaska Anchorage. Hartz is always open to a challenge. Her innate abilities combined with a deep understanding of what needs to be done to achieve her goals has been the hallmark of her career and moved the quality of health care in Alaska to a higher level.