True North

Bartlett Regional Hospital in Juneau, Alaska, serves the entire southeastern portion of the 49th state, known as the Alaska Panhandle. Stretching 500 miles along the Pacific Coast, with islands making up 40% of its landmass, the region is about the same size as Indiana and home to some 55,000 people. About 32,000 live in Juneau, the state capital, while the rest live in 35 communities—most inaccessible by road—spread throughout the mountainous, rainforested landscape. Alaska Natives make up about 30% of the region’s population. 

“We’re on that southeast leg with all the little islands that seem like they’re really close together, but there are no roads. So you fly into Juneau or you boat into Juneau,” explains Jennifer Twito, BS, Bartlett’s director of staff development since 2020. “We are the regional hospital for southeast Alaska. If something bad goes down in the region, those people are flying to us.” 

Since 2019—aside from a break during the pandemic—students in Columbia Nursing’s Master’s Direct Entry (MDE) Program have had the option of completing their clinical integration at Bartlett. The clinical integration experience—a six-week, required clinical immersion—has served as the capstone of Columbia Nursing’s MDE curriculum since the 1980s. Since then, an ever-broadening array of options and settings throughout New York City and around the world have been available to students in the program. 

‘Small but mighty’ rural hospital offers many options 

Bartlett works closely with its community partners to offer Columbia Nursing students clinical integrations that suit their interests. Someone interested in women’s health, for example, can work with midwives and in the hospital’s C-section suite.  

The 57-bed hospital, with about 900 employees, is also the only facility in southeast Alaska that provides inpatient psychiatric care. In addition, Bartlett fields multidisciplinary mobile crisis teams of psychiatric emergency clinicians and paramedics who respond to mental health crises once a medical emergency has been ruled out in a given case.  

Often, the mobile teams can work with a patient and their family to develop a safety strategy. “They make a plan, and then that person doesn’t need to be transported to the hospital,” Twito explains. “Or if they do, they’ve already created that relationship with the clinician.” 

This multidisciplinary model has been proven to decrease the amount of time patients spend being transported or in the ED, Twito explains. “They’re able to actually address these things in the field.” 

Students who are interested in this specialty can work on the inpatient psychiatric ward, ride with mobile crisis teams, help staff public health clinics for teens, and learn from school nurses. “They’ve been able to be up close and personal, really get to see and learn,” Twito says. “We are small but mighty. We can curate a pretty impressive opportunity for students in most areas of interest.” 

Bartlett offers a robust clinical experience clinically tailored to strengthen skills in each student’s area of interest, notes Candice Smith, DNP, the director of clinical placement at Columbia Nursing. “Bartlett is an engaged clinical partner that meets individually with students, and even came to our career fair to discuss opportunities for future learning and employment.” 

Another unusual aspect of the Juneau clinical placement is the huge variation in patient volume based on fluctuations in the number of tourists, Smith adds. “When the students are there in the beginning, most patients they see are local or have been flown in because care is not available in the rural areas where they live,” she explains. But toward the end of students’ time in Juneau, cruise ships begin docking and disembarking hordes of passengers in the harbor, “so that’s a very different experience.” 

There are some services that Bartlett does not provide, and patients needing those must be flown either north, to Anchorage, or south, to the nearest Level 1 Trauma Center, in Seattle.  

But flights can’t always take off right away—for example, earlier this year huge snowstorms shut down the runway in Juneau. “We have to be prepared to take care of these sick, sick patients,” adds Twito. “We have to have people that are trained and people that are confident in caring for those patients.” 

Providing holistic, preventive mental health care 

Anna Jones, MS ’24, completed her clinical integration at Bartlett in 2024. “A lot of people were flown in from all over the islands and the state to get psychiatric treatment there,” explains Jones, who expects to graduate from Columbia Nursing’s Psychiatric Nurse Practitioner (NP) Program this year. 

Though she was born in Fairbanks and had lived in Anchorage since the age of seven, Jones had never been to Juneau before her integration. “I really didn’t know what to expect. But it was so much fun, and it exceeded all of my expectations.” 

Jones became interested in becoming a psychiatric NP in college, where she studied neuroscience. “I was diagnosed with anxiety and depression, and they put me on a slew of antidepressants that frankly just made everything worse,” she recalls. “I spoke to my first nurse practitioner, and she listened to all of my symptoms, and she took one blood test and said, ‘You have hyperthyroidism, which can present as anxiety.’ We decided together to get off the psychotropic meds and start thyroid medication, and all my symptoms went away.” 

Jones has also seen her mother struggle with panic disorder, as well as episodes of chronic pain. “I wanted to go into an area of psychiatry where I’d have the ability to have a more holistic approach. And I think that being an NP really offers that in a special way.” 

She chose Columbia Nursing because she knew going in that she wanted to be a provider. “This was the fastest way that I could find to do it. They also have such a stress here on the importance of diversity and interdisciplinary collaboration, and I have found that is a really critical piece of patient care.” 

During her time at Bartlett, Jones went out with the mobile crisis unit. “We would go to patients’ homes and make sure that they were taking their meds. We did a couple of finger sticks for some diabetic patients, made sure that they understood when to take their insulin. And we drove a couple of patients to the VA for appointments. We went grocery shopping with a couple of people, just making sure they had what they needed,” she recalls. 

“You could really tell that they care about the people. It’s special what they’re doing with such a small community and so few resources—really making the most of it,” Jones adds. 

While psychiatry is often seen as a luxury, supporting patients before they are in acute need through Bartlett’s integrated model allows care “to be much more casual and much more preventative instead of reactive,” she explains.  

At the same time, working with inpatients gave her a chance to see people suffering from severe mental illness. This experience underscored for her the powerful effects of identifying the right treatment for those with mental illness. “You’re seeing people in the most acute stages. But seeing how drastically people change over the course of a couple of weeks with the right meds, and if it’s not meds, just how much having a supportive environment and someone to check in on you daily really helps.” 

Jones plans to return to Alaska after completing her DNP and would like to implement a similar integrated, preventative approach in other cities to caring for homeless people with mental health issues. 

She has a few pieces of advice for MDE students interested in the Bartlett program: Bring a rain jacket and rain boots, and enjoy Alaska’s natural beauty and myriad outdoor activities. “And lean in to how friendly people are,” Jones adds. "I made a lot of really good connections there and a lot of friends that I still keep in contact with two years later.” 

Finding a calling in the ED 

Hailing from a small mountain town in Idaho, Ali Maricich, MS ’19, initially expected her clinical integration to unfold in the concrete jungle of New York City. But hearing about a unique opportunity in Juneau, Alaska, changed her trajectory forever.  

Maricich applied to join Columbia Nursing’s inaugural cohort at Bartlett Regional Hospital, trading the subway for the rugged scenery of the Last Frontier.  

During her rotation, Maricich explored mental health and obstetrics, but it was her six shifts in the emergency department (ED) that truly resonated. She was immediately struck by the high-caliber medicine practiced within such a tight-knit atmosphere.  

“I found the entire team and the situation to be deeply community-based, offering truly amazing medicine. The way the team operated with such seamless precision was remarkable!”  

Following graduation, Maricich interviewed for a staff position with the Bartlett ED director and director of education. The connection was instant; two hours later, she received the call: “Come on up!” She spent the next four years at Bartlett before transitioning to travel nursing, carrying with her the versatile skill set required of an Alaskan nurse. “In a small-town hospital, nurses aren’t just staff members—they are the backbone and the frontline leaders of the community,” Maricich notes.  

At the Bartlett ED, nurses handle everything from EKGs and IVs to patient transport. They use grit and critical thinking to solve complex cases when resources are lean. Maricich explains further, “When a trauma arrives, the team expands and pivots instantly to support one another. Working in a small town means your teammates are also your neighbors, which creates a deep sense of accountability.”  

For students starting a placement in Alaska’s capital, Maricich says, the best advice is to be gracious and vulnerable in that professional space. Most importantly? “Don’t forget to bring a rain jacket.”  

Photos courtesy of Isper Crissey, Karol Dibello, Ali Maricich, Jörg Meyer, and Jennifer Twito. 

This article originally appeared in the Spring 2026 issue of Columbia Nursing Magazine.