Nikki Billman, DNP-PMHNP: A Homegrown Rural Mental Health Nurse Practitioner
When we talk about growing our own healthcare providers, many think about investing in the next generation of children. But for people like Nikki Billman, growing our own means investing in healthcare professionals at every stage of their careers. A La Grande local, Nikki recently earned her Doctor of Nursing Practice (DNP) as a Psychiatric Mental Health Nurse Practitioner (PMHNP) through Oregon Health and Science University’s (OHSU) innovative distance program. Since graduating in June, she has taken on a vital role as an outpatient provider at New Directions Northwest in Baker City, Oregon, serving the mental health needs of her community. Nikki’s story is a testament to the power of opportunity, persistence, and the belief that we can build strong rural healthcare professionals—right here at home.
When Nikki began her healthcare career, she never imagined working in psychiatry. Her personal experiences with mental illness in her family had made her wary of the field. But while working on the Med/Surg floor, she found herself drawn to patients with mental health challenges in ways she hadn’t expected. Her journey took a pivotal turn during the pandemic when, while working at Grande Ronde Hospital’s clinics, wearing full personal protective equipment to swab people for COVID from their cars, a friend encouraged her to apply for a position at Center for Human Development (CHD) offering Suboxone treatment for addiction recovery. Nikki says, “Just seeing the way like their lives changed was awesome. That was the big thing—watching people with addictions get on the other side of it.”
Though Nikki was passionate about advancing her education and career, relocating to Portland wasn’t an option. She and her family are firmly rooted in La Grande, with her husband working for the La Grande Police Department and her oldest daughter in high school. The only DNP-PMHNP program in Oregon is at OHSU, but it has traditionally been in-person, requiring a move. That was until a partnership between NEOAHEC, OHSU, and the Oregon Health Authority (OHA) made the program available remotely at no cost as part of the Oregon Health Policy Board’s Healthy Oregon Workforce Training Opportunity (HOWTO) grant. Nikki immediately saw the opportunity to follow her passion without uprooting her family or taking on significant debt. As she puts it, “I didn't have to uproot my whole life to go do what I am passionate about.” The program being offered free of cost was an additional bonus for Nikki, who had incurred student loan debt from her undergraduate degree.
Nikki’s clinical rotations during her doctoral program were transformative. Her first rotation was at New Directions, where she works now, and even though she spent much of it shadowing her preceptor, it sparked her passion for the field. Her preceptor from New Directions remains a close mentor, and the two now work side-by-side, an accomplishment Nikki is particularly proud of. Nikki found her first PMHNP position serendipitously—while shopping at Walmart, she ran into her former supervisor from CHD, who now works at New Directions. Even though the position was in Baker City, a 45-mile drive over a mountain pass from her home, Nikki embraced the challenge. She appreciates the people she works with, is happy to help people in her region, and doesn’t mind the commute—though she hasn’t experienced the winter version of it yet.
Nikki’s commitment to serving her community is unwavering. She can’t see herself leaving Eastern Oregon because there is such a great need for mental health professionals—to leave would feel like a betrayal. She reflects, “I'm already in a place that so severely needs this sort of care. It would feel like I'm abandoning people, I guess, if I moved to a different community or a big city.” In her position, she treats people who she has personal connections to. “It's a community that actually cares about the people that are in it,” Nikki says. “I treat people who I know their parents and I know where they went to school. We had the same P/E teacher. So, these people are my community.” This connection makes her work incredibly fulfilling, though she acknowledges the unique challenges of providing mental healthcare in such a rural community.
During her doctoral program, she saw very clearly that her peers in urban areas had access to a range of resources, and Nikki did not. One moment from her program specifically stands out. She remembers, “People in Portland would start talking about a case and I’d say, ‘We can't do that here.’ And there was no perspective. They'd be like, “Oh, just send them to detox.” There's one detox across three counties and they don't have that many beds. They’d ask, ‘Oh, what do they have? 60?’ And it’s six. They were just shocked.” Both the disparity and the lack of awareness about it was abundantly clear throughout the three-year program—but that didn’t stop Nikki from pursuing the degree.
Mental health crises can escalate quickly, and that’s just as true in a small town as it is in a urban area. Nikki explains, “For some people, waiting to see somebody who specializes in psychiatry can take months. And some people don't have months. They're severely mentally ill and instead spend a lot of time in jail. Which is not an appropriate treatment setting, but it's what we have. Which is frustrating for law enforcement. It's frustrating for the hospital. It's frustrating for us as mental health people.” As much as the police department tries to circumvent situations where a person is arrested due to a mental health-related situation, if treatment isn’t accessible or timely, they can still end up in jail. She continues, “It can be very difficult for someone like that to get an ID and therefore very difficult for someone like that to have a place to live. And therefore very difficult for that person to have a job, to get a place to live. And so then they're on the street, right? And when people are on the street, other people have issues with that. Or they're having to steal things to eat, or their mental illness becomes an issue in the community because they're not acting socially appropriate. So, then they get arrested.” Because police and mental health professionals often interact with the same people, Nikki likes that her job is out of Baker City. She feels that it’s better for her to serve a different population than her husband, at least while she is a new provider.
Though Nikki is deeply satisfied with her rural healthcare career, she urges others considering this path to experience rural life firsthand. She explains, “For someone from a large city that's never lived in a small community, I'd ask them to come stay here for a little while, because it's definitely a different animal than what it's portrayed. It's not all rustic and Western. It's just not.” Despite the challenges, Nikki wouldn’t change her career for anything. She reflects, “It's not the 15 minutes you spend with your primary care and you're out the door. There's a lot more relationship with psychiatric patients. It's really a rewarding career so far.”
In her journey, Nikki has proven that we can grow our own healthcare providers at any stage of their career. There are people in Eastern Oregon that want to go into healthcare and NEOAHEC is proud to help them along, even just for a part of their journey.
