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Making a Difference for Small-Town Care

“Just because you’re from a small town doesn’t mean you deserve less.” That mindset has motivated alumna Ashley Tupper (MSN ’14) throughout her nursing career, leading her to the U-M School of Nursing and her very own family practice in Newcastle, Wyoming.

Tupper grew up in the small farming community of Shepherd, Michigan. Her parents were health care professionals and helped Tupper acknowledge her ambitions at an early age. Throughout high school, she took night classes at Mid Michigan College in order to enter the nursing program as soon as she graduated.

“I didn’t have desires on anything other than nursing,” she said.

A dream derailed

During clinical rotations as a nursing student at Mid Michigan College, Tupper started having an unexplainable allergic reaction. Without identifying the underlying cause, the college could not let her continue in the program. “I had hives and blisters on my face,” she recalled. “What can I touch? What can I be around? I had no idea what I was going to do.”

Disappointed but determined, Tupper found a new direction far removed from her dream job. She began selling ads for her local hometown newspaper, working her way up and building a skill set in sales. At age 20, she managed her own team as the classified sales director for the Midland Daily News.

Aha moment

While refinishing a family sailboat, Tupper’s allergic reaction reappeared, triggered by the epoxy her father was applying to the hull. Something clicked, and she eventually learned that contractors who remodeled the nursing home where she had done clinical rotations years ago used an epoxy resin when installing new carpet. “In that moment, I thought maybe I could pursue nursing again — maybe this would be okay,” she said.

At 24 years old, Tupper left her successful career at the newspaper and enrolled in the BSN program at Saginaw Valley State University (SVSU). “The tables turned,” she said. “I was an old student struggling through chemistry class alongside kids who were fresh out of high school.”

Tupper sought out clinical experiences wherever she could, working in medical-surgical units, obstetrics, cardiac catheterization and cardiac intensive care. Eventually, she decided to become a nurse practitioner, preparing for a simple transition to graduate studies at SVSU until a pivotal conversation with a faculty mentor.

“She said, ‘Just because you grew up in a small town doesn’t mean you have to stop here. You can apply to the University of Michigan.’ I never even considered it,” Tupper said. “The U-M School of Nursing was on the cutting edge of evidence-based practice. They were writing the research I was studying as an undergrad. I wanted to be part of that.” Tupper came to interview for U-M’s Family Nurse Practitioner program with a plan – literally. She knew nurse practitioners were starting their own clinics, and she saw a path to provide quality health care for overlooked communities like her hometown. During the interview, Tupper laid out her vision for a nurse-run rural clinic, complete with a business plan.

As Tupper pursued her degree at the U-M School of Nursing, her husband, Michael, joined the College of Engineering to study naval architecture and marine engineering. In two years, Tupper earned her master’s combined with a concentration in occupational health.

Heading west

After graduation, Tupper began working at an urgent care and occupational health clinic in South Lyon, Michigan, while her parents settled into their new home in rural Wyoming. “I always told my husband we would eventually move back to a small town where the businesses shut down on Friday night for football games, because that’s where we grew up,” Tupper said. “One day, my mom called and told me, ‘We found your small town.’”

Wyoming is an independent practice state, where nurse practitioners don’t need a collaborative agreement with a physician to operate. It was an opportunity to execute the plan she laid out so carefully in Ann Arbor. Six months pregnant with her second child, Tupper moved across the country and began working at Newcastle’s only health clinic at the time. “I was the first nurse practitioner to work in the clinic, and I was part of the family right away,” Tupper said. “When I was in Michigan, you didn’t just call or text the neurosurgeon to check on your patient, but that’s exactly what happens here. When you’re in a small town, you have to make connections.”

A tragic turning point

Tupper was settling into life in Wyoming, but back home in Shepherd, her aunt, Peggy, was battling painful complications from an undiagnosed cancer. Struggling to find answers at a local clinic with limited resources, Tupper’s aunt and uncle turned to her for help. She drove across the country in 17 hours and facilitated Peggy’s transfer to Michigan Medicine. “She was terrified and in pain, but she still didn’t think she deserved to go there,” Tupper said. “She would say, ‘That’s where kids with cancer and really sick people go.’” 

Peggy learned she had end-stage uterine cancer. After weeks of world-class care and compassion, she was transferred to hospice to spend her final days with family at home. The experience instantly changed the way Tupper viewed her practice. Instead of an obstacle, small-town care could be an asset.

“Just because you’re from a small town doesn’t mean you deserve inferior care,” she told her patients. “We're not going to let you fall through the cracks. You can call my cell phone, you can message me on Facebook, you can stop me in the hallway while I'm dropping my kids off at school, because that's where we live, and we're going to start seeing that as a benefit.”

Fulfilling a vision

Tupper opened Hometown Medical Clinical in September 2019, with her mother running reception, her father helping with administrative duties and her husband as chief operating officer.

Now, with a team of 11 employees and two other providers, the clinic serves local families and provides occupational health services to some of the community’s largest employers. They have a direct care program for the uninsured, work with the state’s Cancer Coalition to provide free screenings and were the first in their community to offer COVID-19 testing. Now with 3,706 registered patients in a town of only 3,400, the clinic will move into a larger new space next year. “I wouldn’t have had the confidence, knowledge and experience to do this if I hadn’t followed that path to the University of Michigan,” Tupper said.

To make quality health care more accessible for communities like Shepherd and Newcastle, Tupper knows it will take a new generation of nurses who share her mindset. “Don’t be scared to get out into the small towns and independent practice states,” she said. “Caring for these communities can come with personal sacrifice, but the rewards are unexplainable.”

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