Don’t Let Constructs of the Mind Hold You Back

Don’t Let Constructs of the Mind Hold You Back

I fondly remember sitting in the waiting room for a scholarship that was offered to African American students to be of use for academic endeavors. I was waiting to be interviewed. However, I remember not feeling nervous and feeling confident that I would be able to answer any questions they may have for me. This surprised me then and surprises me now as an adult. At the aforementioned time, I was only 17 years of age and a senior in high school. There was one question, though, that I did not anticipate as I sat in a room of nurse leaders.

They asked me, “As a young African American like yourself, what do you see as the barriers to your success?”

I just looked one of the interviewers square in the eye and stated, “There are no barriers, from my point of view.”

I’ll never forget the interviewers being so shell-shocked. I do not think they expected this answer.

I explained, “Barriers are what we perceive them to be. If I do not perceive any, they simply do not exist.”

Now, as an African American nurse who has attained her baccalaureate and master’s degrees and is currently working on her doctorate, I see the importance of this idea in my life. The brain can perceive many things, and they may not necessarily be real. This has been proven true again and again in the perception of illusions, or tricks of the eye. The same proves true in the outlook of minority nursing students today. Merriam Webster confirms that constructs are the things created by the mind or the product of ideology, history, or social circumstances. You must remember that barriers to success are simply constructs, only true if you choose to accept them into your reality. Such barriers may come in the form of racism, a challenging nursing course, financial troubles, or other adversities. There may be difficulties, but there are always ways to overcome these difficulties as one strives to complete an entry-level nursing program or pursue an advanced degree in nursing.

I was awarded that scholarship. And to think, it was attributed to a positive idea that my mind constructed. As a result of this positive idea, I was able to have a generous contribution made toward my baccalaureate degree. Yes, my positivity was a source of success and continues to propel me forward in this great profession. Do not let constructs of the mind hold you back in achieving your own elaborate dream of success.

The Lumbee Indian Nurses

The Lumbee Indian Nurses

The origins of the 55,000 member Lumbee Tribe of North Carolina are unclear. Many think the Lumbee are descendants of Sir Walter Raleigh’s Roanoke Island “Lost Colonists” of 1587, the first permanent English settlers in North America. A new group of settlers arrived on Roanoke Island in 1590 to replenish supplies and grow the colony. However, when they arrived, the fort was deserted and all they found was the word “Croatoan” carved into a tree. According to this theory, sometime between 1587 and 1590, the settlers moved to another island or mainland location called “Croatoan.” The idea continues that the English colonists settled among and intermarried with the friendly Croatan Indians, and by 1650 the tribe migrated to the area in and near present-day Robeson County, North Carolina. The ancestors of the Lumbee were mainly Cheraw and related Siouan-speaking Indians who have lived in the vicinity of Robeson County since the 1700s. The Lumbee have been recognized as a Native American tribe since 1885 by the state of North Carolina, although they have yet to receive federal recognition. They take their name from the Lumbee River, which winds its way through their ancestral lands.

For the first half of the twentieth century, North Carolina laws called for triple segregation—separate schools for African American, Lumbee, and white students, with African American and Lumbee schools far inferior in funding, equipment, and general support to white schools. Lumbee were also frequently discriminated against in employment, housing, recreation, and health until the 1960s. Despite these hardships, a few young Lumbee women were determined to become nurses. All of the early Lumbee nurses went out of state to receive their nursing education; a few returned to help their neighbors and families. Here are their stories.

THE EARLIEST KNOWN LUMBEE REGISTERED NURSES

Viola E. Lowry Armstrong is the first known Lumbee registered nurse. She was born on June 25, 1897 in the crossroads community of Elrod in Robeson County, North Carolina, to Henry H. and Julia Revels Lowry. Shortly after graduating from Wesleyan College in Athens, Tennessee in 1918, Armstrong enrolled in the Knoxville General Hospital School of Nursing (KGHSON). According to KGHSON historian Billie McNamara, Armstrong was the first Native American nurse to enroll at the school.  She graduated in 1923 and soon married William Franklin Armstrong, a local businessman. The couple had a son in 1926 followed by a daughter two years later. The Armstrongs spent their lives in Knoxville where Nurse Armstrong managed family responsibilities along with a part-time, private duty nursing career until her retirement at age 75.

Two of Armstrong’s first cousins, sisters Lorraine C. Lowry Evans and Lessie Lowry Blakeslee, followed Mrs. Armstrong into nursing. Evans was the sixth of eight children born to the Reverend Doctor Fuller and Jessie Mae Hatcher Lowry on January 22, 1916 in Robeson County, North Carolina. Shortly after graduating from the nursing program at St. Thomas Hospital in Nashville, Tennessee, she married a local man, John Robert Evans, in June, 1938.  Her life was cut short when she died of breast cancer in 1957. Her Nashville death certificate lists her occupation as a registered nurse and her place of employment as Gordon Hospital.

Lessie Lowry Blakeslee was the third of eight children born to Reverend Doctor Fuller and Jessie Mae Hatcher Lowry in 1912. She graduated from Philadelphia General Hospital School of Nursing and later became a U.S. Army nurse. She lived in several parts of the country before dying in Nebraska in 1954.

Another early Lumbee registered nurse was Bertha Locklear Berkheimer. She was born on September 4, 1908 in Robeson County, North Carolina to Reverend Peppers Mahoney Locklear and Mary Catherine Hunt Locklear.  After graduating from Pembroke High School she went to Philadelphia, Pennsylvania, to pursue her nursing education.  By 1940 she was living in Philadelphia, married to Jessie Berkheimer, was mother to a son and daughter, and was a nursing supervisor at the Philadelphia State [Psychiatric] Hospital. She lived in Philadelphia until her death in 1981.

Velma Mae Lowry Maynor: Community Health Nurse

The first Lumbee registered nurse to return to Robeson County after graduating from nursing school was Velma Mae Lowry Maynor. She was born on September 9, 1907 to Edmond and Sally Hatcher Lowry. After graduating from what is now the University of North Carolina at Pembroke (UNC-P) with a teaching certificate, Maynor taught school for a few years in Robeson County. By the late 1920s, Maynor pursued her calling to become a nurse and entered the Philadelphia General Hospital School of Nursing. After graduating in 1933, Maynor worked for four and a half years at the Philadelphia General Hospital as a medical floor supervisor.

The Great Depression of the 1930s led President Franklin D. Roosevelt to establish many new government programs, policies, and agencies to help the poor and unemployed across the country. These new initiatives were known collectively as the New Deal.

As part of President Roosevelt’s New Deal, the Federal Emergency Relief Administration—and beginning in 1935, the Resettlement Administration—helped to establish homestead communities that encouraged landownership and, in many cases, fostered agricultural skills. In North Carolina, the resettlement projects were rural farming homesteads. The idea behind the homesteads was that the settlers would rehabilitate the land and learn valuable agricultural and subsistence skills (Tillery Farms historic marker).

Robeson County was selected as a site for a farming homestead project, called Pembroke Farms, specifically created for Lumbee people. Each family who lived at Pembroke Farms had a modest house and 11 acres of land. Once the farm was in working order, the homesteader could purchase the land through the federal government. Pembroke Farms had its own school, community center, and several staff on hand to assist with agricultural practices, homemaking skills, and health. The only full-time, permanent, Lumbee employed at Pembroke Farms was Mrs. Maynor, the nurse. According to Malinda Maynor Lowery, historian of the Lumbee people and author of Lumbee Indians in the Jim Crow South: Race, Identity, and the Making of a Nation, “her duties centered on curbing the area’s malaria, tuberculosis, syphilis, and other diseases through treatment and education.”

Several articles in the local newspaper, The Robesonian, note Nurse Maynor’s activities during the four years she worked at Pembroke Farms (1939-1943).  The first, on September 8, 1941, mentions that she is teaching a home nursing course at Pembroke State College (now UNC-P), a course she would repeatedly offer to the community during the WWII years. A month later, she judged several exhibits at the Pembroke Fair.  The newspaper reports her extensive involvement with the 4-H club and her service on the Board of Directors of Odum Home, an orphanage for Indian children.

World War II brought an end to most New Deal programs, including Pembroke Farms. Many men were serving in the military and jobs were more plentiful. Nurse Maynor’s job at Pembroke Farms ended. She worked as a night nurse at the N.C. Cancer Center in nearby Lumberton from 1952 until 1966 when she became a school nurse for Robeson County. Again, The Robesonian often described her activities during the seven years she cared for the school children. Maynor and the other schools’ nurses screened children for vision, spinal, dental, and other common childhood health problems and made sure all the children received proper care. Maynor’s obituary states that she was also the first nurse to serve the Robeson County Department of Corrections. After a lifetime of caring for her community, Maynor died on November 18, 1997, at the age of 90.

Eva SampsonEva B. Sampson: Student Health/Infirmary Nurse

Another nurse who dedicated her life to her Robeson County community was Mrs. Eva Brewington Sampson, RN. She was born on July 31, 1932 to Clyde and Lillie Mae Brewington. She was one of the earliest nursing graduates from Southeastern Community College, earning her Associate Degree in Nursing in 1968. After working two years at Southeastern General Hospital, Sampson became the Director of Student Health Services at UNC-P. While working in the student health center she earned her bachelor’s degree majoring in psychology and sociology. During Sampson’s 25-year tenure at UNC-P, she was involved with the students and campus life. She served as an adviser to the Tri-Sigma Sorority and established the John W. (Ned) Sampson endowed scholarship, to assist deserving young athletes in paying for their schooling. Mrs. Sampson was also active in her profession and her community. She was an active member of the NC State Nurses Association, a Cub Scouts Den Mother, and a volunteer for the Pembroke Rescue Squad and the Caregiver Support group. She served on the Board of Directors for the Southeastern Regional Medical Center, Hospice of Robeson County, the Lady’s Lion Club, the Professional and Business Women’s Club of Pembroke and was active in her church’s Women’s Mission Union. In addition to her employment and volunteer activities, Sampson had a devoted husband and raised three daughters and a son. She passed away on January 11, 2014.

PRESENT DAY

With the passage of state and federal laws outlawing racial segregation and ensuring equal rights for Native Americans, Lumbee people have earned degrees from a variety of nursing schools and become nursing leaders. Today, two of the most prominent Lumbee nurse leaders are Bobby Lowery, PhD, RN, MN, FNP-BC, FAANP, and Cherry Maynor Beasley, PhD, MS, FNP, RN, CNE. Their admirable accomplishments inspire today’s young nurses, both Lumbee and non-Lumbee, to excel in their profession.

Bobby LoweryBobby Lowery is a native of Robeson County and a member of the Lumbee Tribe. With over 30 years combined nursing experience as a family nurse practitioner, health policy advocate and educator, he holds a BSN and PhD in Nursing from East Carolina University and a Master of Nursing from Emory University. Lowery retired at the rank of Captain after twenty years of service as a Commissioned Officer of the U.S. Public Health Service. He developed, implemented, and directed the inaugural DNP Program at East Carolina University College of Nursing where his work with the virtual community clinic learning environment is the foundation for $2,197,446 in funding for Interprofessional Education. A respected leader, he has served on the North Carolina Nurses Association Board of Directors, chaired the NP Executive Committee, and was appointed as the inaugural chair of the Commission for Advanced Practice Nursing. Lowery also served on the Board of Directors for the NC Board of Nursing where he has chaired the NP Joint Subcommittee, Education and Practice Committee and the Midwifery joint committee. Nationally, he chaired the NCSBN Distance Education Committee and is a past AANP State Representative. Lowery’s research on NP regulation expands nursing knowledge and informs stakeholders regarding the need for evidence-based NP regulation and interprofessionalism in health care. He is a Fellow of the American Association of Nurse Practitioners. Currently, he serves a Nursing Practice Consultant-NP for the NC Board of Nursing where he participates in proposed recommendations on actions relating to regulation of nursing practice for consideration by the Board and serves on the Senior Staffing Practice Committee and Research Committee. Lowery is currently participating in a one-year fellowship program with the American Nursing Advocacy Institute where he is focusing on full-practice authority for Advanced Practice Nurses in North Carolina.

Cherry Beasley is the Anne R. Belk Endowed Professor for Rural and Minority Health at UNC-P. She earned her BSN in 1973 from the University of Michigan, a MS in Nursing and Public Health Nursing at UNC-Chapel Hill, a post-master’s FNP from the University of South Carolina, and her PhD in 2009 from East Carolina University. Beasley is the first Lumbee to have earned a baccalaureate, masters, and doctor of philosophy all in nursing. Her areas of expertise are cultural role in health care decision making, rural health, diabetes, nursing workforce issues, and women’s health. Beasley is a member and leader in numerous nursing organizations, including the American Nurses Association, the North Carolina Nurses Association, Sigma Theta Tau, and the National League for Nursing, and Delta Omega.  She is the past chair of the NC Center for Nursing. Beasley has successfully written and administered many grants and is the author of numerous articles. A generation of nursing students have benefited from her dedication to and excellence in nursing education. She continues to live and work in her native homeland where she serves on several local boards and has recently been selected as the first Secretary of Health for the Lumbee Tribe.

LOOKING FORWARD

Lumbee nurses’ contributions to nursing have been overlooked in the literature. Despite being a relatively small, federally unrecognized tribe, and having suffered racial discrimination and segregation for most of their history, the Lumbee Tribe has produced several outstanding nurses. These nurses have both provided care to vulnerable people under difficult circumstances and enhanced the nursing profession. Their lives and work should not be forgotten.


Acknowledgments. Both Cherry Beasley and Bobby Lowery were invaluable in writing this article. Through conversations and draft revisions each has improved the accuracy of this piece. Any errors are mine alone.

Wounded by Words

Entering the patient’s room, I immediately took note of the look on the elderly woman’s face. There was no way I could look past her grimacing. As an African-American male nurse, I had seen this look before and knew it was in response to my gender, my race or both. Pulling away from the side of the bed where I was standing, she demanded: “Where are all the white people?”

Busy and rushed for time as most nurses are, I was not sure how to handle this situation and still get my medication pass done in a timely manner. I did not think therapeutic communication or touch would work in this particular case. She would not let me get that close to her, either physically or emotionally. Acting as if I could not comprehend her, I offered her the medications that were ordered. She looked at the medicine cup and abruptly said, “I’m not going to take that!” Now the dilemma had evolved into how to distribute medication to this patient.

Who knows what was going through this woman’s mind? Maybe she thought that my being alone with her in her room was a perfect opportunity for racial retaliation: Here was this black man who was finally going to pay her back for centuries of racial injustices. More than likely, she felt I was not intelligent enough to follow the physician’s orders and that the meds I was offering her were incorrect. At this point, it was all irrelevant. My intention was to help her, but in her mind I only represented someone from a race she considered inferior and had spent a lifetime hating.

This patient may not have known the date, or what the name of the health care facility was, or even her own name, but she could and did hold on to racial intolerance. Years of other life training may have abandoned her, but the training she had received about race remained intact. I saw in her face what could only be described as a mixture of hate, fear and anxiety. The year was 2004, but in my mind this incident transported me back to our nation’s past and gave me a taste of how ugly and complicated life must have been for past generations of black and white Americans.

Frustrated with my inability to administer medications to this patient, I exited her room and searched for the other nurse on duty. She was also African American, but I thought there was a chance she would fare better because she was female. This nurse was not new to the ward and she was not surprised by the patient’s reaction to me. When I asked her how I should handle this matter, she replied, “She won’t take medications from me either.”

Needless to say, this patient did not receive her medication that particular shift. I documented the incident and continued to care for the patients who would allow me to.

Unfortunately, it seems the only repercussions that resulted from this incident of racism were the painful feelings that have continued to stay with me. Nothing was ever addressed on any other level that I was made aware of. My employer’s apparent reluctance to acknowledge the problem disappointed me. It seems that even the most liberal and up-to-date facilities fall short when it comes to addressing this issue.

 

“Get Over It”

Another of my notable experiences involving racism in a patient care situation was an encounter I had with a veteran. This incident affected me deeply for two reasons. First, I am a veteran myself, having served eight years in the U.S. Air Force. Veterans usually feel a kinship toward other vets, regardless of their background, branch of service or duration of service. Secondly, I had taken care of this particular patient for some time and thought that our relationship had somehow transcended race. Until this incident occurred, our interactions had always been very cordial and respectful.

This was a patient who needed total care. He was paralyzed on his left side from a stroke and needed another’s help for even his most basic needs. The incident occurred on evening shift. Because of our limited staffing, once the total care patients were put to bed for the night it was our practice to leave them in the bed until morning. But on evenings when bingo was being played, I would help this patient get dressed again, put him in a wheelchair and push him to wherever the game was located.

He was prone to fits of yelling and anger, but in the past I had always been able to calm him down. Entering the room this particular night, I could tell that he was not in the best of moods, but I was not expecting the encounter that ensued. All of my attempts to calm him failed. In fact, they seemed to just heighten his anger. And at the apex of his anger, he yelled, “N- – – – -, get out of my room!”

Many emotions ran through me at that moment-certainly too many to count. What I did next escapes me. I assume I must have straightened his blankets and did what I thought would make him comfortable. I do know that I exited his room angry and told the charge nurse about the encounter.

The nurse in charge was totally sympathetic but at a total loss as to how she should handle the situation. I was sitting in the staff break room obviously angry and frustrated, with my arms crossed on top of my chest. She under- stood that she could not just let this incident go without some intervention on her part. Her decision was to call the house supervisor.

I had what I thought was a decent working relationship with the house supervisor, so I was not against discussing this incident with her. When the evening supervisor arrived on the ward, I was still in the break room fuming from the incident. She came in and asked me to explain what had happened; I gave her my interpretation of the incident. Her reply did nothing to soothe my anger. She basically said, “Get over it.”

She then began to relate some incidents of disrespect she had encountered in her own journey through nursing. Being called out of her name, having her level of intelligence questioned and being touched inappropriately were all situations she described. She seemed to indicate that this was part of our job and we had to take it.

I sat there listening, refusing to believe what I was hearing. I also refused to accept her personal doctrine that this type of treatment was “normal” and that nurses should accept it. I sat there respectfully, but her words did nothing to redeem my dignity or help repair my relationship with this patient.

The incident did send some minor ripples toward the higher-ups at the facility. They never spoke to me directly, but their messages found a way to me somehow. The messages consisted of blaming the occurrence on the patient’s condition, saying that stroke patients sometimes react that way. The patient’s medication was also increased, especially his psychiatric medications.

 

A Gesture of Healing

The one person who truly seemed to understand how much this incident had hurt me was the patient’s wife. His wife, who was a volunteer at the facility, was tireless in her efforts to continue caring for him and many other veterans. She seemed to be his exact opposite in terms of temperament. She volunteered mainly on the day shift, but our paths crossed as the day shift ended and the evening shift began. She too had always been very cordial and respectful to me. The day she confronted me about this incident was no different. I did not intentionally avoid her, but I was not looking forward to encountering her either.

Our discussion took place in the doorway of the patient dayroom. She had always been very direct and that part of her personality was very much in evidence now. She looked me straight in the eyes and said, “I heard about what happened between you and my husband, and I would like to apologize for the awful word he called you.”

I immediately dropped my head and was silent, not because I was ashamed but because I was so full of anger. She continued, “My husband was not a man who used that type of language when he younger, and we did not raise our children to use that type of language either.”

I was still silent, but now we were staring into each other’s eyes. We could both see how deeply this incident had touched me. “I have offered an apology and I can not force you to take it,” she said, “but I hope that you will and that you will continue to care for my husband in the same manner as you have always done.” That was her last statement to me as she gently patted my hand and walked away.

We did speak again after that, but the subject of what happened that day was never touched on. Our conversations were genuine and honest, but I believe we both felt that enough had been said on the subject. Even though I never said anything to her about the incident, she comprehended the depth of the damage her husband had caused by uttering that offensive word.

 

Emotional Scars

As much as I would like to say that my treatment of that patient did not change, the truth is that it did. I was still very professional and considerate to him. But all of the things one would describe as “extras” ceased. I never got him up for bingo again and my conversations with him held brevity in my tone.

Time passed and I was transferred to another unit at the facility. But I never forgot that patient or that painful incident. Any time I visited that unit to see past co-workers, I would always peek into his room just to see how he was managing.

I began to hear that his health was declining. By the time I had gathered enough courage to actually step into his room, he had deteriorated to the point where he was alert only to himself and being fed by a nasogastric feeding tube. I stood at his bedside and asked him how he was doing, but all he could do was gaze up at the ceiling and mumble incoherent words. He continued to steadily decline until a co-worker notified me of his death.

Later that week I read his obituary. I was surprised at the sterility of the announcement. There he was in an old picture from his military days, hat cocked to the side, smiling. The obituary mentioned a lifetime of loved ones and military service. It was brief and to the point. He existed, but now he was gone.

I was not sure of my feelings then and I am still not sure of them now. All I knew was that he was dead and our joint legacy of pain had died with him. But it still lives in me.

The point of this personal reminiscence is that we in the nursing profession must ask ourselves how to handle the issue of racism in the nursing workplace, and more specifically, how to handle racism when it is expressed by patients. I guess the first step is to admit that the problem exists. Even when they are in a hospital receiving care for the effects of diseases, aging or traumatic physical injuries, there will always be some individuals who will put their racial ideology above anything they are confronted with. That is their right.

But we professional caregivers of color also have the right and the obligation to stand against such behavior and demand to be treated with respect and dignity.

Careers in the Indian Health Service

It’s probably the best working example of universal health care in America. It’s a system that provides millions of people with a widely comprehensive range of health and wellness services–everything from disease prevention programs to dental and optical services to hospital and ambulatory medical care. Its goal is to “ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to all American Indian and Alaska Native people.”

It is the Indian Health Service (IHS) and it remains the nation’s largest employer of American Indian and Alaska Native nurses. But regardless of race or ethnicity, if you’re a nurse who has a strong desire to experience different cultures, work with medically underserved communities, fight minority health disparities and reap the benefits of a career that offers chances to advance to leadership roles, working for the Indian Health Service may be just the opportunity you’ve been looking for.

The Details

In 1921, Congress passed the Snyder Act, which established the Indian Health Service as the primary federal health care provider and health advocate for Indian people. It’s a role the agency has continued to play for 80-plus years, providing a comprehensive national health delivery system designed to elevate the health status of American Indian and Alaska Native people to the highest possible level and to encourage the maximum participation of tribes in the planning and management of those services.

Although Native tribes are sovereign nations, the IHS is a U.S. government organization operating under the Department of Health and Human Services (HHS) umbrella. Today, it cares for 1.6 million of the nation’s estimated 2.6 million Native Americans from more than 560 federally recognized Indian tribes and Alaska Native corporations coast to coast.

The IHS is an extensive system, divided into 12 regional areas, that encompasses 36 hospitals, 63 health centers, 44 health stations and five residential treatment centers in 35 states. In addition to these facilities, most of which serve American Indians who live on or near reservations, the IHS also has 34 urban Indian health projects that provide a variety of services. Some IHS facilities are managed by the tribes themselves with financial and administrative support from the federal agency. At others, all daily operations are completely managed by IHS.

Nurses hired at tribally operated facilities (“direct hires”) are considered employees of the tribe. If the nurse is recruited by the IHS to work at a federally operated facility, then he or she is a federal employee. In addition, some nurses who work for the IHS do so as officers in the U.S. Public Health Service Commissioned Corps, a federal program under the direction of the U.S. Surgeon General in which nurses work for local, state, federal or international health agencies in a variety of capacities. Generally, nurses in the Commissioned Corps tend to have more experience and education and receive an expanded benefits package.

According to IHS statistics, there are currently more than 2,500 nurses in the organization working in inpatient, outpatient and ambulatory settings. Additionally, the agency employs public health nurses and nurse educators to carry out its numerous health awareness programs, among other duties. Many of these campaigns are created with input from tribal and spiritual leaders to address a particular community’s specific health care and cultural concerns.

Of course, like any large health care system, the Indian Health Service also provides opportunities for experienced clinicians to move into management positions on local, regional and national levels. But it’s the challenge of working with a unique patient population in a specialized environment that many IHS nurses cite as the most rewarding aspect of their career.

 

The Need

Like other health care employers today, the IHS is struggling under the weight of a severe nursing shortage and the increasing financial burdens of doing business in the current economic environment, despite a proposed budget of $2.9 billion for fiscal year 2004.

“We have a 14% nursing vacancy rate right now, compared with the national average of 13%,” says Celissa Stephens, RN, MSN, acting principal nurse consultant and senior recruiter for the IHS national headquarters in Rockville, Maryland.

The reasons for the nurse staffing crisis within the IHS mirror those for the health care industry in general. Fewer young people are choosing nursing as a career, while at the same time, the current RN population continues to inch toward retirement age. But this second factor has had an even bigger impact on the IHS than on private sector nursing employers. “The average age of nurses in the IHS is 48 years old, which is even older than the national average of 43 years,” Stephens explains.

More specifically, the IHS reports that approximately 755 of its 2,500 nurses are 41 years old or older. Of those, 8% were eligible for retirement last year. Even more alarming is that another 20% will be reaching retirement in the next five years.

While skilled, experienced nurses are urgently needed throughout the IHS system, Stephens says some specialties are in more demand than others. “At the present time, the greatest needs are in the areas of emergency, operating room, ICU and obstetrics,” she reports. “We’re also interested in Certified Registered Nurse Anesthetists (CRNAs).” There are also many career opportunities open for advanced practice nurses and Certified Nurse-Midwives.

The People

“Everything you do [as an Indian nurse working for IHS], you can see it making a difference. You’re working toward a goal to improve the health of our families and communities,” says LaVerne Parker, RN, MS, an IHS nurse consultant in the Aberdeen Area of South Dakota and a member of the Turtle Mountain Band of Chippewa Indians.

Indeed, there seems to be a very strong connection between American Indian/Alaska Native nurses and careers in the IHS. The agency reports that approximately 66% of nurses working in the federal system or for tribally operated health care organizations are Native Americans. While this may be partially due to the fact that IHS has Congressional authority to give American Indians and Alaska Natives preference in hiring, working for the IHS also appears to be a traditional career path for many Indian nurses.

For instance, Parker grew up relying on the IHS as her own health care provider. When she became interested in a nursing career, IHS was foremost in her mind. “I always wanted to work with my own people,” she explains.

“There was never any doubt that I would be working for my [Indian] community,” says Lisa Sockabasin, RN, BSN, of her career choice as diabetes nurse coordinator for the North American Indian Center of Boston, an urban IHS facility in Boston, Massachusetts. “I saw so many health disparities among American Indian communities during my experience as a research fellow at Harvard Medical School, including cardiovascular disease, diabetes and cancer. I really wanted to work in preventing morbidity and mortality in our communities.”

While it may be a sense of community that brings Native nurses to IHS facilities, it’s the rewarding work and career advancement opportunities within the system that are keeping them there. Working for an IHS or tribal-run hospital or clinic is different than the “typical” nursing job in a number of ways. First and foremost, the patient population is almost exclusively American Indian or Alaska Native. Therefore, culture plays a very prominent role in health care delivery.

“There are so many different meanings of what good health is and how it’s perceived in so many different cultures,” says Sockabasin, who is half Patsanaquoddy Indian.

Culturally and linguistically, Indian tribes are by no means all alike, even though there may be some common threads among the different groups when it comes to health issues–such as high incidence rates of heart disease and diabetes–as well as general beliefs about health and illness, such as an emphasis on the use of natural remedies.

“You can’t make generalizations about the tribes because they’re all different,” emphasizes Stephens, a member of the Choctaw tribe. “It’s important at the local level that new employees are provided with culturally appropriate orientation to the tribal communities they will serve.”

Language can also impact health care delivery in Indian communities, especially with older patients who may not speak English very well or at all. The majority of IHS settings have an interpreter on staff, or other bilingual staff members who can help with translation. However, caution must be used in this circumstance, because when it comes to health care terms there is little room for misinterpretation.

“Some medical terms, such as cancer, don’t translate into the Navajo language, for example,” Stephens explains. “The term for cancer in Navajo could be described as ‘lood doo na dziiyigii,’ which means ‘a sore that does not heal.’

“Traditional Navajos believe that spoken words are like arrows, and arrows can wound people,” she adds. “Therefore, it would not be appropriate to discuss the patient’s mortality or potential outcomes in the first person. In order to avoid ‘inflicting wounds,’ the care provider must discuss the medical condition in the third person–for example, ‘some people experience x, y and z.’”

The Setting

One of the most distinguishing features of a nursing career with the IHS is where you work. The vast majority of IHS hospitals and clinics are set on or near Indian reservations, which are usually in rural areas. Not only are they small communities, but they’re often located at substantial distances from the nearest town or city, which can be problematic for nurses who have families or are not accustomed to small-town life. For example, there may not be immediate access to employment and social outlets for spouses and children.

“Families have to adopt a certain lifestyle to live in our communities,” notes Stephens. “We need nurses who have a sense of adventure, are willing to accept the challenges of a rural lifestyle and are interested in being involved in the communities they serve. On the other hand, IHS nurses get to experience the [richness of] Native community life and culture. You may not get that opportunity in the private sector.”

Indeed, when HHS Secretary Tommy G. Thompson announced the awarding of $1.7 million in grants to six American Indian and Alaska Native tribes and organizations last fall to assist them in recruiting and retaining health care professionals, he specifically cited location as a contributing factor to the ongoing need for health care personnel. “The national shortages of nurses, physicians, pharmacists and many other health professionals is particularly serious in the remote and isolated areas where many tribal communities are located,” Thompson noted.

The HHS grant recipients were the Maniilaq Association in Alaska ($99,931), the Ketchikan Indian Corporation in Alaska (($91,693), the Seneca Nation of New York ($96,467), the Nisqually Indian Tribe in Washington state ($100,000), the Confederated Tribes and Bands of the Yakima Nation in Washington ($100,000) and the Northwest Portland Area Indian Health Board in Oregon ($92,209).

The Opportunities

Like other health care employers that urgently need more nurses, the IHS is intensifying its recruitment and retention efforts, both within and outside the American Indian and Alaska Native communities it serves.

“Having Native American nurses in the community is probably our biggest retention key,” says Parker. “Many of them have been able to go to nursing school through IHS scholarships and they come back here [to work] and they stay. They are our staple staff.”

Of course, another key to attracting and retaining nursing talent is to offer plenty of professional development opportunities. And the IHS certainly has its share. For example, new RN graduates can compete for a position in the RN Internship Program, which allows them to rotate through a variety of different nursing specialties in a preceptor-like training environment.

Another option is the Public Health Nurse Internship, where nurses with BSN degrees receive specialized training as health educators and advocators. For nurses with at least one year of clinical experience, the IHS offers residency programs in critical care, OR and obstetrics, often with the opportunity to become certified upon completion.

To participate in any of these programs, however, nurses must be willing to move around, because they are only offered at specific IHS facilities. “We have the most difficulty recruiting in obstetrics or the OR because there are so few IHS hospitals in our area that offer those training programs,” states Parker. “We’re trying to develop more programs locally, but for now, we also work with outside hospitals that might provide our nurses with training services.”

Then there are long-term training and continuing education opportunities that help nurses at various career levels pursue academic degrees. For example, American Indian and Alaska Native nurses employed with IHS, tribal or urban facilities can take advantage of long-term training opportunities such as the Section 118 program. In this program, which is sponsored by the IHS Headquarters Division of Nursing, LPNs can pursue either an associate’s or bachelor’s degree in nursing; RNs with associate’s degrees can pursue BSN degrees.

“To date, more than 55 nurses have received advanced training and additional degrees through IHS long-term training programs,” says Stephens. “Currently we have 18 nurses in advanced training. Nurses receive full salary, benefits, books and tuition while pursuing advanced education. That’s a benefit the private sector usually does not offer.”

In addition, financial aid opportunities for third- and fourth-year student nurses are available through COSTEP, the U.S. Public Health Service’s Commissioned Officer Student Training and Extern Program.

But perhaps the single most irresistible benefit for nurses is the IHS Loan Repayment Program. Simply put, this program offers nurses–including tribal direct hires–repayment of up to $20,000 per year toward nursing education loans. In return, the nurses agree to a minimum two-year service contract at an IHS facility, usually one that has a high nursing vacancy rate.

 

The Experience

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Being an Indian Health Service nurse is an opportunity for minority nurses of all races and ethnicities to live a unique personal and professional experience that is simply not available anywhere else. Not only will you encounter a fascinating culture and people, but your expertise as a nurse will be valued and broadened. Within a health care system that offers such a broad spectrum of services, the opportunities to explore different career specialties and gain additional skills are wide open.

“When I worked in the private sector, I didn’t have the ability to move from clinics to ambulatory to inpatient or emergency,” says Parker. “But within the IHS, you can work in a variety of areas and with a variety of cultures.”

You’ll also see how your efforts to care for, educate and advocate for patients can have a ripple effect on the entire community. As Sockabasin explains, “When you work for the IHS, you have the ability to touch a population that is in so much need of good nurses.”

Nursing for Uncle Sam

Nursing for Uncle Sam

Careers in government nursing are as varied as nursing careers in the private sector. However, when many nurses hear “government nursing,” they may assume that means working for a veterans hospital. But the Department of Veteran Affairs (VA) is only one of many government agencies where skilled nurses who want to work for the government can build their careers.

In fact, there are a variety of government agencies and positions where nurses can put their skills to work, including the Centers for Disease Control (CDC), the Indian Health Service (IHS), the U.S. Army, the National Institutes of Health (NIH), and the Center for Medicare and Medicaid Services.

Think a government career might be a good fit for you? Keep reading for stories from nurses who work for the government and tips on how you can too.

Military nursing takes sacrifice

“The army’s been very good to my family,” says Lt. Col. Christopher Weidlich, U.S. Army, who is currently finishing his Ph.D. in nursing at the University of Miami on a U.S. Army Long-Term Health and Education Training Scholarship (scheduled to graduate in 2013). He has served in the military for 17 years. “I really enjoy taking care of people, and doing whatever I can to help them out.”

When Lt. Col. Weidlich graduated from high school in 1990, his original goal was to become a doctor. “I wanted to go to medical school, but I didn’t have the grades to support it,” he says. “When I graduated from high school, I found out the Army was offering nursing scholarships.”

He went on to graduate from the University of Miami in 1994 on an Army ROTC scholarship and decided to stay in the military after graduation. He worked as an army psychiatric nurse and a psychiatric mental health nurse in various locations, including Nebraska, Georgia, Kentucky, and North Carolina, in addition to Iraq and South Korea.

After several deployments, Lt. Col. Weidlich feels that while military life comes with unique challenges, he has enjoyed his career. “Being a military family has its ups and downs like any profession, but it’s hard on my kids,” says the father of four.

Despite the personal sacrifices, Lt. Col. Weidlich says his career so far has been a very rewarding experience for him and his family, and advises other nurses considering military nursing careers: “If you go into the military, take advantage of your education,” he stresses. “There are a lot of schools that you could go to within the Army. I would recommend you take any educational opportunities that are there.”

Careers with government agencies

Nurses seeking a more stable lifestyle will find an abundance of opportunities within government agencies. Many have built their careers in the government, like Dinora Dominguez, Chief of Patient Recruitment and a public liaison in the Office of Communications at the NIH Clinical Center, Department of Health and Human Services. Dominguez has worked for the NIH since she graduated from college in 1986.

Dominguez always held an interest in doing research and was attracted to the NIH due to the research involved in her position. Today, she coordinates clinical trials and educates the public on the importance of participating in clinical trials—something she’s passionate about.

Bruce Steakley, R.N., B.S.N., a nurse manager in pediatric and adult inpatient behavioral health at the Ambulatory Care Behavioral Health Clinic (NIH), has a career that spans 30 years. He first came to the NIH six years ago.

“After working in community-based mental health inpatient settings and one outpatient setting for all those years, I got discouraged with psychiatry and the state of mental health care delivery in the country,” Steakley says. “So I left and tried other avenues of nursing, but was bored. And so I always returned to mental health and discovered my current position by word of mouth. A friend of my wife told me about this job and I decided to apply for it and now, here I am.”

Clifton J. Kenon Jr., M.S.N., R.N.C.-O.B., C.-E.F.M., I.B.C.L.C., R.L.C., A.W.H.O.N.N., fetal monitoring instructor and maternal-child health nurse consultant at Indian Health Service, found his way to the IHS by posting his résumé on the USAJobs.gov website. “I was recruited to go work for the Indian Health Service as a maternal child health consultant in South Dakota in April of 2011,” he recalls. “And in this role, I’m actually able to have an influence and to lead maternal health programs for the Indian Health Service for our four-state region: North Dakota, South Dakota, Iowa, and Nebraska.”

Steakley also applied through the USAJobs.gov website, which he says is the best place for nurses interested in a government job to go. “I occasionally have people who somehow reach me on the phone and want to apply for a job,” he says. “I step way back from that and just refer them directly to USAJobs.gov. There’s a structure for applying, and I follow the structure.”

Steakley notes that nurses seeking to gain entry with a government agency should bring patience to their job search.

“The hiring process is longer and slower, but somewhat more professional,” he says. “I was here on three different occasions, interviewing with three different sets of people. My sense was that they were looking for highly qualified people. I’ve since had opportunities to participate in a number of interviews with nurse manager candidates and clinical manager candidates. Over the years, I’ve hired a lot of people myself, and I think that although I see room for improving the process, I would nevertheless maintain it’s better here than in other settings.”

If you desire to make a leap from the private sector to the government sector, Kenon’s advice is to actively seek out opportunities, put yourself out there, and post your résumé on the U.S. Office of Personnel Management (www.opm.gov) and USAJobs.gov websites.

“Continue searching for openings that would meet your qualifications or are willing to train, and call regional recruiters. Most government agencies have recruiters that are actively recruiting new talent to the agency,” he says, adding that recruiters love to hear from those interested in public sector careers. “[They] have unique and challenging opportunities for nurses that want to serve their country.”

Government work culture

Is working for the government much different than the private sector? Some nurses who have experience in both sectors note some differences.

Kenon was a labor and delivery nurse at Duke University Medical Center and the University of Virginia. “The difference between working in the private sector and public sector is being a public servant, as I like to see myself in working for the government. I am helping to fulfill the mission of the United States Department of Health and Human Services. And I’m helping to serve the American people with health care on a national level, as opposed to in the private sector where I was more concerned with serving a local aggregate of people or a specific community.”

Steakley, who worked for various community-based facilities before joining the NIH, says that he feels more supported as a government employee, adding that he has a lot of reinforcement from the three units he manages in terms of clinical management, clinical educators, and clinical nurse specialists. “That allows me to have a slightly more elevated role,” he says, which removes him from the “nitty-gritty” of direct patient care, and enables him to be more involved in management and “setting the philosophy, growth, and performance improvement plans for the unit.”

For Kenon, working for the IHS has changed his whole perspective on nursing. “As an African American nurse, being a public servant and working within the United States Government, it has given me a clearer picture and a greater professional identity for the role that nursing has in leading health care on a national and global level,” Kenon says. “Now, I see what an invaluable role nurses play all across the government with legislative change, translating change into practices, and actually being leaders for the health care delivery system.”

Abundant opportunities

If you think a career in the government is a good fit for you, Dominguez encourages other minority nurses to pursue it because there is a wide array of positions available—not just on the clinical side. She says there are many opportunities for nurses to “think outside the box.” As you start researching for a job, Dominguez says to think of the specific skills that you can bring to the role, and just go for it.

Kenon says a government nursing career is all about dedication. For nurses considering these jobs, his advice is to make sure they have solidified a mission in nursing and the core values of the profession.

“Whether you’re in the private sector or public sector, core values such as caring, innovation, passion, and diversity are going to need to be deeply imbedded in each individual nurse’s philosophy to have a successful career in government,” he says.

Most of all, Kenon believes nurses considering such a career should know that they will be dedicating their career and lives to serving the American people. “That is a calling not to be taken lightly,” he adds.

Once you get your foot in the door, opportunities are abundant for growth, Steakley says. “They’re all around. I think that the nursing leadership and the medical leadership in the clinical center are very supportive of intellectual growth of nurses,” he says. “So I think just getting one’s foot in the door is the hardest part.”

Kenon sees himself building a long-term career as a government nurse. “In five to 10 years, I certainly see myself continuing to serve the American people and hopefully continuing to work within maternal child health,” he says. “I love working for the Indian Health Service and I love serving the Native American and the Alaska Native people. And certainly, within 10 years, I still hope to be leading the maternal child health program within the Indian Health Service.”

Our Voice at the CDC

“Things change when Indian people get inside federal policy-making organizations, and it’s exciting to see that happen,” says Captain Pelagie “Mike” Snesrud, RN.

Snesrud, a Certified Public Health Nurse and career officer in the U.S. Public Health Service Commissioned Corps, is literally in a position to know. In January 2002 she was appointed to a key policy-making position at the Centers for Disease Control and Prevention (CDC) in Atlanta: She is the Senior Tribal Liaison for Policy and Evaluation in the Office of the Associate Director for Minority Health.

In this capacity, Snesrud–whose tribal affiliation is Dakota from the Shakopee Mdewakanton Sioux Tribe–serves as the office’s primary point of contact for leadership and coordination of the CDC’s activities supporting American Indian and Alaska Native health initiatives. She is responsible for helping to develop and facilitate CDC projects, programs and policies that benefit and improve the health status of Native American communities nationwide.

As her title implies, a key part of Snesrud’s role is acting as a liaison between the federal government agency and the nation’s 569 federally recognized Indian tribes, which are sovereign nations that have a government-to-government relationship with the United States. With her more than 24 years of experience working with Indian health programs and her distinguished record of effective leadership working with tribal elders, tribal governments, and local, state, regional and national public health programs and agencies, it is easy to see why the CDC sought her out for this important post.

Mike Snesrud’s nursing career over the past 30 years has been remarkable and determined, showing a singular drive and ambition to serve the Indian community, be a role model to other Indian nurses, and balance this work with her equally important responsibilities as a wife and mother of four children. A closer look at her professional path clearly shows it is no accident that she has arrived at her destination as a national leader in Indian health today.

Setbacks and Successes

Snesrud grew up in Shakopee, Minn., on land indigenous to the Mdewakanton people.  In 1974, after graduating from Winona State University with a BSN degree, she embarked on her career as a public health nurse. She worked for the City of Bloomington (Minn.) Health Department for four years. From the beginning, the young nurse’s goal was to work with American Indian people after she had obtained sufficient experience in the field.

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Moving to Kansas with her husband, a teacher, in 1978, Mike obtained a position at the Douglas County Health Department. Within six months, however, she faced her first big professional disappointment: She was dismayed to find that the agency’s level of commitment to minority health did not measure up to her experience in Minnesota, a leader in the nation’s public health system. Although Douglas County was rich in resources, she recalls, many of its minority residents did not have adequate health care available to them.

Frustrated by this situation, Snesrud transferred to Lawrence Memorial Hospital in Lawrence, Kan., to work on the surgical floor. In this acute-care setting, where patients only came to her when they were very sick and left shortly after surgery, she realized the limitations of hospital nursing and that public health nursing was indeed her true calling. “We didn’t get to see the whole picture,” she explains, “and I learned that I preferred to interact with patients in their own environment, where they were in control.”

A major turning point came in 1980, after Snesrud had given birth to her fourth child. She was recruited to work at the Haskell Indian Junior College (now known as Haskell Indian Nations University) Ambulatory Care Clinic in Lawrence. It was here that she first began her service to Native people and saw firsthand the importance of having Native health professionals providing care as well as administrating programs. In addition to accepting her new position at the college, Mike decided to keep working about 30 hours per week at the hospital–partly to provide more income for her growing family and partly to help enhance the communication between the two organizations.

Simultaneously, she was asked to serve as a clinical instructor with nursing students in the new RN Program that had been established at Haskell. The Native nursing students needed a hospital rotation and it made sense to have Snesrud, who was already known and trusted by the hospital staff, assist in forging a closer relationship with the Haskell nursing program staff and students. Many of the American Indian surgical patients treated at Lawrence Memorial were also clients of the college’s clinic, and Mike saw this as an opportunity to bridge a partnership between the two health care facilities.

Drawing on her strong administrative and leadership skills, she played an important advisory role in the expansion of the college’s nursing program. As a clinical instructor at Haskell, she was able to regularly bring a troop of nursing students to the hospital on a weekly basis.

Unfortunately, a lack of institutional support prevented the nursing program from flourishing. In two years it folded altogether, which was a huge disappointment to Mike, other Native nurses and the college. During this period, however, the health director for the Fond du Lac Band of Lake Superior Chippewa in Minnesota began to call her every six weeks in hopes of recruiting her to head his public health nursing program. His goal was to hire a Native nurse from Minnesota who had a strong commitment to improving the health of Indian people. So in 1982, Snesrud accepted the position and moved back to her roots in Minnesota, where she stayed to nurture her public health career and raise her family for the next 20 years.

“An Amazing Opportunity”

When Mike first arrived at the Fond du Lac reservation, the Human Services Division was in its infancy stage, with a staff of only eight health and social services personnel. But by the time she left in 2002 to accept her appointment at the CDC, it had become one of the premier tribal health programs in the nation and a shining example of how health care staff can collaborate successfully with tribal governments.

Under Snesrud’s leadership, the public health nursing program grew to encompass a staff of 48; 75% of them are Indian people, many from the Fond du Lac community. One of its most successful initiatives was a maternal-child health program that provided care to 98% of the community’s pregnant women. It included a check-up program that provided a minimum of six home visits during a child’s first year. As a result of these visits, children’s immunization rates improved from 30% to more than 90%.

The 1990s brought many more opportunities for Mike Snesrud to demonstrate her exceptional leadership skills in highly visible executive positions. In 1993, she became the first president of the newly formed National Alaska Native American Indian Nurses Association (NANAINA). Between 1995 and 1997, she was chair of the Indian Health Service’s National Council of Nurse Administrators (NCONA), which represents nurse administrators from IHS, tribal and urban Indian health programs. From 1996 to 2001, she represented tribal public health nurses on the National Council of Nurses (NCON).  Currently, Snesrud is the project officer of a CDC cooperative agreement with the American Indian Higher Education Consortium (AIHEC), a professional association representing 34 tribal colleges in the U.S. and Canada.

Speaking at NANAINA’s eighth annual national summit last year in Oklahoma City, Mike called her CDC appointment “an amazing opportunity for an American Indian public health nurse”–an opportunity to serve as a powerful voice that can speak up for the needs of Indian tribes at the highest level of federal health policy making and program development.

“The CDC is a huge bureaucracy with very specialized Centers, Institutes and Offices, and it can be very hard for tribal leaders to relate to,” she says. “That’s why it’s so essential to have someone inside the CDC who can be an advocate who says ‘what about tribes?’ and can build a circle of players that will come together to help Indian people.”

“Native Nurses Are the Cream of the Crop”

A Conversation with CAPT. Pelagie “Mike” Snesrud, RN

Minority Nurse: When you first arrived at the Fond du Lac reservation in 1982 [to become director of public health nursing for the Fond du Lac Band of Lake Superior Chippewa], what were the biggest challenges you faced?
Mike Snesrud: There was a lack of trust between the Native people in the community and the medical and nursing staff.  In the past, county workers did home visits and reported back that they thought the Indian children were not being cared for properly. As a result, sometimes children were taken away and family life was disrupted. Families consequently were extremely hesitant to allow nursing staff to come into their homes and their community. We had to earn the trust of the community and the tribal council.   There was not an Indian hospital on the reservation, so Native patients were referred to one of four non-Indian hospitals. There was a lot of prejudice and resentment on both sides because of historically bad relationships and this needed to be addressed to ensure Native people received the quality care they deserved.

MN: How were you able to make improvements at Fond du Lac?
MS: I helped develop cultural sensitivity and competency in our health care team—the home health aides, the community health representative, the nursing and physician staffs. Many of the providers who were non-Indian did not have a good understanding of where the Indian community was coming from [culturally]. Some of the elders’ concepts of health and illness were very different from the physicians’. Many did not come in for health care until it was an emergency. Patients wouldn’t follow their plan of care and there was no follow-up. So the health staff had to be taught to do much more than the usual: arranging transportation, helping people to assess various programs for assistance, following up to ensure that the patient heard the right information, and allowing Indian people to own their health and well-being by making their own choices.

MN: Tell us about your own Indian background.
MS: I am affiliated with the Dakota Sioux Tribe on my grandmother’s side and the Ho-Chunk Tribe on my grandfather’s side. I grew up in Shakopee, Minnesota, which was named that because of Chief Shakapay and the Dakota Sioux people who were present in the area for years. During the 1950s and ‘60s, the reservation nation wasn’t well developed and Indian people just were not treated very well. One thing that really stands out in my mind is the prejudice that was directed at me and other Native people as I was growing up. As long as we were quiet and invisible, that was fine. But when we spoke up, there was animosity and conflict.

MN: What inspired you to become a nurse?
MS: I had an older sister who was an RN and I looked up to her as my role model. She practiced nursing for more than 40 years and often provided me with real professional expertise and visible nursing leadership that gave me high standards to work towards.  I was about five years old when I attended her graduation from the Mayo Clinic, and I knew then that I wanted to get involved in health care somehow. My sister became a head nurse at the Shakopee Community Hospital and I began candy striping under her when I was about 11. During high school I became a nurse’s aide. I saw that nurses often were the ones who spent time with the patients and had the ability to impact them more intensely than physicians, so I opted to become a nurse.

MN: What are some of the challenges for Indian nurses in the 21st century?
MS: Recruiting American Indians and Alaska Natives into the nursing profession and then recruiting Native nurses into tribal [health care] positions. Even though tribes and the IHS have many nursing positions open, it is extremely difficult to compete with other public and private hospitals and agencies that can offer higher salaries, sign-on bonuses and quick hires.

MN: How would you describe Indian nurses?
MS: My feeling is that most Native nurses are the cream of the crop because they have had to go through many personal and professional challenges to get to where they are today. Almost 90% of Native nurses are the main breadwinners for the family. That means they juggle the scheduling of a career and raising their children. Many are single mothers who survived a lot of hurdles to get through nursing school.

MN: What was it like for you to have to balance the demands of being a nurse, wife and mother of four children?
MS: My husband and I have been happily married for 32 years, marrying quite young when we were both still in college. Early on, we both agreed that we were committed to one another and to our children. We knew we needed a certain amount of resources to care for our family and it didn’t matter whether he or I got those resources. He totally supported me through nursing school and my various career choices that have helped me be successful, fully involved and free to try whatever I want to do. Public health nursing allowed me the flexibility to be very active professionally and also arrange many of my children’s activities around my work schedule, so I seldom, if ever, felt unable to get involved. Sometimes the days and workweeks got long, but when a family is the driving force and your professional role fits well with your personal values, life is fun and work is fulfilling.

MN: How did you ultimately move from your tribal health position at Fond du Lac to the CDC?
MS: My experience at Fond du Lac had given me many different opportunities and skills.  I liked interacting with people at all levels and impacting policy decisions. I was ready to diversify what I had been doing. Different people had been tantalizing me to work at the national level, but I had not actually considered a move until my children were through with school and moving on with their life choices. It was the right time and the position excited and challenged me.

MN: What are some of your responsibilities at the CDC?
MS: I am a public health analyst for the Office of Minority Health/Office of the Director, and I function as a Senior Tribal Liaison for Policy and Evaluation. I help CDC Centers, Institutes and Offices (CIOs) to partner and work more effectively with tribes and Native organizations. I am a resource both within the agency and to tribes, to help connect people to work together on public health issues. One of the activities I have been engaged in is coordinating the CDC Tribal Consultation Initiative. Prior to my coming to CDC, a Tribal Consultation Work Group developed a draft consultation policy that needed input from tribal leaders. During May to November of 2002, I and other CDC staff took this policy out to 11 Regional Consultations in Indian Country to listen to tribal leaders give CDC specific guidance and recommendations about consultation and public health needs.

MN: What have your meetings with the tribal leaders accomplished so far?
MS:  The tribes needed to see that CDC was willing to take the time and interest to go out into Indian Country before formulating its Tribal Consultation Policy and Plan. CDC wants to work with tribes in many different areas of public health prevention and recognizes that tribes themselves need to be fully engaged in the process. CDC’s Office of Minority Health is just completing its review of the transcripts from the meetings and is distributing summaries back to the tribes of the recommendations from the consultation held in their region. Input and recommendations from the tribes will help constitute CDC’s tribal consultation policy and ongoing activities and relationships.

MN: What are some of the most critical public health issues affecting Indian communities?
MS:  CDC and other federal agencies need to assist tribes in developing and expanding a Native public health workforce with the experience and training to deal with the unique needs of their population. Native nurses, doctors, epidemiologists, statisticians, environmentalists and scientists are all needed. Tribes need to have technical assistance and resources to build their infrastructure and capacity. Most important is good data that is accurate and readily available to tribes as they build their health programs and interventions. Assistance is needed not only in getting data but also in analysis and research.

MN: What about health disparities between American Indians/Alaska Natives and the majority population? What are some of the most common health problems that need to be addressed?
MS: For hundreds of years Native people have not had access to quality health care. They are very entrenched in poverty and have a consistent lack of resources to deal with many basic issues in their communities. Much of what negatively affects Indian people today is related to preventable chronic diseases such as heart disease, cancer, diabetes, liver disease and lower respiratory disease, as well as preventable accidents and injuries.   Pregnant women do not come in for early prenatal care, children and elders don’t always get the immunizations they need, and people do not wear seatbelts or ensure that their children are in car safety seats. Many Native people abuse alcohol, tobacco and other drugs and therefore do not make good choices. Rates of STDs and HIV are on the increase and there are not a lot of dollars for core public health activities.

MN: What advice do you have for other Indian nurses?
MS: Nursing is a great career choice that allows you many different opportunities that fit with your individual goals and aspirations. It’s important for you to stay connected with your community and Native people, but also be willing to extend yourself and accept challenges based on the skills and strengths you have gained. Don’t be afraid to ask for help and then, in turn, to help and mentor someone else. Be willing to accept opportunities in a totally different environment than the one in which you are used to practicing. Federal agencies like the CDC, the Centers for Medicare & Medicaid Services, the National Institutes of Health and the Food and Drug Administration need Native people working within their organizations to help them to work more effectively with tribes, increase financial and other resources going to tribes, and to help cultural competency grow and systems change. Agencies need to be reminded about the sovereignty of tribes and the important role that tribal councils play on a daily basis.

MN: Anything else you’d like to add?
MS: It’s an exciting opportunity to be part of such a dynamic and outstanding cadre of health professionals at the CDC. Working with CDC and the tribes is a huge challenge. CDC is a large federal agency made up of many very committed professionals who want to make a difference in decreasing health disparities. People often are willing to get involved when someone can assist them in talking to the right person at the right time.  CDC and Indian Country have much to learn and share with one another to collectively address the public health of the nation as a whole.

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