The Importance of Diversity, Equity, and Inclusion in Nursing

The Importance of Diversity, Equity, and Inclusion in Nursing

Diversity, equity, and inclusion (DEI) are hot topics in the healthcare world, but including a DEI module in our yearly education isn’t enough to address these issues. Policy is a valuable tool, but actual change needs to come from a more personal level, from each and every staff member.

Before we can have a meaningful conversation about DEI that might lead us toward significant change, we need to understand the meaning of diversity, equity, and inclusion and why it is important in healthcare.

First, the issues often relate to our biases, especially those so deeply ingrained in our life circumstances that we aren’t aware of them. We can’t advocate for what we don’t understand, and if we don’t advocate for change, we will stay in our “safe” silos, which only strengthens the idea that we are separate and different.

Understanding that we are separate and different and what that means is the first step in making diversity, equity, and inclusion a part of our workspace and nurse recruitment.

Diversity

Diversity is simply including people with different backgrounds. For example, when healthcare systems conduct nurse staffing while considering different cultural, gender, religious, sexual orientation, and socioeconomic backgrounds, the staff benefits from exposure to differences among coworkers, and patients feel more comfortable knowing they aren’t alone.

Our healthcare system has been lacking in diversity from the beginning, and although we’ve seen a lot of progress since the days when only white males could practice medicine, we are far from diverse.

In one study, over 56% of physicians identified as White and 64% as male, according to the Association of American Medical Colleges (AAMC). According to Minority Nurse, about 75% of RNs identify as White, and 91% are female. So if most doctors and nurses are white, most doctors are male, and most nurses are female, who are we really serving?

When we don’t have a common background, it’s easy to make the mistake of seeing the patient through our own lens instead of their reality. Our lenses place them where we want them to be—fully able and capable of taking the steps we want them to take for their health. The outcomes we desire assume the tools, processes, and understanding are within their reach and that they have the same goals we do.

Textbook knowledge can never make up for the lack of diversity in our own lives. And our lack of understanding of our patients’ reality can lead to misunderstanding or errors in care, creating inequity. Hiring a diverse workforce promotes understanding and creates a more comfortable environment for patients and coworkers alike.

Equity

Equity is a concept that often gets confused with equality. In healthcare, equality means giving everybody the same resource or opportunity to achieve their health goals. Equity is recognizing that each person has different circumstances and honoring that by allocating opportunities and resources to allow them to reach an equal outcome.

Simply giving someone an opportunity isn’t enough if they don’t have the means to use it. Equity can only be achieved when nobody is allowed to be disadvantaged due to age, race, ethnicity, nationality, gender identity, sexual orientation, geographical background, or socioeconomic status.

Access to life-saving medication is an example of inequity we see every day. A medication that costs hundreds of dollars every month may not be out of reach for someone with superb insurance coverage and a large bank account. For someone whose job doesn’t offer prescription coverage or who doesn’t make a living wage, that life-saving medication is technically available but far out of their reach. Far too many patients fail to fill the prescriptions they need for this reason.

Healthcare policy can promote equity, but we can also change how we treat and educate patients. In our medication example, we could address a patient’s ability to obtain a prescription before they leave the office or hospital. No patient should walk out the door with a prescription they can’t fill.

Inclusion

Inclusion is about deliberately creating a respectful and safe environment for all staff and patients. Inclusion means giving patients and staff a voice in giving and receiving care and encouraging diversity. Healthcare isn’t the place for a one-size-fits-all approach. We must all strive to embrace diversity and promote equity.

Nurses Are Uniquely Positioned to Champion DEI

Nurses may have little say in enacting policy within their healthcare systems but are very likely the first and last staff member a patient sees and the role they interact with most frequently. That close relationship with our patients makes nurses the most important role to champion diversity, equity, and inclusion with our patients, in nursing education, and within our own workspaces.

One of the most essential directives we learned in nursing school may have been to meet patients where they’re at. Let’s add and coworkers to that and, together, we can create a more effective healthcare system that serves all people.

 

Heart Health for Busy Nurses

Heart Health for Busy Nurses

February is American Heart Month — what better time to reassess how well you are taking care of your heart health?

Know Your Risk Factors

As a minority nurse, you probably know certain minority groups have higher risks for heart disease. According to the American Heart Association, African Americans, American Indians/Native Alaskans, and Hispanics have an increased risk of heart disease and its associated problems like high blood pressure, heart attack, and stroke.

Other risk factors include hereditary factors (others in your family have heart disease), smoking, obesity, sedentary lifestyle, and poor diet.

Know the Signs

According to the Centers for Disease Control and Prevention, there are a few heart attack signs and symptoms that you shouldn’t ignore.

If you experience any of these symptoms, call 911 immediately.

  • Pain or discomfort in the jaw, neck, or back
  • Feeling weak, light-headed, or faint
  • Chest pain or discomfort
  • Pain or discomfort in arms or shoulder
  • Shortness of breath

Women also tend to have symptoms that are different from men and, therefore, aren’t always immediately considered as heart trouble.

Watch for these unusual signs:

  • Nausea or vomiting
  • Heartburn
  • Extreme fatigue
  • Feelings of unease or anxiety

Heart disease isn’t called the silent killer for no reason. If you feel something is off, whether that’s occasional chest pain with exercise or under stress, heart palpitations, or off-and-on chest discomfort, always be cautious and get it checked.

Reduce Your Risk

If you have risk factors for heart disease, you should monitor your blood pressure, your cholesterol, and your blood sugar. Try to reduce your risk by maintaining a healthy weight, getting enough physical activity, being sure to rest, staying connected with loved ones, and trying to keep your stress levels in check.

With the hectic pace of a nurse’s day, getting any time to bring your stress down a notch is a struggle. But one simple way to help with stress reduction is to step outside. Plenty of research backs up the idea that more time outside is better for your health. A few minutes walking at lunch, parking far enough away in a parking lot, or even just getting a few breaths of fresh air on a break can have huge benefits on your physical health and your mental health. Getting into nature can clear your mind, lower your blood pressure, and help you clear out the mental clutter enough to focus better when you come back to work.

Heart disease is the number-one killer of men and women in the United States, so paying attention to your own heart health is one of the best preventative measures you can take.

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.

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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