American Indian / Native American Archives

Careers in the Indian Health Service

by | Mar 30, 2013 | Magazine, Minority and Community Health, Native American Nurses, Nurse Recruitment, Nursing Careers

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.”

Been There, Done That

by | Mar 30, 2013 | Magazine

Yolanda Talbert at her BSN graduation; starting nursing school at age 37 was a challenge.

“I’m the kind of nurse who wants to get as much as possible out of my career rather than staying in one area,” says Yolanda Talbert, RN, BSN, LMT. “I want to see it all.”

That desire for many different experiences is at the heart of Talbert’s philosophy of life. At 50, this American Indian nurse has packed more adventure and spirit into her life than most people manage to do. A member of the Navajo Nation who now lives in Alaska, she is a mother, grandmother, caregiver, massage therapist, educator, artist and even a dog sled musher. The precious nature of time and all living things is something Talbert respects deeply. She epitomizes the tenet of Navajo spirituality that praises “life, the land and well-being.”

Talbert spent much of her childhood on the Navajo reservation in Ganado, Ariz., the second oldest of five girls. Her father was in the Air Force, so the family moved around a lot, including a stint in Germany. In addition to the frequent relocations, Talbert’s family life was made difficult by poverty and her parents’ alcoholism.

“Both my mother and father were impaired by alcoholism,” she recalls. “So my sisters and I had a rough time. We were very poor [on the reservation]. We lived in Third World conditions. My mom died when I was about 10, so my sisters and I were put in welfare homes for a while and then passed along to our relatives. My father was still alive, but he was still drinking, so we weren’t getting much support from him.”

Reservation life was not without hope, however. “I had a grand aunt that we had stayed with when all this upheaval was going on,” Talbert says. “She instilled in us that if we wanted to get out of our poverty situation, we had to go to school. Education was going to be our ticket out of poverty. And I think that has always been a factor for me.”

Talbert heeded her aunt’s words and finished high school, eventually getting an associate’s degree in fine arts while living in Oklahoma. In the 1970s, she “got married, had [two] children, and then I got divorced.” In 1982, she married her current husband, David, and they added another child to the family. David Talbert, like Yolanda’s father, was in the Air Force, so again she was traveling and living at various military bases. Eventually the Talberts were stationed in Leavenworth, Kansas, where David worked at the maximum-security military prison.

“That’s when I decided I wanted to go to go [back to] school,” Talbert remembers. “I wanted to try nursing. My dream school was the University of Colorado Health Sciences Center in Denver. So my husband got out of the military and we moved to Denver, bless his heart.”

Following Ancestral Roots

Starting nursing school at the age of 37 was another challenge for Talbert. “You needed to have a 3.0 grade point average to get into [the Colorado program],” she says. “So that was aiming pretty high. I’d never been in an academic environment at the university level. [My classmates] were so smart, and they were younger than I was. I was just blown away by how fast-paced the system was.

Talbert with her dog sled: When she first heard about the re-enactment of the historic 1925 Serum Run, she knew she had to do it.

“In my first semester my GPA was only 1.8, but I caught up,” she continues. “I got a lot of support from the minority nurses group there that helped me survive on campus. And I had a very supportive family and kids and husband. They kept pushing me on: ‘C’mon, you can do it, you can do it.’”
Talbert’s interest in nursing can be traced back to her reservation experience—specifically to her great aunt, Adele Slivers. “During World War II, she was a lieutenant in the Army Air Corps and she was one of the nurses who was behind enemy lines,” Talbert explains. “She would tell us stories of how they would put the wounded on glider planes so they could get them to the hospital. There is a plaque [commemorating those nurses] at Sage Memorial Hospital [in Ganado], and she’s on that plaque.”

After graduating with her BSN from the University of Colorado Health Sciences Center School of Nursing in 1992, Talbert needed to fulfill her Indian Health Service scholarship requirement of working in a Native American health care facility for two years. She applied for—and got—her first choice: Alaska.

“My dad had told me that he was stationed in Anchorage for about a year when I was a little girl,” she says. “He told me that Alaska Natives were really similar to the Navajos, .” There is indeed a historical connection: It’s believed that Alaska Native people—ancestors of today’s Navajo and Apache Indians—migrated from the far north of the North American continent to the American Southwest around 1000 A.D.

Alaskan Adventures

Over the next eight years, Talbert would work in a variety of health care settings in Alaska, including the IHS Alaska Native Medical Center in Anchorage, and handle a variety of roles: Med/Surg nurse, home hospice care provider, nurse educator, utilization reviewer, ICU nurse (until she developed a latex allergy) and more. Not content with a full plate, she added another helping to her workload by doing registry nursing for the American Nursing Services staffing agency. It’s the variety that appeals to her, even when that means spending time behind bars.

Talbert (third from the left) at Ground Zero: “When the snow falls [in Alaska], it reminds me of the ash falling.

“I work in three different corrections facilities right now,” Talbert says. “[Prison inmates] are very similar to pediatric patients. You have to use very concrete thinking with them. My husband’s a correctional officer and his philosophy is that they’ve committed a crime, they’re paying for the crime, there’s no reason to shove it in their face. You have to be professional. I’m always polite, and they respond really well.”

According to Talbert, health care in Alaska is “state of the art”—by necessity. With so many Alaskans living in rural and remote areas (called “the bush”) where the nearest hospital is miles away, the state has had to innovate to assure good health care for its residents.

“Some of the clinics in the larger villages have a physician assistant and some nursing staff,” Talbert explains. “If they don’t have those in the village, then they have a nurse assistant out there, and she works almost like an LPN. There are [telehealth] systems where [health professionals in the village] can relay information [by computer to doctors in Anchorage or other off-site locations] for emergency operations. [The physicians can pull up the image on their computers] to look at the patient and tell the nurse what she should do next while they’re getting ready to transport that person out.”

Nursing in Alaska is rife with challenges—which is right up Talbert’s alley. “You have to be adaptable,” she says. “Things break down and you just have to learn to be flexible. You could get stuck in a blizzard, or a snow machine could stall. Sometimes you won’t even have a phone. You have to be self-reliant.”

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This spirit of being adaptable was the inspiration for a famous historical event that took place in Alaska in 1925. With an epidemic of diphtheria ravaging the Native population of remote Western Alaska and neither planes nor ships able to traverse the rough winter terrain, dog sled teams relayed much-needed diphtheria antitoxin serum from the Alaskan midlands to Nome on the far western seaboard. Today, that 800-plus-mile Serum Relay Run is recreated annually in Alaska. Four years ago, Yolanda Talbert was one of the dog mushers, riding alone across the wilderness with her own team of huskies.

When Talbert first heard about the re-enactment of the historic 1925 Serum Run, she knew she had to do it. She and her husband raised a dozen dogs, built their own sled and taught themselves how to mush “through a lot of trial and error,” she laughs. Until a separated shoulder halted her ride, Talbert had covered nearly 500 miles of the trek.

“I’d never gone that far,” she says proudly. “And I had to do it all by myself. I was dragged, knocked between trees, I sprained my ankle, got lost—and there’s nobody there to help you. I got a respiratory infection. All my nebulizers had frozen—it was 28 below zero! I ended up taking my emergency dog medication—Prednisone—but it worked.”

Healing in the Wake of Tragedy

A year later, Talbert would rise to a more tragic challenge: She spent two weeks at Ground Zero in New York City after the terrorist attacks of 9/11, as a member of the volunteer Alaskan Disaster Medical Assistance Team. Her experience working in the rubble of the fallen World Trade Center is something Talbert says she’ll never forget.

Performing a massage at the National Alaska Native American Indian Nurses Association Summit: “I’ve learned just how powerful touch is.”

“[When we got there on] September 28, the status had changed from rescue to recovery [of the dead],” she says. “The critically injured victims had already been removed, so what we were there for was [to provide care to] the recovery workers. They’d drop things or get smashed hands; they’d suffer smoke inhalation, emergencies, heart attacks—all kinds of stuff. The site was still burning, so we had to wear our masks all the time. We set up four clinics there.

“You really felt like you were an American then, because [there were so many people from different nationalities] working for one goal,” Talbert continues. “The energy was just amazing. The scope of [the recovery operation] was enormous. You’d see those huge cranes and trucks right in front of you and they were humongous, but when you saw them out there in the field, they looked like little toy trucks. And the smell—I can still smell it to this day. When the snow falls [back in Alaska], it reminds me of the ash falling.”

The Power of Touch

Touching people—quite literally—is Talbert’s most recent passion. A licensed massage therapist (LMT), she is currently finishing an oncology massage certification program.

“Nursing is so demanding,” she says. “You’re so caught up with all the duties that you have very little time where you can relate to your patients. I felt that quality time was missing in my nursing. [As a massage therapist,] I’ve learned just how powerful touch is. It’s not like a massage you have in a spa—it’s totally different. It only takes five or 10 minutes out of my nursing time, and it makes such a big difference to the patient. I remember one time I was in NICU taking care of these little babies and every time I did a diaper change on them I’d do a light massage on the infants. None of the monitors were going off on my babies and the other nurses were saying, ‘That’s no fair, Yolanda.’”

For Yolanda Talbert, caring for people has been as important to her journey as embracing life to the fullest has been. Her Navajo heritage is interwoven with both her personal and professional life, and it all comes together to reinforce her belief in the importance of family.

“You are nothing unless you belong to a group,” Talbert emphasizes. “Whenever you introduce yourself to another Navajo, you introduce yourself by your clan. I’m Manygoats: That’s my mother’s clan. And I’m born for the Towering House People—that’s my father’s clan. So they know you belong to all these different people and they know what part of the reservation you’re from. You always belong to something.

“With nursing, I always consider [that concept of belonging] with my patients. What is the tribe that they belong to? What is their family unit like? That’s how I relate to them. They are part of a family. You’re not just treating the patient. You’re treating the whole family unit.”

American Diabetes Association Supports Increase in Indian Health Service Funding

by | Mar 30, 2013 | Magazine

Diabetes has reached epidemic proportions among Native Americans, according to the American Diabetes Association (ADA). Over 12% of all Indian populations in the United States suffer from type 2 (non-insulin-dependent) diabetes. The Pima Indians in Arizona have the highest rate of diabetes in the world—about half of adults between the ages of 30 and 64 are diagnosed with the disease.

In September 2000, the ADA announced its support for increasing funding of the Indian Health Service by $229 million for 2001 and is calling upon Congress to approve this additional funding. The ADA also congratulated President Clinton for his initiative to renew a five-year $150 million grant for treatment and care of diabetes in Native American communities.

Of particular concern to the agency is the high occurrence of type 2 diabetes among minority children, especially Native Americans. According to a recent Newsweek cover story entitled “Diabetes: An American Epidemic,” the rise in type 2 diabetes in youth is especially disturbing because of the potential for serious complications to occur at a much earlier age, compared with adult-onset diabetes.

Complications from diabetes are a major cause of health problems and death among all minorities, but especially Native Americans. These complications include:

• End-stage renal disease: Among people with diabetes, the rate of kidney disease is six times higher for Native Americans.
• Amputation: Each year, 54,000 people lose a foot or leg to diabetes; among Native Americans that rate is three to four times higher.
• Diabetic retinopathy: Native American populations are hit hard with this disease; it occurs in 24.4% of Oklahoma Indians.

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In October 1999, the ADA officially launched its new community-based program, “Awakening the Spirit: Pathways to Diabetes Prevention and Control,” which provides information to Native Americans to help curb the epidemic rate of diabetes. “Awakening the Spirit” calls on tribal leaders, national organizations, community members and even Native American children from across the country to promote community wellness, the importance of healthy eating and physical activity.

For more information about diabetes and the work being done by the American Diabetes Association in Native American communities, call 1-800-DIABETES (342-2383) or log on to www.diabetes.org.

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