Nursing program aims to improve Native health care with masters-level courses

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MINNEAPOLIS - A unique health care provider education program has sprung up at the University of Minnesota's School of Nursing. The Native Nurses Career Opportunity Program is the only masters-level scholarship program for American Indian/Alaska Native nurses.

The program is for advanced caregivers in public health, nurse midwifery and nurse anesthesia. ''This is a unique program that allows Indian nurses to get a master's degree while they stay on their reservations and keep working wherever they are. This factor helps lead to success. The program educates students to a higher level, and this will eventually affect management and leadership in Indian health care,'' program director Margaret Moss told Indian Country Today.

The effort began in 2002 when the IHS put out a call for a scholarship project, and a faculty member at the university's school of nursing wrote a grant application. UMN already had a masters-to-doctorate bridge program for nurses, and the new program was seen as was a way of supporting that effort. This is the last year for the bridge program, but the master's scholarship program will continue.

Preference is given to Indian nurses, but scholarships can go to anyone interested in working in Indian country. There is a payback commitment of two to four years of work for the IHS. Students must find their own placements, but that hasn't been a problem. ''Most people who apply are already working for the IHS,'' Moss said.

That's just how Winona Begay, Navajo, came to participate in the program. A nurse at the IHS Northern Navajo Medical Center in Shiprock, N.M., Begay offered to make a call to the university on behalf of some of her colleagues who had heard about the opportunity. They had associate degrees and wanted to further their education. Begay found out early in the conversation that entry into the program required a bachelor's degree. The recruiter asked her if she had her bachelor's, and then invited her to apply. ''Things just fell into place,'' Begay said, and a few months later she was taking her first course: biostatistics. Having been out of school for more than 10 years, the course - the most difficult she would take, though she didn't realize that at the time - was challenging.

Begay worked full-time while completing the program. She told ICT that her supervisor was extremely supportive and helpful in arranging her schedule so she could meet the in-residence requirements of the program. ''It was manageable, but it was a lot of work,'' Begay said. ''I dedicated a lot of my nonworking time to my courses.'' Working closely with her adviser, she studied for two solid years and finished in May 2006.

The scholarship covers tuition, travel, monthly stipend, books and fees, Moss explained. Most of the curriculum is online, so students from Shiprock, Spokane, Wash., and Oklahoma have been able to participate. A few face-to-face encounters with faculty each semester are required, but the scholarship covers the costs of travel and hotels, as well as expenses for each student to attend one conference a year.

The course of study for everyone includes theory, research methods, grant and proposal writing, leadership skills and public health. Then students study within their disciplines with nurse practitioners focused on clinical work, public health nurses studying epidemiology and anesthesia nurses working with the Minneapolis veterans hospital. Everyone is required to complete a small research project, which can be an actual study in their area, a secondary analysis of information available in databases or a comprehensive review of the literature on a specific topic. These ''Plan B'' projects have included a report on menopausal symptoms in American Indian women and a study of children's exposure to methamphetamine production byproducts.

Begay's Plan B project started out as a review of the literature on diabetes among American Indians. But she noticed that the information garnered through research was seldom communicated back to the people who participated in the research itself. She began to suspect that part of the reason was that translating the concepts to Navajo-speaking people, for example, was difficult because of the profound differences between the Navajo and English languages, and she confirmed her intuition by actually trying to translate medical concepts back and forth from one language to the other.

''As much work as I have done on translating medical concepts, I still find it difficult to convey certain information to my patients,'' she said. ''For example, my people have had a lot of historical trauma, and life is often difficult for them, but there is no word in Navajo for 'stress,' which is often part of the diagnosis for our patients.''

Begay explained that a Navajo glossary of medical terms is being developed to help solve this problem. ''We cannot just use terms like glucose tolerance test, leptin resistance, cholesterol and hypertension, expecting that people will understand,'' she said. ''The terms must be translated in such a way that the concept is explained. The next goal for the glossary developers is to work on terms related to cancer and its treatment.''

The program graduated its first three students in 2006 and three more graduated this May. Five slots are available each year. Students come from the areas of management, public health, clinical nursing and sometimes from the U.S. Health and Human Services Department's Public Health Service Commissioned Corps.

Moss said that people who complete the master's program are sure to be assigned administrative duties because there are so few Indians with master's degrees in the IHS.

In general, there is an acute shortage of nurses in Indian country. The causes for this, Moss said, include geographical isolation, language and cultural differences, family ties, role expectations, financial barriers, transportation issues, and the fact that the American Indian/Alaska Native population is young. Another significant problem, Moss said, is that courses taken at tribal colleges often are not transferable to four-year, non-Indian colleges, so a person who has attained a two-year degree at a tribal college may well have to start all over at a non-tribal college or university, with no courses carrying over for credit.

Begay is now a registered nurse and the patient-nurse coordinator at the Northern Navajo Medical Center. As such, she works with the nurse team as a district planner and case manager. She said that getting her master's has given her ''a deeper understanding of public health and the needs of our people.'' She tries to be a role model to youth and to interest them in careers in the health field. ''I explain how it was possible for me and that there are opportunities for everyone.''

For more information about the Native Nurses Career Opportunity Program, visit www.nursing.umn.edu/NNCOP.

Indian Health Service facts

* The IHS is a branch of the U.S. Health and Human Service Department's Public Health Service.

* The IHS has 16,000 employees; about 70 percent are American Indian.

* Eight hundred and ninety-six physicians and 2,600 nurses serve 1.9 million American Indians and Alaska Natives residing on reservations and 600,000 American Indians in urban clinics. This is a ratio of 36 doctors per 100,000 people.

* In the District of Columbia, where funding decisions are made, there were 768 doctors per 100,000 in 2003. In Massachusetts, there were 443 per 100,000, and in Idaho, which ranked 50th among the states, there were 170 doctors per 100,000.

* The total federal appropriations for the IHS in fiscal year 2006 were $3.1 billion, with an average of $2,158 expended per person on IHS patients, compared with $5,921 spent per person per year for the total U.S. population.

Sources: Information on the IHS is from the IHS Fact Sheet at http://info.ihs.gov. Information on physicians per 100,000 people is from the U.S. Census Bureau at www.census.gov/statab/ranks/rank18.html.