A Conceptual Model that Promotes Recruitment and

Retention of American Indians into Nursing

Loretta Heuer, PhD, RN, FAAN, North Dakota State University

Lane Azure, PhD, Cankdeska Cikana Community College

Mary M Wright, PhD, RN,CNE, North Dakota State University

Melinda Anderson, DNP-C, RN, North Dakota State University

Literature

• Nursing pipeline• Illustrates the need to have a plan and

resources to meet the nursing workforce needs.

•Minority nurses ‘pipeline’• Closes health care disparities (Mcalister, Gold &

Sullivan-Bentz, 2011).

North Dakota Nursing Statistics

Purpose

• To have academic and community partners identify themes with related strategies that would lead to the successful recruitment, education and employment of American Indian Nursing Students.

• A pipeline for American Indian Students.

Methodology• Event• Future of American Indian Nursing in North Dakota

Conference

• Site• Standing Rock Reservation – Prairie Nights Casino &

Sitting Bull College

• Design• A community based participatory action data collection

methodology

• Sample• Tribal elders, nursing faulty, nursing staff, nursing

administrators, and directors

Sample (N=35)• Education:

• Some college (n=1, 2.9%)

• Two year degree, LPN (n=1, 2.9%)

• Four year degree, 11% (N=4)

•Master’s degree (n = 19) or a doctorate (n = 8), 54%

•Employment:

• University 49% (n = 16)

• Four- (n = 5) or two-year (n = 5) universities/colleges (n = 10), 28%

• Income:

• $70,000 or above (n = 22, 63%)

• $55,001To $70,000 (n=4, 11%)

• $40,001 to $55,000 (n = 4, 11%)

• $25,001 to $40,000 (n = 2, 5.7%).

• Ethnicity:

• White 66% (n = 23)

• American Indian or Alaska Native population 29% (n = 10)

Nominal Group Technique

• Designed by Delbeq & Van de Ven

• In the early 1970’s

• Maximized group participation in making decisions and reaching consensus.

• Process

• A number of steps that can be adapted in small ways, while retaining the goal of the method.

• Three groups

• Group 1 – 13 Participants

• Group 2 – 10 Participants

• Group 3 – 12 Participants

Items Generated

• The steps included:

• Group 1 – 85 items generated

• During clarification step, some items combined

• Data reduction to 9 items

• Group 2 – 43 items generated

• During clarification step, some items combined

• Data reduction to 8 items

• Group 3 – 56 items generated

• During clarification step, some items combined

• Data reduction to 15 items

Group 1 Ranking• Mentoring services 107

• Develop support systems in the institution 105

• A designated area in college /facility where students feel safe-home away from home 93

• In-house daycare for jobs/school 92

• Tribal support 91

• K-12 stem curriculum 91

• Nurse camps at grade schools at reservations run by nursing college students 91

• "NO EXCUSES" Orientation 87

• Employment for spouse 86

Group 2 Ranking

• Peer to peer mentor support system 78

• Adequate orientation 3-6 months after graduation 77

• Development of Self-Confidence/Leadership programs for American Indians77

• Access to education resources to attend trainings 74

• Cultural sensitivity for instructors (nursing) 73

• Increase visibility of American Indian nurses (e.g. Publicity(Recognition) for nurses who are role models . Show a variety of nurses who are role models to American Indians in primary and secondary schools). 67

• Plan of action (global) with all invested parties (IHS, Tribal, Nation, Schools, etc.) 67

• Heath career tracking in high school 61

Group 3 Ranking• Mentoring program 85

• Assess academic risk 82

• Need for American Indian nurses 78

• Multiple methods of teaching and learning in nursing 74

• Increase family support and involvement 72

• Develop a sense of belonging 71

• American Indian faculty 70

• Counseling life skills non academic student support services 68

• Academic support at the elementary and secondary level 67

• Strengthen relationships with other nursing students 67

• Develop onsite residential nursing programs 64

• Goal setting , time-line within the discipline 59

• Prescreen for barriers 53

• Change admission criteria 53

• Educational opportunities for K-16 51

ThemesEducational Preparation K-12

Non-Academic Supportive Programs

Nursing Program Support

Transitional Support for a Nursing Career

Recruitment and Retention of American Indian Nurses within the Workforce

Global Plan of Action

Educational Preparation K-12

• Academic support at the elementary and secondary level

• K-12 STEM Curriculum

• Sciences, math, technology

• Cultural Knowledge and Application

• Clear need for American Indian nurses Educational opportunities from K-12

• Nurse camps

• Grade School

• High School

• Tribal Support

• Mentoring & Experiential Opportunities

• Health care tracking in high school

Non-Academic Support

• Tribal Support

• Family Support

• Employment for spouse

• Increased family support and involvement

• Counselling of life skills

• Financial workshop

• Financial Support

• Daycare

• College

Nursing Program Support

• Preparing for Admission

• Prescreen barriers for enrollment into nursing school

• “No Excuses” Orientation

• Adapting Program Policy• Admission criteria

• Designated space

• Home away from home

• A sense of belonging

• Centralized access for mentoring

• Support services

• Tutoring, advising,

• Assessment

• Assess for Academic Risk

• Early detection and intervention in students that need additional help.

Nursing Program Support

• Cultural Knowledge and Application

• Cultural sensitivity for nursing instructors

• Resources Access to educational resources for faculty

• Mentoring Program

• Peer-to-peer mentor support system

• Encourage students to seek mentor

Nursing Program Support

• Curricula Delivery

• Goal setting time-line within the discipline

• Giving student deadlines

• Cultural sensitivity nursing instruction

• Explore innovative approaches to curriculum delivery

• Develop circular teaching methods vs linear (Group 3 , 12)

• Multiple Methods of teaching and learning

• Faculty

• Native faculty

• Increase number of diverse faculty

• Student Relationships• Relationships with other nursing students

Transitional Support to Nursing Career

• Leadership Program

• Self-confidence/Leadership programs for American Indians

• Cultural

• Develop Onsite Residential Nursing Programs and foster integration of cultural aspects.

• Environment of care setting and patients

• Mentoring Program

• Support systems within the institution

• Adequate orientation 3-6 month after graduation

Recruitment and Retention of AI nurses within the Workforce

• Need for child care resource and referral related childcare

• Increase need for American Indian nurses

• Recognition for nurses who are role models for NA in the schools

• Opportunity to serve as role models

• Increase visibility of American Indian Nurses

• Media

Global Plan of Action

• Convene Community Stakeholders

• Involve invested stakeholders

• Potential Students

• Current Students

• Parents

• Elders

• Nurses

• Tribal Council

• Elementary and Secondary School Councilors

• Tribal Colleges

• Nursing Program Directors

• IHS representatives

• Legislators

• Foundation Representatives

• Disseminate the findings

• Presentations

• Publications

Elementary Secondary

Post –Secondary

Career/Vocation

Pre-School, Kinder- garten

Educational Preparation K-12

Non-Academic Support

Nursing Program Support

Recruitment &

Retention

Results of Nominal Group TechniqueNorth Dakota American Indian Community & University Partnership

American Indian CORE VALUES

TransitionSupport

Wisdom &

Guidance of Elders

ExtendedFamily

SpiritualityCulture

Language

FriendsPeersTribal

Community

Conclusions• Nominal Group Technique

• Provided an opportunity to receive input from variety of constituents.

• Identified themes provide components for further exploration and work.

• Implemented some components.

• Nurse camp (Edventures in Health Careers)

• American Indian Nurses Visibility

• Recruitment and Retention Video

• American Indian Nursing Documentary

• Policy Paper

• Future Work• Explore and validate the themes

along with specific strategies that can be implemented and evaluated.

Questions? CONTACT INFORMATON

Loretta Heuer, PhD, RN, FAANProfessorNorth Dakota State UniversityPhone: 701-231-8205E-mail: Loretta.heuer@ndsu.edu

Funded by The University Partnership Research Grant for Health Professional Opportunity Grant, # 90PH0019, Office of Planning, Research, and Evaluation, Administration for Children and Families.

A special thank you to Mary Leff, MS, Evaluation/Research Coordinator and Juessica Grund, BS, Academic Grants Coordinator for their work in this project.