Background: The growing shortage in healthcare professionals across the nation has been an increasing problem which is attributed to an aging workforce as well as an aging population with increased health needs.1 This issue is compounded in rural communities because of the limited resources. Smaller populations of rural areas do not typically attract healthcare professionals and the loss of these individuals in rural communities can greatly impact the surrounding area; especially where people travel greater distances for healthcare.2,3 Although there is a shortage of healthcare professionals throughout the entire country, North Dakota (ND) has an uneven distribution in cultural diversity of health professionals, which can be a shortfall when caring for patients in Tribal communities or surrounding rural areas. In 2015, there were 13,933 employed licensed nurses, including all ethnicities. Of this population, there were 195 or 1% employed self-reported American Indian nurses.4 Per the Institute of Medicine Report, a culturally diverse nursing workforce is essential to meeting the health care needs of the nation and reducing the health disparities that exist with minority populations.5
In recognition of the severe underrepresentation of American Indians in the health care workforce, Cankdeska Cikana Community College partnered with the Recruitment and Retention of American Indians in Nursing (RAIN) Program, University of North Dakota to implement the “Next Steps Program.” This program provided opportunities for American Indians to access an “educational pathway” leading to careers in the nursing profession. Services provided to students enrolled in the Next Steps Program include financial support for tuition fees and books for participation in healthcare education and training, support services to meet childcare and transportation needs and intensive mentoring services.
Methods: A qualitative descriptive design was used to obtain detailed descriptions of the program, services provided and impact on the students’ success.6 Participants involved with the Next Steps Program were recruited by purposeful sampling (N=27). The data were collected through a semi structured interviews from November – March 2014. Validity and reliability was confirmed when recurrent themes were identified by researchers through independent coding. All interviews were analyzed using qualitative inductive content analysis to identify key themes.
Results: The Next Steps staff and mentors were enrolled members of a North Dakota Tribal Nation. One of the two Next Steps staff and three of the four mentors were female. Three mentors were 50-59 years old while one was in the 30-39 age group. Educational level of the mentors included one with a Bachelor’s degree, two with master degrees and one doctoral prepared. Sixteen students were enrolled in one of the North Dakota Tribal Nations. Three resided in North Dakota but were enrolled members of Tribal Nations in other states. The student nurses were all female, older than average students and the majority were single with children. Thirteen were enrolled practical nursing programs in one of the three North Dakota Tribal Colleges while one attended a State College. Four were enrolled in university Baccalaureate Programs. The perceptions and experiences of the twenty-seven participants were classified into six major themes: 1) Next Steps Support Services, 2) Mentoring Experiences, 3) Challenges in higher education, and 4) Future educational and/or employment plans. These four main themes occurred repeatedly and affected the life experience of the participants.
Conclusion: The Next Steps Program staff and mentors provided support and services to older than average Native American students with children. These services allowed them to obtain their dream of becoming nurses. While personal commitment is an important factor, the Next Steps staff, mentors, and peers played an important role in the success of the student nurses. All the student nurses clearly valued the financial assistance for living expenses including child care, tuition, and gas cards so they could travel to their clinical sites. The majority of the nursing students believed that without the support and services of the Next Steps Program, they would not have been successful in the enrollment process or completion of their nursing programs.