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Prospective Native American Health Care Providers Declining in Number 

Mentors, support and culturally appropriate recruitment efforts urgently needed, experts say

Native American Doctors and Nurses

Marilyn Angel Wynn/ Images

Jazmine Rae GoodIron (Lakota) always wanted to be a nurse, but then “life happened.” She had her first child at age 18 and later took a job as a receptionist at a hospital in South Dakota, putting her dreams on hold in order to support her growing family. But then mentors stepped in and changed the course of her career and future.

“My director said to me, ‘This isn’t what you wanted to do your whole life,’ ” GoodIron said. “He encouraged me to go back to school, and it turns out that I needed that push.”

In response to the dropping numbers of American Indian-Alaska Native (AI-AN) medical and nursing students, mentorship and support programs are being developed in schools and organizations around the country. In addition to career advancement for individual tribal members, the hope is that increasing the number of AI-AN medical professionals will improve health conditions overall for Indian country, whose people suffer some of the worst health outcomes of any ethnic group in the United States.

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GoodIron’s workplace offered to accommodate her nursing school schedule and provide tuition reimbursement. Once enrolled in the nursing program at South Dakota State University, she met Bev Warne (Oglala Lakota), an experienced nurse who runs the Student Nurse Mentoring Program for AI-AN students.

“I refer to it as my own personal cheerleading squad. They are there when you need them, to vent to and provide emergency financial assistance,” GoodIron said. ”All students have stress, but Native American families seem to struggle more than most people. Without their support I may not have been able to continue my studies.” 

Addressing the shortage

In 2016, there were only 935 new AI-AN registered nurse graduates nationwide, down slightly from earlier years. The percentage of AI-AN students in medical school decreased from 0.39 percent in academic year 2006-07 to 0.20 percent in 2017-18, according to the report Reshaping the Journey from the Association of American Indian Physicians (AAIP) and the Association of American Medical Colleges.

Jazmine Rae GoodIron and Bev Warne

Courtesy Jazmine Rae GoodIron

Nursing student Jazmine Rae GoodIron and mentor Bev Warne at the South Dakota State University scholarship banquet in October 2018.

"All other racial groups saw dramatic increases in medical school enrollment [over this time period], but we maintained or lost,”  said Tom Anderson (Cherokee), executive director of AAIP. 

Frequently cited challenges for AI-AN medical students include lack of financial support — not just for medical school itself, but also for entrance exam preparation and applications — and a lack of Native American faculty and mentors at medical schools and in tribal communities to help serve as role models and guides, Anderson said.

Mentorship has been key to success for Lacy Manuelito (Navajo Nation), a fourth-year medical student at University of Arizona, Tucson. Programs through AAIP helped her to traverse being a first-generation college student. 

“Even though there was a hospital full of physicians 10 minutes away from my front door, none were Native American, let alone Navajo. This made it a little intimidating, and I did not reach out for advice from any of them,” Manuelito said.

Mentors, networks also key to nursing success

“Programs that provide positive reports on recruiting and retaining Native nursing students provide mentorship, and that seems to be making a difference,” Lisa Martin (Lac du Flambeau Band of Chippewa) tells AARP. She is president of the National Alaska Native American Indian Nurses Association (NANAINA).

AARP Foundation, AARP and the Robert Wood Johnson Foundation are partners in the Campaign for Action and work with NANAINA in offering a series of informational webinars regarding Native American issues and nursing.

“We want Native American people to have access to clinicians who are very familiar with all of the challenges that they face,” said Winifred Quinn, director of advocacy and consumer affairs for AARP's Center to Champion Nursing in America. “That gets into the cultural competency of clinicians, of understanding what people experience in communities where social determinants of health are stacked against them.”

In Oklahoma a partnership between the state and the Cherokee Nation will launch the first tribal-affiliated medical school on Indian lands in the U.S. The school is starting in 2020 with an initial class of 50 students.


A balancing act

GoodIron, now 28 with three children, says that the idea of working in a tribal community once she graduates sparks a passion within her. While she still struggles to balance all of her responsibilities and nursing school, she is persevering and learning to accept support from her school and employers.

“Pride is a big thing and I had to learn to accept help,” GoodIron said. “Now I hope to be able to inspire others the way [my mentors] inspired me. We need more Native Americans in leadership roles who want to empower others to do better and achieve bigger things in life.”

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