South Dakota State University
What has been most instrumental to your progress?
Wokunze Wicaske Alliance Advisory Board: The development of the Wokunze Wicaske Alliance (WWA) Advisory Board was a critical component instrumental in our work. Native American (NA) student support services were implemented because the WWA Advisory Board identified the need, and guided the strategies for development through the decision-making process. The Advisory Board assured cultural relevance and acceptability of the proposed student support. With the input from tribal, healthcare, community and academic leaders, an avenue to learn and understand the challenges NA students face has been created. This awareness has informed the SDSU program and WWA staff about issues relevant to Lakota and other NA nursing students. Strategies were identified for the most efficient and effective ways to aid those students through mentoring, tutoring and talking circles. Due to this ongoing relationship, the WWA Advisory Board’s presence is known within the community, four reservations, and surrounding healthcare facilities, allowing partnerships with other NA groups, i.e., Great Plains Tribal Chairman's Health Board (GPTCHB) and the Oglala Education Consortium.
Mentoring model: Recruiting and retaining NA students in the nursing program is a recognized obstacle, affecting the NA nurse workforce. With the expertise of a NA nurse mentor, Ms. Warne, the WWA developed and implemented a mentoring program for NA students, supporting both pre-nursing and enrolled nursing major students. The WWA team hosted Carol Dahozy and Leilani White, consultants and mentoring experts, who presented multiple mentoring training workshops at different venues, i.e., Regional Health and Sioux San Hospital. Over 110 NA nurses, faculty, staff and interested community members participated in the training. With this training, WWA established a mentoring orientation program and began to identify NA nursing mentors willing to assist nursing and pre-nursing students. In collaboration with Great Plains Native American Nursing Association, WWA established a mentoring handbook to assist and guide the mentors. The implementation of the mentoring program has not only increased retention of NA students enrolled in the nursing major, but these students have the confidence to offer peer mentoring to other NA students in the program.
Outreach: Over the past two years, the outreach activities have grown exponentially. Bush funds supported hosting two known NA nurse experts whose input informed the WWA staff, NA nurses, faculty, healthcare leaders and community members. Our diversity officer/advisor attended four to six recruiting events each month across all four reservations and the surrounding Black Hills area. Along with mentoring, the WWA established regular opportunities for students, community members and SDSU faculty and staff to participate in cultural learning experiences offered by Lakota elders. In order to better understand the cultural diversity and underserved populations in the area, some of the learning experiences included smudging ceremonies, basic Lakota language skills, and use of traditional plants. The WWA was able to provide free nurse camp enrollment for NA reservation K-12 students, offering a glimpse into the nursing profession. Additionally, NA nursing students and WWA staff traveled to reservation schools, i.e., Wounded Knee to share their story and inspire future nurses. The impact of this outreach led to greater collaboration with tribal schools around the region.
Key lessons learned
While the assumption was NA students raised in the local area would be knowledgeable of their tribal culture, history, values, and language, a gap existed for many of the students. Furthermore, some NA students are more hesitant to embrace their rich history and heritage. Historic trauma and disrupted family life contribute to a generational gap in cultural awareness between our students and NA elders. Therefore, the WWA offered opportunities for students and others to build their awareness. In preparing future nurses, students need to learn and understand how tribal values, traditional medicine and Western medicine influence NA people's healthcare decisions. By partnering with Lakota elders and NA nurses, a rich Lakota cultural experiences was offered to NA students and WWA team members. In the spirit of inclusiveness, NA nursing students were invited to attend, regardless of the college or school training program. Through WWA activities provided because of the Bush Innovation Grant, this NA nursing program has been recognized by other groups, including the Great Plains Tribal Chairmen’s Health Board (GPTCHB) and Regional Health.
Finding and sustaining NA nurse mentors who have completed mentorship training and are willing to volunteer their time, is an ongoing challenge. In most cases, the NA nurses are actively employed, working full-time positions in the local healthcare area. NA nurses, who are employed at the local Indian Health System (IHS) would be ideal mentors; however, the IHS system places limits on their professional involvement during off-work hours. As a result, only recently has the goal of five NA nurse mentors who are able to commit their time to mentoring NA students been reached. While not ideal, this number allows the NA nurse mentor coordinator and four additional nursing mentors to support the 12 NA nursing students in the major and 15 pre-nursing NA students. Likewise, students struggle to meet their mentor on a regular basis when trying to balance school life with their family, home, work and meeting basic survival needs. When a stipend for students meeting specific expectations was provided, students’ engagement with the mentoring program was greater. The loss of the stipends makes it more difficult to keep the NA students involved in the mentoring process.
The number of NA students who are enrolling in the SDSU pre-nursing and nursing courses has consistently increased since the inception of the WWA Advisory Board. Implementing the strategies proposed by the Advisory Board has shown some success in recruiting and retaining NA students. Consistent with this growth is the need to increase the number of mentors. Many students are first generation college students whose retention and success are threatened by limited financial resources, educational preparation, and family and social support; these factors impact NA students' self-confidence and undermine their success. Therefore, the importance of the WWA program's support for the students must be recognized and continued. The NA mentor coordinator is continually reaching out to working NA nurses, as well as seeking support from retired NA nurses. NA students need mentors who are available and committed to being present for them. Recently, the WWA reached out to an experienced masters-prepared NA nurse whose scholarship area is in mentoring, with the hope of hiring her part time. It is our expectation her presence will strengthen our mentoring program and student support.
Reflections on the community innovation process
The most important elements of the diagram were being inclusive and collaborative. Building the relations and assembling a network with key stakeholders, including the tribal communities, schools, Chamber of Commerce, Regional Health, GPTCHB, Great Plains Native American Nurses Association (GPNANA), Sinte Gleska University and Oglala Lakota College was imperative to the success of this project. By gaining the support of key stakeholders, students received aid through mentorship, as well as financial support. Efforts to expand the NA nursing workforce were recognized by the Health Resources & Services Administration (HRSA) who sought input on collaborating and sharing ideas/strategies. Because inclusiveness and collaboration were core values in this project, students, faculty, and community members were welcomed to regular events to share cultural expertise through cultural awareness conversations, educational programs, diversity presentations, and multiple mentor-training programs.
Progress toward an innovation
Creation of the WWA advisory board was the necessary first step in an ongoing process of connecting SDSU's leadership with the tribal, healthcare, and community leaders. Listening during traditional "talking circles", generating new ideas and testing different strategies to increase enrollment and retention of NA students in nursing while achieving the overarching goal of reducing healthcare disparities in our region. While the WWA has made significant progress in this goal, it is still a continuous process. When this grant started, eight NA nursing students were enrolled in the West River Nursing department. Currently, twelve NA nursing students are enrolled in the nursing major, seven of which were admitted this semester, and an additional 15 NA students are taking pre-nursing courses. Additionally, our success has helped inform the leaders of SDSU (main campus), as they are in the process of starting a similar program called the Wokini Initiative. The WWA nursing leaders have been providing information about the mentoring program, with one WWA staff member sitting on the Wokini Advisory Group.
What it will take to reach an innovation?
While great strides have been made in creating a program to strengthen recruitment and retention for NA students into nursing, each day brings new challenges and obstacles which can interfere with students' success. Many NA students set goals to become nurses, but being unable to feed your child or simply, a dead car battery can impact their confidence and derail their school program. Based on graduates' feedback, some NA students lack basic life skills related to housing, food, clothing and finances, so they continually struggle. Intentional mentoring is one key strategy for keeping students in the program; however, locating enough mentors to guide the increasing number of NA students through their academic journey is still a challenge. Along with mentoring, funds are needed to assist NA students when they lack the resources to feed their children or keep the heat on in the winter. Seeking more funding is a continuous process, but one which will help students satisfy rising educational costs and meet their basic needs; allowing them greater focus on their goals and educational priorities, in turn, strengthening students' confidence and achieving success.
The WWA will strengthen the mentoring program by recruiting more mentors for the growing number of NA students. The Bush Innovation grant funding started the conversation which led to creating the WWA advisory group. From there, the Native American Nursing Education Center was established, which houses support staff, the mentoring program, and hosts numerous cultural learning experiences and opportunities. The work of the WWA Advisory Board and nurse mentors was key to SDSU’s efforts to establish a larger university initiative to increase NA student enrollment across sites. However, more funding is needed to serve the needs of NA students on the West River campus, which is 350 miles from the main campus. As such, we continue to seek funding to support the expansion of the program and reaching out to NA students (potential and actual) in the surrounding area. We will continue to seek input from the WWA advisors and tribal leaders about ways to expand our program, address cultural needs of our NA students and celebrating students’ achievements during and after graduation.
If you could do it all over again...
One piece of advice would be to plan for interferences with scheduling. Establishing and maintaining the WWA board members’ participation and presence at meetings has been a challenge. Travel has been one barrier as some WWA board members are elders and live 100 miles or more from Rapid City. Therefore, willingness to travel far distances, need for hotel accommodations, and South Dakota winter weather were issues that hindered meeting attendance. Likewise, some members were employed full time at tribal schools, IHS and other healthcare agencies, which limits their time and availability to be present. Since funded, several board members were replaced due to unplanned circumstances such as a member's death, retirement, position changes, etc. While Advisory Board members’ engagement has been high, it was always difficult to get the entire board together to meet. Furthermore, electronic communication was often irregular. Without their input, a wealth of experience and knowledge was lost. Therefore, it was essential to distribute agenda information and reports prior to meetings; the process should be well organized to use the board members' time respectfully and wisely.
One last thought
This program has truly benefited and grown due to the support from the Bush Foundation. The WWA was allowed the freedom and resources needed to move the mission and vision forward. The diagram provided a framework to move forward but also allowed this group to recognize the process is ongoing and fluid. The development of the goal was never at a standstill, always moving multiple aspects of the program in various places along the diagram flow. Attending the Bush Foundation meeting, the leaders were given great feedback and were able to converse with others, make connections and generate new ideas for this program. Lastly, the Rapid City "Classroom on Wheels" was a valuable opportunity for the WWA team to tour Lakota spiritual sights and learn more about the Lakota people, their history and cultural connections with the visited locations. This gave the team members a better understanding of NA students, their background and culture while allowing the team to build supportive relationships.