Anchorage’s Alaska Pacific University received a nearly $3 million grant from the U.S. Department of Labor to be distributed over five years to help diversify and expand the state’s nurse workforce.
The university partnered with Bethel’s Yuut Elitnaurviat and the Yukon-Kuskokwim Health Corporation on a Licensed Practical Nursing program. Nine students have graduated so far, and the partners are aiming to improve health outcomes in rural Alaska.
The new nursing program is rigorous, and many students have to travel for hours on snowmachines or take multiple flights to get to clinicals and exams.
“They have families, they have lives, they have jobs, they have a lot of things, a lot of responsibility,” said APU’s director of nursing, professor Marianne Murray.
A lot of things about the program are non-traditional. For example, the majority of nurses in the U.S. are white women — but not in this program.
Diane Droutman, the coordinator of the LPN program, said that the scheduling is different too. She and their partner at the Yukon-Kuskokwim Elder’s Home in Bethel designed a one-week-on, one-week-off schedule to be flexible for life on the Yukon-Kuskokwim Delta.
“And she was like, ‘We can do that?’” said Droutman. “And I went, ‘We’re starting the program. We can do whatever we want.’”
They also split up the program so that students can build credentials incrementally. Instead of completing a three- to four-year program in one go, students can start by earning their certified nursing assistant certificate, which is a six- to nine-week program. Then they can work in the field as a CNA to make sure they enjoy the profession. If they want, they can go back work on their LPN credential.
The initiative is a response to Alaska’s nursing shortage. A study by the National Center for Health Workforce Analysis projects that Alaska will have the highest number of nursing vacancies in 2030, with almost a quarter of positions left unfilled.
“If there’s one thing I’ve realized since living in Alaska for the last, what, 12 years now? It’s that you have to pretty much grow your own, especially if you want people to stay,” said Murray.
She said that there is a roadmap to building a homegrown Alaskan nursing corps.
“The way that we increase the number of nursing students is through increasing faculty, as well as increasing partnerships so that we have access to those clinical environments where we can teach our students,” said Murray.
The U.S. Department of Labor grant is intended to educate a more diverse range of nurses to improve rural and tribal health care. APU has a holistic admissions process that considers a person’s community and what they’ll give back to it. The program costs more than $30,000, which includes living expenses, books and tuition.
“The good thing is because of our tribal affiliation there is huge scholarship opportunities,” Murray said. “For students that both work in the tribal health care system, and then any of those students that have Indigenous or Alaska Native heritage.”
APU also wants to teach cultural safety, a framework developed for health equity for Native people in New Zealand.
“One of the big tenants of the culturally safe health care is removing that power level, like the doctor has all the power. Because the patients know what their life is like. They know what they can and can’t do. So we need to work with the patients to find out the best way for them to manage what’s going on in their life,” said Droutman.
The program also discusses power structures that students may not realize they’re perpetuating. Murray said that they talk about implicit bias, stereotypes and the historic dynamics contributing to health care inequity. They do exercises where the students write down what they think of when they hear “bad patient.”
Droutman described one patient’s journey that opened her eyes to why it’s so important to have local facilities. He had a gunshot wound. When he got to the closest village, they didn’t have a health care worker so they had to send them to the next one.
“So they had a dogsled. So they took him by dogsled to that village. He then had a snowmachine to the next village who put him on a float plane to the clinic,” Droutman said. “They said, ‘Oh, you need a little bit more, put him on a plane to Bethel.’ Bethel said he needed more care. So they put him on a plane to Fairbanks. And then Fairbanks said, ‘You know, he really needs a specialist’ because it was in his foot and they didn’t want him to lose mobility and more use of that foot. So they sent them to Anchorage.”
It took 30 hours to get him from a village to Anchorage.
It’s challenging for APU to operate in the bush. At times, they have classes with no water and can’t wash their hands for clinicals. There have been times when students are online with faculty or taking an exam and the internet drops. Plus internet service is expensive, so APU decided to make sure students had hard-copy backups of exams.
“So they send out a printer, we’re setting up the printer, we got it all set, and a plane goes over and it stops working. Because it was a wireless one,” said Droutman.
Program organizers are using the grant to make it easier for students to navigate issues. They’re giving them thumb drives so they don’t have to download their slides. And they’re getting high fidelity simulation mannequins, for which they’re planning to record Elders speaking in Yup’ik for simulations practicing overcoming language barriers.
They’re also teaching more culturally rooted medicinal practices for Native people. They talk about shaman, the use of plants and herbs for healing and health. For example, Murray said that they explore the medicinal use of dandelions.
“When dandelions are young, a lot of people will make, like, dandelion honey and dandelion wine, dandelion soup,” Murray said. “And then, of course, you can eat the leaves. Well, dandelions have been shown to actually help with liver disease. They’ve been a [help] for arthritis. For some of those, it helps with kind of overall aches and pains.”
Classes start up again in Bethel on Aug. 21. After their success in Bethel, three more hospitals reached out to establish partnerships, including the Foundation Health Partners and Denali Center in Fairbanks. Over the next year, the program plans to expand to Anchorage, the Mat-Su Valley, and Juneau. Droutman said that her hope is that patients will get a different experience with care when fellow Alaskans are focusing on their needs.