Priorities and partnerships in Indigenous nursing
Marilee Nowgesic has been the executive director of the Canadian Indigenous Nurses Association since January 2018 and has more than 25 years of experience working on Indigenous issues. Originally from Thunder Bay, she is a member in good standing with the Fort William First Nation and is an Eagle clan member. Canadian Nurse sat down with her recently to get an update on what her association is working on.
What led you to take on the executive director role with CINA?
I have worked in various capacities for the federal government, private and public sector organizations, national Indigenous associations and non-profits. The knowledge collected in these positions over many years (along with my traditional teachings) is behind my interest in Indigenous health, continuous professional learning and supporting the voice of Indigenous health-care professionals in Canada.
I have several nurses in my family, and a number of my friends also work in various nursing roles. So, my admiration and respect for nurses has been part of my desire to connect continuous learning with knowledge exchange, data collection and corporate affinity partnerships — and to help Indigenous nurses integrate traditional health practices and have these recognized as part of their professional role.
What are CINA’s current short- and long-term priorities?
CINA is developing responses to the Truth and Reconciliation Commission’s calls to action, based on an Indigenous nursing perspective, to further their understanding and implementation. This opportunity has generated a series of partnerships with non-Indigenous stakeholders, while addressing issues and concerns of Indigenous leadership organizations such as the Assembly of First Nations (AFN), the Inuit Tapiriit Kanatami and the Métis National Council.
CINA has also identified the need to develop alternative approaches to increasing Indigenous membership in our organization. As well, we are working to better recognize Indigenous nurses’ professional contributions through our partnership with FNIHB on the Awards of Excellence in Nursing and by resurrecting the Jean Goodwill scholarship fund.
In June CINA will be in Regina for a collaborative conference/workshop with the Community Health Nurses of Canada — our first such event with this group — where we will learn about and share experiences and best practices in nursing. In early October, we will give a joint panel presentation with AFN in Montreal at the 22nd International Congress on Palliative Care.
We will also be working intensely with the Canadian Association of Schools of Nursing (CASN) on revising the nursing curriculum, which must include Indigenous content.
In CINA’s role as a member of Canada’s chief public health officer’s advisory committee, we are providing Indigenous nursing expertise related to the government’s efforts to protect and promote the health and safety of all Canadians.
What can you tell us about the relationship between CINA and CNA?
CINA and CNA have been able to amend their 2016 partnership accord to better address the changing Indigenous health environment, regardless of jurisdiction. To that end, both have reviewed current policy documents and position statements and have established a more collaborative approach on how we are responding to the TRC calls to action. The two organizations continue to develop research and project initiatives that draw on their extensive expertise, such as federal/provincial committee presentations on the opioid crisis, cannabis legalization and cultural competence. The accord now also contains provisions on accountability and transparency and includes indicators for measuring our success.
What other partnerships is CINA involved in?
CINA is working to develop several key partnership agreements with organizations that are addressing Indigenous health, such as the Indigenous Physicians Association of Canada. Alongside these agreements, we will lead the development of the National Indigenous Healthcare Providers Partnership (NIHPP), which is a response to a call from Indigenous Elders and the Indigenous community to design a process that takes a proactive approach to improving Indigenous health outcomes. NIHPP will facilitate discussion on specific health issues and identify approaches that are culturally appropriate while being mindful of the regulatory or legislative guidelines for the health professions involved.
CINA is also working with the private sector to design, develop and implement a business strategy to meet demands of the rising costs associated with Indigenous health, the professional development of Indigenous health-care providers and their recruitment and retention.
What health concerns are remote Indigenous communities having to deal with?
There is no singular concern but rather an accumulation of issues that add complications to health service delivery for remote or isolated Indigenous communities — in some cases, the issues relate to rural areas (such as municipal services, bus transportation). Of course, most Canadians are aware that the present conditions in Indigenous communities are less than adequate. We are seeing increases in boil water advisories, overcrowded housing and chronic diseases.
For the most part, these communities are faced with a severe lack of adequate health personnel to assist in health care, prevention and promotion and too few health clinics and nursing stations. In cases where clients must travel to a tertiary care facility, there is often a lack of support for travel escorts and others who can explain the procedures and tests a client must undergo.
The Non-Insured Health Benefits program, which provides health benefits to First Nations and Inuit populations, requires preapprovals for travel, examinations and prescriptions and contains other constraints. These bureaucratic processes tend to deter Indigenous patients from accessing health services. Under such conditions a patient will likely choose to abandon their treatment and/or simply live with an undiagnosed or untreated illness.
Are there gaps in data gathering that affect Indigenous health outcomes?
Effective data is essential for introducing and evaluating policies aimed at improving health status. These gaps prevent us from comparing health figures with those of the Canadian population, and they diminish our capacity to determine the best practices to improve Indigenous health outcomes. Because information in hospitals or clinics is not being tracked, it is difficult for Indigenous health-care providers to identify and respond to potentially reversible health status inequities. This area is just starting to change, as Indigenous health research is promoting the First Nations Principles of OCAP (ownership, control, access and possession). The aim of OCAP is to give Indigenous nations control over the data collection processes in their communities. Under these principles Indigenous people will own, protect and control how their information will be used and determine access to the data for external researchers.
What is needed to more effectively recruit and retain Indigenous nurses?
CINA is currently reviewing the recruitment and retention of nurses with federal partners as part of an effort to address the rapid changes in workforce trends. The Aboriginal Health Human Resources Initiative (first offered through Human Resources and Skills Development Canada) has declined over several years. CINA has identified an urgent need for an extensive analysis of Indigenous health human resources. Doing so will help nursing schools provide culturally competent and culturally safe practicums. Because there are insufficient financial resources to actively participate in career fairs and trade exhibits, CINA is developing alternative methods to stimulate recruitment, such as showcasing Indigenous nurse leaders at the community level as part of a mentor-mentee process.
Are nursing schools making progress on integrating cultural competence into their programs?
CASN has been a constant and supportive partner to CINA and is working to address the inequities and the urgent need to modify this curriculum to give students the information they need to make informed decisions about Indigenous health care.
CASN has committed to the mandatory inclusion of cultural competence in the curriculum, and CINA has recommended that CASN work to have the Blanket Exercise incorporated in all nursing schools — for both students and faculty.
In addition, we are working with CASN to identify emerging concerns that will be part of our responses to the TRC’s calls to action.
Can you give some examples of the impact of cultural competence?
CINA, along with Indigenous health-care providers, is working with programs, services and agencies to identify best practices that will support better outcomes for Indigenous health. However, the social determinants of health play a large role in these outcomes and add to the complexities. For instance, we know that when Indigenous patients are hospitalized, giving them access to country foods improves their recovery, since they may choose not to eat foods they aren’t accustomed to. We also know that developing and delivering health services in a language or setting that resonates with Indigenous cultures leads to better results in health promotion. This practice can be seen in midwifery, in combining the use of traditional medicines with western medicines and in the adoption of Indigenous languages in health treatment plans.
What supports are needed to encourage the next generation of Indigenous nurses?
We know that Indigenous nursing students have expressed an overwhelming interest in combining traditional practices with new technologies. We are planning a series of discussions with the Canadian Nursing Students’ Association to learn about some of the concerns and issues in nursing programs and practicums.
We are also organizing a national nursing leadership symposium for 2019 in collaboration with CASN. It will help determine what nursing schools know about Indigenous nursing, identify best practices in recruiting Indigenous nurses and ensure nursing programs are meeting the needs of the profession while fully incorporating Indigenous knowledge.
In addition, we are looking to provide more information on resources, scholarships, etc., that will assist students in professional development and in maintaining Indigenous connections. The next generation needs to know that they will be able to get their training closer to their communities and families. We are also examining the use of different kinds of apps to help Indigenous nurses meet their professional needs.
What needs to be done to make the TRC’s calls to action a reality?
This issue is too large to address in such a short space, but CINA’s goal is to respond to the calls to action, in collaboration with external stakeholders, in a way that will educate and promote better understanding in nursing.
The question then becomes: how do we ensure that the calls to action are recognized when the general Canadian population lacks basic awareness about the history of Indigenous populations? It was an arduous task to obtain the truth — imagine how long it will take to obtain reconciliation.