By Caitlin Clark
Just two years after launching a new project designed to increase the number of Native American nurses in the workforce, the School of Nursing has graduated two students from the Success Through Recruitment/Retention, Engagement, and Mentorship program.
Brianna Boston-Kemple and Alexandra DeSautel joined STREAM during their first year in nursing school. They initially learned about it through emails, and both were intrigued to learn there was a program specifically for Native American nursing students.
“Native Americans are a very, very small population on campus and the nursing school’s population is even smaller. So, the fact that this program was so specific about supporting Native Americans interested in nursing was very interesting to me,” says Boston-Kemple.
Impact on Students
Campus does offer other resources and programs for Native American students, including American Indian student advising services in the Office of Diversity and Equity, the American Indian Student & Cultural Center (AISCC), and Wunk Sheek (an American Indian student organization). Yet Native American students still struggle.
A Badger Herald article from February documented the challenges that Native American students face—from lack of cultural awareness, to low numbers of Native American peers, to confusion about available resources, to outright racism—in and out of the classroom. While STREAM is not meant to address all of those issues head-on, it is designed to attract more Native American students to nursing and then to offer targeted and culturally appropriate support once they are enrolled in the school.
“Native Americans are a very, very small population on campus and the nursing school’s population is even smaller. So, the fact that this program was so specific about supporting Native Americans interested in nursing was very interesting to me.” —Brianna Boston-Kemple.
“The presence of a program for Native nurses creates more visibility and allows for another avenue of opportunity for future Native nurses,” says STREAM coordinator Haley Burkhardt. “UW–Madison can be a big, daunting place for students of color so this community that the students and STREAM staff are building could be the difference between a Native nursing student feeling welcomed and supported or possibly feeling isolated.”
Fostering community is a key facet of STREAM. The program helps Native nursing students connect with each other through monthly talking circles, trips, and other Native American cultural events. Burkhardt and Melissa Metoxen, the community and academic support coordinator of the Native American Center for Health Professions, are STREAM’s monthly talking circle facilitators. Both believe the program’s greatest impact has been the relationships the students have forged with each other, and both say they have witnessed the students grow close and support each other while embracing their identities, which can be difficult to do, especially in a predominantly white institution.
“The monthly talking circles provide a platform for the students to talk about a variety of topics like mental health and their experiences as Native nursing students, which strengthens their bond as a group,” Metoxen says. “It’s been a positive experience for the students overall. Our graduates [Boston-Kemple and DeSautel] haven’t had STREAM for their full time in school, so they are glad students who are just starting out [as freshmen and sophomores] will get [to benefit from] the full experience.”
“The STREAM program gives us this community where we can feel accepted. We accept each other, we’re there for each other, and I really like that about the program because I haven’t really found that anywhere else on campus.” —Alexandra DeSautel
STREAM also provides a foundation for Native students to engage in the self-reflection and discovery that is often a part of the undergraduate experience but that can be particularly challenging for Native students when they feel isolated from their communities and peers. “It’s easier to stay connected with your culture and the Native community when you’re at home and with your family, but when you’re away from that on a campus that’s predominantly white, it’s easy to get disconnected from your cultural identity,” says Boston-Kemple. “STREAM has given me the opportunity to explore my identity more. I have a better foundation in who I am and feel more prepared for my career as a Native nurse.”
Boston-Kemple and DeSautel both appreciate that they have a group of people who are going through similar struggles whom they can lean on for support. DeSautel says she often feels pressure from her non-Native peers to be the “spokesperson” on Native American-related topics in class, and the monthly talking circles provide a safe space to talk about shared experiences. “The STREAM program gives us this community where we can feel accepted. We accept each other, we’re there for each other, and I really like that about the program because I haven’t really found that anywhere else on campus,” DeSautel adds.
Impact on School of Nursing
The School of Nursing adopted a holistic admissions process to meet a requirement of the $1.3 million Nursing Workforce Diversity grant it received from the Health Resources and Services Administration to launch STREAM. The holistic admissions process more deliberately balances attributes valuable to nursing practice with previous academic achievement. While the school’s admissions process always considered multiple factors for each applicant, recent changes reflect a deeper commitment to meeting the profession’s call for a workforce that more closely mirrors the population it serves. It has also created an opportunity for school faculty and staff to learn more about Native communities and Native students.
“It’s important to have a solid knowledge base about students’ cultures when reading applications, which is why our office works to share information about our tribal communities, cultures and histories with faculty and staff,” says Metoxen, who, along with NACHP Director Danielle Yancey, leads trainings to help admissions committees recognize quality candidates. “These efforts to broaden employees’ cultural competency are just one of the successes of the STREAM program.”
In addition to changes in the admissions process, Mel Freitag, School of Nursing diversity officer and co-director of STREAM, works with faculty to create a more inclusive curriculum. They use feedback from the STREAM students as a guide. “The STREAM students give feedback through talking circles and other peer support activities to provide valuable insight about the quality of their student experience within nursing—including classroom, clinical, and their entire professional experience,” says Freitag. “Their voices and stories provide useful and meaningful ways that the school can improve—so it not only improves the STREAM student lives, but the experiences of all nursing students, faculty, and staff.”
Boston-Kemple says school staff supported the students when they experienced issues and that she feels heard when she shares her thoughts and opinions. “I felt like the way we’re experiencing the nursing school matters. Being able to speak up when things aren’t going well and feel like people care about what you’re saying is really powerful,” says Boston-Kemple.
Impact on Communities
According to the U.S. Census Bureau, individuals from ethnic and racial minority groups accounted for 38% of the U.S. population in 2014, and minority populations are projected to become the majority by 2043. Yet nurses from underrepresented backgrounds comprise only 19.2% of the nursing workforce as a whole. Just 0.4% of nurses are Native American.
Yet a culturally diverse nursing workforce is vital to providing quality, culturally competent care. The nursing profession calls for the recruitment and retention of nurses from underrepresented groups to better reflect the patient population. When patients are able to identify with the clinicians providing them with healthcare services, disparities in health outcomes shrink and access to care improves. Currently, however, only 10% of nurses in tribal clinics self-identify as Native American.
The Future of STREAM
The school plans to build on current STREAM success and expand programming available to participating students. Freitag and Audrey Tluczek, School of Nursing professor and STREAM co-director, are in the process of getting three tribal clinics approved as clinical sites. Once approved, these sites will be available to STREAM students for clinical placements as early as January 2020. “These new clinical sites would provide our students with an opportunity to learn and practice in tribal communities, rounding out their educational experience and giving them a chance to see what it would be like to work in these communities after graduation,” Freitag says.
While Burkhardt says it is “bittersweet” to see two students leave the STREAM community, she believes their success at the school and presence in the workforce will support efforts to attract more Native students to nursing and to STREAM.
“We couldn’t be prouder of all their accomplishments,” she says. “They’ve both demonstrated strong leadership qualities in the program and I’m excited to see them succeed in their careers going forward.”
Read more about becoming a STREAM student. Ready to apply? Complete a STREAM interest form. STREAM also accepts applications for mentors from current or former practicing nurses who self-identify as Native American/American Indian or Alaska Native and can commit to serve as a mentor for a minimum of one year.
Disclaimer: Success Through Recruitment/Retention Engagement, And Mentorship (STREAM) for Native American Nursing Students is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $400k/year with 6% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.