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Aaniiih Nakoda CollegeNursing Education Program Feasibility StudyFigure 2: Demographic population data for the three counties close to AaniiihNakoda CollegePopulation: Blaine County Montana, by 56,907Population: Hill County Montana, by PercentageAge2008200920102020Under 1931.0%30.9%30.0%28.6%19 and Over56.7%56.8%57.4%55.2%65 and 272Population: Phillips County Montana, by PercentageAge2008200920102020Under 1925.7%25.3%25.1%20.7%19 and Over52.0%52.9%54.6%55.3%65 and ource: Montana.gov Census & Economic Information CenterAgeUnder 1919 and Over65 and 1%18,955203020.5%51.1%28.4%4,234American Indian workforce nursing needs for the state of Montana There are significant employment opportunities which will increase witheach passing year for qualified nurses in Montana. However, AmericanIndians are sorely underrepresented in the workforce data. The populationof Montana is 6.5% American Indian with only 2.3% of the registered nursesin Montana being American Indian. (Dr. Cynthia Gustafson, ExecutiveDirector, Montana Board of Nursing, personal communication, 11 February2015) Despite recent statewide efforts to increase the number of AmericanIndians enrolled in nursing education programs, only 4% of all nursingstudents enrolled in nursing programs across Montana in 2014 wereAmerican Indians, and only 3% of those who graduated in 2013 wereAmerican Indian. While the underrepresentation of American Indiansamong nurses in Montana diminishes the overall quality and diversity ofcare across the state, it is especially troubling in communities on or nearMontana’s Indian reservations, including Fort Belknap. Health careproviders in these communities serve large numbers of American Indianpatients who would greatly benefit from the care provided by nurses whoare both technically and culturally competent.

Aaniiih Nakoda CollegeNursing Education Program Feasibility Study Locally, the Fort Belknap Indian Community has a great demand for welltrained nurses. The Indian Health Service (IHS) operates a critical accessfacility at the Agency (6 beds) and a clinic in Hays. The Tribal HealthDepartment administers a 638 contract for providing more than a dozenhealth service programs on the reservation, including Chemical Dependency,Health Education, Family Planning and Public Health Nursing. The locallabor force has difficulty providing qualified nurses to fill those positions forwhich a registered nurse is required. Tribal Health and IHS collectivelyemploy 25 registered nurses and only 52% are American Indian. There are5 RN positions currently vacant. According to the IHS Director of Personnel,the situation is not unusual as the IHS service unit operates with at least25% vacancy for RN staff at all times. So with only 52% of all existingpositions filled with Tribal members a solution was sought to “Grow OurOwn”. However, the lack of locally available training opportunities,combined with Fort Belknap’s remote local and extreme geographicisolation, has presented a challenge not only on the reservation but forneighboring communities that would hire qualified nurses. The offsitereservation hospitals and clinics also struggle to hire and retain nurses,especially those who possess the experience needed to provide quality carefor American Indian patients. For Havre, Chinook and Malta current vacancyrates range from 12-to 23%. There are 40 positions currently open in Havrefor either CNA’s or nurses for their long care facility or for the hospital! (Ms.Christin Obresly, Director of Personnel, Northern Montana Care Center,personal communication) At the 14 service units within the Billings Area Office’s jurisdiction inMontana and Wyoming, they have 223 positions that require RN licensures.At the same time, they have 50 current vacancies for RNs, for an extremelyhigh vacancy rate of 22%. Virtually all patients at these sites are AmericanIndians and would greatly benefit from the culturally and technicallycompetent care provided by qualified American Indian nurses. ( Jackie Black,Human Resource Specialist, IHS Billings Area Office, personalcommunication, 13 March 2015)Fort Belknap Community Need In order to determine if the community wanted a nursing educationprogram at Aaniiih Nakoda College a meeting was held for all membersliving on the reservation or in the surrounding areas. They voicedoverwhelming support for establishing such a program (Appendix 2:Minutes of the community meeting). The ANC Public Relations Specialistwrote articles for the Havre Daily News and The Blaine County Journal, Newsand Opinion which appeared on the front page of these Hi-Line newspapers.(Appendix 4). Our ANC students taking Public Speaking discussed the issue

Aaniiih Nakoda CollegeNursing Education Program Feasibility Studyand went on our college radio station KGVA 88.1 to educate the Fort BelknapIndian Community, other Hi-Line residents and listeners throughout IndianCountry to the need and steps to go through in establishing a nursingeducation program. Survey questions were then drawn up (approved by our IRB chair, Dr. SeanChandler) and placed on the ANC Web page where community and Hi-Lineresidents could access the survey at www.ancollege.edu. Within less than 48hours 63 people had filled out the survey and answered the relevantquestions. At the end of nearly a month 141 responses were recorded(Appendix 3: Complete Survey data with extensive comments) Seventy-six percent were strongly interested or interested in the program;71% had family or friends interested in a nursing program. The followingare two examples of the responses to questions on the survey.Figure 3:When asked if a cultural emphasis would be important for thenursing education program 89% said yes!

Aaniiih Nakoda CollegeNursing Education Program Feasibility StudyFigure 4: When asked if a nursing program would impact the health ofthe community 94% said yes!There were 13 questions in the survey and participants were asked aboutthe kind of nursing program they envisioned at ANC. Respondents’ answersto open-ended questions reflect the priorities and values of the community,and these comments will inform the development of the programcurriculum. Please refer to Appendix 3 for a detailed transcription of surveycomments.

Aaniiih Nakoda CollegeNursing Education Program Feasibility Study(1) (b) type of educational program and proposed timetable for initiatingthe program; The Associate of Science (AS) degree in Allied Health at AaniiihNakoda College has been the most popular at the college, averagingbetween 40 and 50 declared majors per year (approximately 25% ofthe full-time student body). Currently, students in the Allied Healthprogram can complete up to 31 semester credits that can be directlyapplied to the State of Montana Model Nursing Curriculum, includingall 24 credits required during the first year of an ASN degree program(see pages 9-10 for Model Nursing Curriculum).With theoverwhelming community support and workforce need the next stepwould be for ANC to have this highly successful program evolve intoone offering the ASN degree as the pool of talent is already on board. To have a nursing education program at Aaniiih Nakoda Collegewould not only increase the number of American Indian nurses in theworkforce but ensure their success. Comments from studentsattending the Aaniiih Nakoda College Community Forum on NursingEducation on December 3rd 2014 (Appendix 2) repeatedlyemphasized the importance of providing locally available trainingopportunities for careers in nursing: “I would be interested in taking the Nursing Program here at ANC. Iwon’t have to worry about driving hundreds of miles, finding ababysitter, and finding a place to live One of the greatest benefits thisprogram would provide is eliminating the financial burden of relocatingand starting whole new way of life in another location. This will alsokeep our local population of native students from dropping out andabandoning their dreams of obtaining a nursing degree I think itwould be beneficial to offer a nursing program at ANC because yearafter year enrollment in Allied Health is constant, and students chooseto go into pre-nursing. The students then transfer to other collegestrying to pursue their dream in nursing and have to drop out due tofinancial difficulties. Fort Belknap believes in “growing our own”: and ifthe program was offered at ANC, it would allow us to meet the futureneeds of our community’s health.” The educational program would follow the state of Montana curriculacurrently in place and incorporate any changes that are beingimplemented by the curriculum committee currently deciding theseissues. The following table outlines the course requirements andsequencing of the Montana State Model Nursing Curriculum.

Aaniiih Nakoda CollegeNursing Education Program Feasibility StudyModel Nursing CurriculumYear One – Fall SemesterCourseCreditsDidactic/Clinical/LabAnatomy & Physiology I3/0/1 4Freshman English3/0/0 3College Algebra3/0/0 3Nutrition2/0/0 2Nakoda/Aaniiih Language I (AIS 150/155)*3/0/0 3Total14/0/1 15*Aaniiih Nakoda College requirement, not part of Model CurriculumYear One – Spring SemesterCourseCreditsDidactic/Clinical/LabAnatomy & Physiology II3/0/1 4Inorganic Chemistry with Lab3/0/1 4Introduction to Nursing1/0/1 1General Psychology3/0/0 3Introduction to American Indian Studies (AIS 100)*3/0/0 3Total13/0/2 15*Aaniiih Nakoda College requirement, not part of Model CurriculumYear Two – Fall SemesterCoursePharmacologyFundamentals of NursingGerontologyTotalYear Two – Spring SemesterCourseCore Concepts of Adult NursingCore Concepts of Maternal/Child NursingCore Concepts of Mental Health NursingTotalCreditsDidactic/Clinical/Lab3/0/0 34/0/3 71/1/0 28/1/3 12CreditsDidactic/Clinical/Lab4/3/0 72/1/0 32/0/0 28/4/0 12

Aaniiih Nakoda CollegeNursing Education Program Feasibility StudyContinuation of Nursing CurriculumYear Three – Fall SemesterCourseCreditsDidactic/Clinical/LabComplex Care Needs – Maternal/Child Client2/1/0 3Complex Care Needs – Mental Health Client1/1/0 2Pathophysiology3/0/0 3Microbiology3/0/1 4Total9/2/1 12Year Three – Spring tion to Sociology3/0/0 3Complex Care Needs – Adult Client2/2/0 4Advanced Clinical Skills0/0/1 1Managing Client Care2/2/0 4Total7/4/1 12PROGRAM TOTAL59/11/8 78**72 credits required for Model Nursing Curriculum; 78 credits required for ANC’sASN Degree

Aaniiih Nakoda CollegeNursing Education Program Feasibility Study The instruction offered in the nursing education program will be embeddedin a teaching/learning context that reflects and affirms the lifeways andvalues of the Aaniinen and Nakoda tribes. Elders will visit classes on aregular basis to talk with students about traditional notions of health care,healing and wellness. Real-life case studies will provide the basis fordiscussion and reflection on contemporary health care issues facingAmerican Indians. All nursing students will take six credits of AmericanIndian Studies courses as part of their program requirements. The following ‘Word Cloud’ depicts the community’s responses.

Aaniiih Nakoda CollegeNursing Education Program Feasibility Study A question in the survey asked “What qualities should a nurse have in orderto serve the Fort Belknap community and the broader Hi-Line residents intreating children, youth, seniors and Elders?” The answers given are bestdisplayed in the following ‘word cloud’. These are the soft skills that wouldbe enhanced in discussions on the values and lifeways taught and practicedwithin the traditional Aaniiih and Nakoda culture.

Aaniiih Nakoda CollegeNursing Education Program Feasibility Study(1)(b) Continuation, time table for initiating the programACTIVITYTravel to various schools of nursing forinformation and show intentHire nursing consultant who had successfullyeducated American Indian students from theFort Belknap Reservation in a nursing programHelps with development of program(University of Great Falls)Gather documents and data for feasibilitystudyMeet health care providers along the Hi-Linefor potential clinical sites for student educationANC submits ANA SEEDS Grant for fundingNursing Education ProgramCoordinate data and write feasibility studySubmit Phase I Feasibility Study to Board ofNursingAdvertise for Director of Nursing and NurseInstructorBoard of Nursing Meeting outcomeHire Director and Nurse Instructor if Phase IapprovedBegin all facets of Curriculum DevelopmentForm Advisory Board-meetFormulate student handbookCreate syllabi for RN programPrepare and submit Phase II report to BONOrganize and sign MOAs with clinical siteshaving previously committed verbally totraining studentsSubmit Phase II Report to BONBON site visit if Phase II Report acceptedRecruit 15 applicants for the RN program (poston ANC web site)Curriculum reviewed by ANC CurriculumCommitteeApproved curriculum sent to NorthwestCommission on Colleges and UniversitiesAdmit 15 students after strict selection processDATESeptember 2014STATUSCompletedSeptember 015March 2015CompletedMarch 2015March 2015CompletedCompletedMarch 2015OngoingApril 15th – 16thApril-May 2015PendingPendingMay-July 2015May 2015June 2015June 2015June 2015June-July 2015July 22nd -23rd, 2015July 2015August 2015August 2015August 2015August 2015CompletedCompleted

Aaniiih Nakoda CollegeNursing Education Program Feasibility Study(1) (c) total student enrollment;Aaniiih Nakoda College will recruit and select 15 applicants per year for the RNtraining program. Stringent selection criteria will ensure that only the mostqualified applicants are chosen to participate in the training program. The directorwill chair an applicant selection committee comprised of the nursing instructor, ANCAllied Health Department faculty and representative from a local health careprovider. The selection committee will select qualified applicants based on preestablished criteria, including American Indian preference. Selections will be basedon the evaluation of completed applications packages that include the followingmaterials: Completed application for admission to Aaniiih Nakoda CollegeHigh school and college transcripts (if applicable)GED/HiSET credential (if applicable)Medical work experienceStatement of health care philosophy and career goalsTwo letters of recommendationBackground check clearance

Aaniiih Nakoda CollegeNursing Education Program Feasibility Study(1) (d) list of proposed faculty positions and faculty qualifications;POSITIONDirector (MSNNursing)FULLTIMEYesNurse Instructor(MSN)YesNurse Instructor(MSN)YesNurse Instructor(MSN)CURRENT ANCFACULTYFaculty (MS)YesFaculty (PhD)YesFaculty (MS)Faculty (MS)YesYesFaculty (MS)Faculty (PhD)Faculty (EdD)YesYesYesFacultyNoCOURSES TOBE TAUGHTNursing education coursesoffered as part of the Stateof Montana Model NursingCurriculum (see pp. 9-10)Nursing education coursesoffered as part of the Stateof Montana Model NursingCurriculum (see pp. 9-10)Nursing education coursesoffered as part of the Stateof Montana Model NursingCurriculum (see pp. 9-10)Anatomy and Physiology(1&2) with lab, NutritionGeneral and InorganicChemistry with Lab, NursingPharmacologyMicrobiology with LabCollege Algebra (Statisticsalso)Psychology, SociologyCollege Writing IIntroduction to AmericanIndian Studies, AaniiihLanguageNakoda Language (Elder)CLINICALPARTTIMEYesYesYesYesYes

Aaniiih Nakoda CollegeNursing Education Program Feasibility StudyThe full-time Director of the Nursing Education Program and the full-time NursingInstructor positions have been advertised and the job descriptions are found in theAppendix 5. The Aaniiih Nakoda College full time faculty that would teach in the nursingeducation program include the following instructors. Ms. Erica McKeon-Hanson is chairwoman of the college’s Allied HealthDepartment. She earned her BS degree in Biology from the University ofMary (Bismarck, ND) and her MSE in Learning Development from MontanaState University-Northern. She is currently completing a Master’s in PublicHealth from Johns Hopkins University. Ms. McKeon-Hanson has been amember of the college’s Allied Health faculty since 2008 and possesses priorteaching experience at the high school (Havre, MT) and college (MSUNorthern and Stone Child College) levels. Her research interests includeearly onset tooth decay (childhood caries), and she is actively engaged incommunity-based participatory research investigating the incidence ofchildhood caries in Head Start children at Fort Belknap. She will teachAnatomy & Physiology (I and II) in the nursing program. Dr. Susan King is Aaniiih Nakoda College’s chemistry and environmentalscience instructor. Dr. King earned her BS in Chemistry and PhD in WaterChemistry from the University of Wisconsin. She joined the ANC faculty in2012, and her professional experience includes seven years as an assistantresearch professor at Montana State University. Her area of researchexpertise is methylmercury contamination, and she is currently conductingresearch on mercury cycling within prairie pothole wetlands of the NorthernGreat Plains. She is a certified Haz WOPER and HazMat instructor, and,among numerous publications and professional reports, her articles haveappeared in journals such as Applied Geochemistry, EnvironmentalMicrobiology, and Ecological Applications. Mr. Dan Kinsey is chairman of the college’s Environmental ScienceDepartment. An enrolled member of the Aaniinen tribe, Mr. Kinsey earnedhis AS degree in Natural Resources from Aaniiih Nakoda College, his BSdegree in General Science from MSU-Northern, and his MSSE (Master ofScience in Science Education) from Montana State University. He has beenteaching natural resources and environmental science at ANC since 2004 andis the current director of the college’s USDA Land Grant Office. Prior toteaching at ANC, Mr. Kinsey worked as the sanitarian for the Fort BelknapTribal Health Department and Wetlands Coordinator for the Fort BelknapEnvironmental Protection Office. He maintains active research projects inthe fields of water quality and insect-borne diseases, specifically the WestNile Virus. He will teach microbiology in the nursing program.

Aaniiih Nakoda CollegeNursing Education Program Feasibility Study Mr. Janardan Pokharel is a mathematics and physics instructor as ANC. Anative of Nepal, Mr. Pokharel earned his BS in Physics, Chemistry andMathematics from Trichandra College (Nepal), MS in Physics from TribhuvanUniversity (Nepal), and MS in Physics from the University of North Dakota.His area of specialization is theoretical astrophysics, and he has beenteaching at Aaniiih Nakoda College since 2011. He will serve as the CollegeAlgebra instructor for the nursing program. Mr. John “Frenchy” Dillon is ANC’s Human Services and PsychologyInstructor. An enrolled member of the Crow Tribe, Mr. Dillon has spent morethan three decades working with tribal colleges as an instructor, counselorand governing board member. As a member of Crow Central EducationCommittee he helped charter Little Big Horn College in 1980. He earned hisBS degree in Rehabilitation and Related Services and MS degree inRehabilitation Counseling from Montana State University-Billings. Inaddition to his academic career, Mr. Dillon also has worked as a professionalsocial worker, treatment manager, and counselor. He will teach thePsychology and Sociology courses required as part of the Montana StateModel Nursing Curriculum. Dr. Donna L. Miller teaches English and education courses at Aaniiih NakodaCollege and also serves as project director for the college’s Nee-tha-hatsanak/Wa’-Uspe-Wica

Aaniiih Nakoda College Nursing Education Program Feasibility Study programs, five one-year certificate programs, and a number of short-term (less than one year) career and technical training programs. Eighty-four percent of ANC students are American Indian and among those 91% are enrolled members of the Aaniinen and Nakoda nations.