Nurse Practitioners Going the Extra Mile to Care for Rural Patients
Learn how nurse practitioners are improving the health of Indigenous patients through their work in the remote villages of Alaska.
Beyond the bustling cities across America — where hospitals and clinics are only minutes away for most patients — are rural regions where patients have challenges seeing providers, getting medication or even calling an ambulance. This is especially true in Tribal nations and Indigenous communities. According to the Centers for Disease Control and Prevention, American Indians and Alaskan Natives (AIs/ANs) have the lowest life expectancy when compared with other racial and ethnic groups. The U.S Department of Health and Human Services adds to this by stating that “In 2022, 19% of people who identify as AI/AN alone reported being in fair or poor health.”
Thankfully, nurse practitioners (NPs) are helping to increase access to care in rural, tribal and underserved communities across the U.S. In observance of Native American Heritage Month, the American Association of Nurse Practitioners® (AANP) spoke to Diane McGinnis, DNP, APRN, FNP-C about her experiences gaining the trust of and caring for the Indigenous peoples of Alaska.
Q: Before ever setting foot in Alaska, what was your work as an NP like?
Diane McGinnis: I worked in a rural clinic and was the only provider in town. No pharmacist, no veterinarian, no optometrist — no other nurses, even. I primarily worked in urgent care, but I have worked in the ER multiple times. While working in this rural area, the fire chief said, “Hey, I need some more firefighters. Do you want to be a firefighter?” I was like, “Sure!”
So, I became a full-fledged, trained, volunteer firefighter. I trained mostly on evenings and weekends so I could still work as an NP in the federally qualified health center, all while training and responding to calls.
Q: Could you tell us how this opportunity presented itself and your decision to go off to such a remote area to provide care?
McGinnis: The company I was working for went under, so I had a break from my employment. I was looking for another position when a recruiter reached out to me and said, “We’re looking for providers for rural Alaska. Would you be interested?”
The move from Nevada to Alaska may seem drastic, but I grew up in North Idaho about 100 miles from the Canadian border. So, I had been accustomed to the full four seasons and the strong winters. I didn't really have any winter clothes left, but I was familiar with that.
Q: NPs who have worked with Indigenous patients have stressed how important it was to gain the patients’ trust in order to provide care. How did you break through and gain the trust of your patients?
McGinnis: When I asked the people in one of the villages how they came to trust me, they said, “Well, you tried our native things when we offered it to you.” So, I've had bowhead and beluga muktuk — which is whale blubber — black whale meat, moose and caribou. I've had Alaskan ice cream, which is a mix of berries, Caribou fat and seal oil.
Wait until they offer to share their culture with you. You don't want to come in wearing clothes or something you think they might like. Eventually, members of the community offered me one of their native shirts — a kuspuk — and they helped me sew it and everything.
I would go to the school (there is only one in each village) for their sporting events, make sure to shop locally and bring some snacks. Just do the normal things that you'd do when walking down the street to greet your neighbor.
Q: You described some of the unique foods of the region, but were there any other dietary adjustments you had to make while there?
McGinnis: I worked in whaling villages as well as villages that hunted Caribou and moose to feed the community. You can’t access a lot of fruits and vegetables in this area — delivery services that would normally take a day or two elsewhere take at least two weeks to get there.
By the time fresh fruits or vegetables get there, they're right on the edge of wilting. So, you must be creative, getting packets of fruits and vegetables like applesauce to make up the difference and using dried fruits and vegetables in casseroles and other recipes.
Q: In such a remote region, what occurs when a patient requires treatment beyond what the local clinic can provide?
McGinnis: There are no roads between the villages that I'm in. They're only accessible via air by either a landing strip or even a float plane. Sometimes you must put a sick patient on a commercial aircraft because the Medevac is already out getting another patient.
If somebody has a broken bone in the village, I have to put them on a plane to the local community access hospital to get an X-ray. The same can be said for any specialist appointments. Most villages only have scheduled flights twice a day on planes that only hold about 9 to 10 people. Your ability to fly out is very influenced by the weather, and once you get backlogged by one plane load, you're pretty much backlogged for a while.
Q: How else did the environment in Alaska challenge you and your patients? How did you overcome these challenges?
McGinnis: The fiber cable that provides communications to several of the villages runs underneath the ocean. One day, the cable got cut and our village suddenly had no internet and no landlines for 10 days. Almost everyone lost their cell service, except for me. I had an uncommon phone provider for that area.
Though people could call 911, operators couldn't call the firefighters or the police officers in the village to respond. In order to ensure the safety of folks in the village, I had the 911 operator call me on my cell phone, and then I would get on the radio and tell the police and firefighters where they needed to go. I became a substitute 911 operator for 10 days, all while seeing patients.
Q: For those NPs that might read your story and become inspired to provide care in remote areas, what advice or recommendations would you offer them?
McGinnis: An emergency background is important. We’ve had different things like gunshots, childbirth and trauma from snowmobile and four-wheeler accidents. I also used to teach wilderness medicine, and I think having a feeling for the outdoors helps. When you’re strapped for resources, you “MacGyver” things. You need to be able to improvise and come up with solutions.
We had an ambulance in the last clinic I was at which was just a pickup truck with a shell on the back. But the front driver's window had been broken for almost a year, and we couldn’t go into winter like that. So, I pulled out an old piece of plexiglass from behind the clinic and said, “There's gotta be some way we can cut this so that it fits the truck.”
All of a sudden, one of the villagers came up and said, “Oh, I have a plexiglass cutting tool.” We cut the window and put it in with some tape to help hold the heat in instead of a plastic bag. Being able to improvise and use what's around you can be very important when going out into a more austere environment.
Gain More Inspiration From NP Pulse: The Voice of the Nurse Practitioner®
If you’re looking for more stories of NPs going the extra mile to care for rural patients, then listen to Episode 99.6 of NP Pulse: The Voice of the Nurse Practitioner® to hear from Veronica Edwards, APRN, FNP-BC, on her experiences working on a Native American reservation and improving access to care. Once you’re done hearing Edwards’ story, check out other episodes in the NP Week series to gain more bite-sized bits of inspiration and knowledge from fellow NPs!