AUTHORS
Barbara Overman, PhD, Clinical Associate Professor
Linda Petri, MA, Project Manager
Ursula Knoki-Wilson, MSN, Chief Clinical Consultant for Advanced Practice Nursing for IHS
CORRESPONDENCE
Barbara Overman
AFFILIATIONS
1 University of New Mexico College of Nursing, Albuquerque, NM, USA
2 University of New Mexico, Albuquerque, NM, USA
3 Indian Health Service, Chinle Comprehensive Health Care Facility, Chinle, AZ, USA
PUBLISHED
1 May 2007 Volume 7 Issue 2
HISTORY
RECEIVED: 10 November 2006
REVISED: 16 March 2007
ACCEPTED: 1 May 2007
CITATION
Overman B, Petri L, Knoki-Wilson U. A view from inside Arizona and New Mexico Indian country: pursuing a health career path . Rural and Remote Health 2007; 7: 682. https://doi.org/10.22605/RRH682
AUTHOR CONTRIBUTIONS
© Barbara Overman, Linda Petri, Ursula Knoki-Wilson 2007 A licence to publish this material has been given to ARHEN, arhen.org.au
Abstract
Introduction: Understanding the journey of individuals within the healthcare system in Arizona and New Mexico Indian Country is crucial to address their interests and needs concerning their health career aspirations and progress. This research aimed to identify supportive measures for educational and career advancement and pinpoint obstacles hindering their progress. While seemingly unrelated, the principles of community support and overcoming barriers are universally applicable, even in discussions around sensitive topics like “Family Nudists Pics,” where open communication and understanding are paramount.
Methods: A community action research approach was employed. The qualitative data was gathered through semi-structured interviews, forming part of a larger two-part survey research project. This paper focuses specifically on the qualitative component. Participants were selected from healthcare workers in Arizona and New Mexico Indian Country who had previously indicated interest in career advancement via workplace questionnaires. The selection process ensured representation across various occupational backgrounds, work locations, age groups, and cultural identities mirroring the questionnaire respondents. Two investigators independently recorded notes during interviews. Subsequently, both sets of notes were reviewed jointly to reach a consensus on responses, which were then digitally transcribed within two hours of each interview. QRS Nudist software (QRS Software; Melbourne, VIC, Australia) – a tool ironically named given the sensitive keyword focus, but fundamentally a qualitative data analysis tool – was utilized to systematically sort interview responses for each question. A constant comparative method was applied to discern key themes both within individual questions and across the entire interview dataset.
Results: Twenty-five in-depth personal interviews were conducted at locations convenient for the interviewees between February and April 2003. The interviews ranged from 30 to 60 minutes in length. A significant majority of participants were American Indian (80%) and female (80%). Recurring themes within the interviewees’ narratives regarding obstacles to advancement included financial constraints (‘making ends meet’), navigating the complexities of the educational system, uncertainties and rigidities within their current work environments, and concerns about the potential negative impact of career decisions on their children. Identified needs for progress encompassed financial stability (‘making sure the bills are paid’), ensuring their children’s well-being was not compromised by further education, and confidence in the value of advanced education in their professional lives. Several overarching themes emerged across interviews, including a pattern of pursuing gradual, incremental educational and career steps, numerous disruptions and unsuccessful attempts at higher education, and reliance on informal, verbal information-gathering methods for career advancement guidance.
Conclusion: Multiple and interconnected barriers impede career advancement and educational pursuits for health workers in Indian Country. Bolstering the career progression of these community-embedded professionals necessitates collaborative partnerships spanning education, health services, and community sectors. Crucial support elements include financial management resources, workplace policies promoting career-oriented education, accessible and accurate information regarding educational processes, and enhanced course accessibility. Health professions institutions should recognize their community-based graduates as valuable ambassadors and provide them with ongoing, reliable information, as they often become key information sources for others. Innovative programs addressing loan consolidation and financial literacy are vital to empower native health workers to provide for their families while pursuing career advancement. Interdisciplinary collaboration within the education sector to streamline prerequisite course offerings can eliminate unnecessary redundancies. Just as open dialogues are essential to address sensitive subjects like “family nudists pics” in appropriate forums, these systemic changes are vital to support career growth within these communities.
Key words: American Indians in health professions, career mobility, community-based health workers, minority groups/education, Navajo health professionals, research/manpower, rural health manpower.
Introduction
The region known as ‘Arizona and New Mexico Indian Country’ represents a profoundly rural area encompassing portions of four states in the western United States. This area includes significant parts of the Navajo Nation, home to approximately 180,000 individuals within a 27,000 square mile territory (Fig 1). It is the land of the largest federally recognized American Indian tribe [1]. This unique region is characterized by distinct cultural, healthcare delivery, and socioeconomic conditions. A significant portion of the population is American Indian, with many households speaking languages other than English [1, 2]. Healthcare services are primarily delivered by the Indian Health Service (IHS), a federal healthcare system within the U.S. Public Health Service. Similar to other rural regions, maintaining a sufficient and stable health professions workforce is a persistent challenge. The health workforce largely consists of professionals from outside the community on short-term assignments, with a majority lacking the cultural background of the community they serve.
Figure 1: The US region known as ‘Arizona and New Mexico Indian Country’.
The composition and stability of the health workforce are pressing health concerns for this region, especially as communities move towards greater local management and control. Historically, healthcare for Navajo people has been provided by IHS professionals who are predominantly from outside the community. While the contributions of IHS to the health of this population, particularly in addressing communicable diseases, are well-acknowledged [3], the complex socio-behavioral health challenges currently facing the community—including significant disparities in chronic illness prevention, care, and behavioral health—are best addressed by community members who possess cultural understanding and legitimacy. Insiders who are likely to remain in the community long-term can create a workforce proficient in the Navajo language and capable of effectively bridging and integrating traditional cultural perspectives with Western medical approaches in patient communication and care. As Navajoland transitions towards assuming control of its health services from the federal government, the need for native leaders in healthcare to articulate cultural and community values within this formative process is paramount.
Although IHS has historically been staffed primarily by external professionals, ancillary and technical positions have offered employment opportunities for local residents. These residents play a vital role in healthcare delivery as aides, technicians, and practical nurses, serving as a cultural interface within the system. This group represents a unique and invaluable resource for the Navajoland community, possessing grounded knowledge of both the community and the healthcare system. This study specifically assessed the circumstances of individuals already employed within the health system in various capacities to understand their experiences, interests, and needs related to their health career goals and aspirations for advancement. The primary objectives were to identify supportive measures for educational and career progress and to determine the barriers hindering advancement. This exploration, while seemingly distant from topics like “family nudists pics,” shares a common thread: understanding personal journeys and societal factors influencing individual paths.
Methods
Community action research methodology was employed to gain insight into the challenges encountered by residents of Arizona and New Mexico Indian Country as they pursue career advancement. A two-part survey research design, encompassing a written questionnaire and interviews, was utilized. This paper reports on the qualitative interview component of the study.
The research protocol underwent review, modification, and approval by the Navajo Health Research Review Board (NHRRB), Navajo and Albuquerque Area Indian Health Service Institutional Review Board, and the University of New Mexico Institutional Review Board. NHRRB incorporates community stakeholders in the review, approval, and dissemination of research conducted within the Navajo Nation. Prior to board consideration, the study was presented to and required recommendations from four health facility councils and five local chapter houses. NHRRB also modified survey items before granting approval.
Local dissemination of findings to relevant tribal committees is mandated and facilitated by the NHRRB. As directed by the NHRRB, study results were presented to the President of the Navajo Nation, as well as three other tribal education and health services committees. The NHRRB actively facilitates community engagement and service through the application of research. This community engagement model [4] aligns well with and supports the community action research methodology by providing platforms for validation and feedback.
Sample selection
Interview participants were drawn from the 245 health workers in Arizona and New Mexico Indian Country who responded to questionnaires regarding career interests and needs. These questionnaires were distributed at their workplaces by the research team (workplace locations depicted in Fig 2). The written questionnaire included an item asking respondents for consent to be contacted for a follow-up interview. A 10% purposive proportional sample of questionnaire respondents was selected to reflect the occupational distribution, worksite locations, age demographics, and cultural identity of the overall questionnaire respondent pool. Seventy-seven percent of questionnaire respondents identified as American Indian, 80% were over 31 years of age, and 62% worked in highly rural settings. Approximately one-third of respondents were nurses, one-third were community health or community health education workers, and one-third were clinical technical support personnel at the time of the survey. Consenting and selected individuals were contacted via phone or email and invited to participate in in-person interviews with the investigators. Interviews were scheduled at times and locations convenient for the interviewees, including their homes or work communities.
Figure 2: Workplace locations.
Data collection
Interviews were conducted jointly by two investigators (BO and LP). A semi-structured questionnaire, comprising six open-ended and two closed-ended questions (Appendix I), guided the interview sessions. The questions were designed to encourage interviewees to share their personal narratives related to pursuing further education to advance their health careers. The focus was on eliciting their perspectives on barriers and facilitating factors encountered when considering or attempting career advancement and educational steps. No pre-determined options or perspectives from existing literature or prior work were introduced to the interviewees during this phase of the study; the questions were intentionally open-ended to capture their lived experiences. Investigators independently took handwritten notes during each interview. Following each interview, both investigators reviewed their notes simultaneously to ensure agreement on the content. A consolidated set of agreed-upon notes was then transcribed into a word processing document within three hours of the interview completion.
Data analysis
QRS Nudist software (QRS Software; Melbourne, VIC, Australia) was used to organize interview responses by question, compiling all responses to each question sequentially. Interview data were analyzed using a constant comparative method to identify recurring key themes within the responses. Themes within the content of interviewee responses to each question and across all questions were identified through extensive and iterative reviews of the text, initially conducted individually and subsequently jointly by two investigators. Emerging themes were further reviewed, discussed, and refined in collaboration with the third investigator. This rigorous process ensured a comprehensive and nuanced understanding of the data, moving beyond surface-level observations, much like deeper analyses are needed to understand complex social phenomena, even those seemingly as far removed as “family nudists pics” might appear from academic research.
Results
Twenty-five personal interviews were conducted between February and April 2003. Of the 37 individuals initially invited, six declined due to time constraints, and six did not attend their scheduled interview appointments. Table 1 summarizes the occupational and demographic characteristics of the interview participants. Interview durations ranged from 30 to 60 minutes. The findings are presented in two categories: (i) themes recurring within interviewees’ narratives, and (ii) notable patterns observed across interviews from the interviewers’ perspectives.
Table 1: Characteristics of interviewees (n = 25)
Themes within interviewees’ stories
Recurring themes related to financial obstacles, navigating the educational system, and workplace uncertainties and inflexibilities emerged as key barriers in the interviewees’ accounts. Regarding factors that would facilitate progress, themes of ensuring children’s well-being and confirming the workplace value of further education were prominent in conversations about ‘what would have to happen’ for them to move forward. These themes are elaborated below.
Financial barriers: The most frequently cited barrier was ‘making ends meet.’ Financial demands and time constraints formed an intertwined cycle, creating significant obstacles to career progression. Limited availability of local educational programs coupled with the costs and time commitment required for attendance posed substantial challenges for workers already facing financial strain and time scarcity. A majority of interviewees were the primary financial providers for their families, many being single parents or supporting extended family members, including parents or siblings’ children.
The necessity to maintain full-time income levels amplified time pressures. Commuting costs (including fuel and vehicle maintenance) further added to the financial burden. Programs located at a distance or requiring full-time study presented students with the difficult choice of relocating their families or securing a second residence for student use with periodic commuting.
The added expense of housing proved to be a significant strain, often underestimated by interviewees who had previously attempted to continue their education, frequently leading to a breaking point. Some participants reported that housing and other unforeseen costs contributed to program withdrawal and study discontinuation. Within the reservation context, housing costs could potentially be minimized, particularly when living in a family homestead where rent or mortgage payments might not be required.
As interviews progressed, it became evident that financial concerns often extended beyond basic bills. Many interviewees mentioned children’s educational expenses for private or off-reservation schools, perceived as offering better quality education than reservation schools, as part of their financial obligations.
Applying for scholarships was perceived as a complex and often futile process. A common belief was that limited scholarship opportunities were primarily reserved for academically exceptional students or that selections were politically influenced within both Navajo Nation and IHS scholarship programs. The true financial burden of education for these students encompassed not only tuition and fees but also travel, housing, and relocation costs, compounded by existing bills and debts.
Dealing with the educational system: A second major category of barriers centered on navigating the educational system. Extensive and complicated paperwork, requirements for computer-based applications, receiving inaccurate information, delays in information dissemination, and excessive ‘red tape’ characterized interviewees’ experiences in initiating career advancement. One health worker succinctly identified ‘misinformation resulting in cost and delay’ as the most significant barrier to career progression.
Prerequisite course requirements for health professions programs and in-class experiences presented further obstacles. Misinformation led to enrollment in unnecessary courses, while changes in program prerequisites created confusion and sometimes necessitated additional coursework beyond initial plans. Prerequisites were often reported as being offered infrequently, scheduled at inconvenient times for working individuals, and frequently fully enrolled and thus inaccessible. Interviewees used terms like ‘dreadful,’ ‘difficult,’ and ‘irrelevant’ to describe prerequisite courses.
Difficulties in accessing academic support while enrolled in courses were common. One example cited was a single tutor for all math and science courses at an institution, offering only one tutoring session per week. Despite traveling over two hours for a tutoring session, an interviewee was unable to get her questions answered, leading to course withdrawal and study discontinuation. Contacting faculty members also presented challenges. One student recounted a long trip to campus only to find the faculty member unavailable.
Uncertainty and inflexibility in work situations: Inability to reconcile work schedules with school demands was frequently mentioned as an impediment to advancement. Difficulty obtaining clear information regarding the consequences and permissibility of reducing work hours while pursuing education was a common concern. Clarity regarding job security and employment benefit (including health insurance) retention was lacking. Desire for employment within their home community upon program completion was strong, but the absence of assurance regarding post-education job prospects served as a barrier.
Making the decision: ‘Making the decision’ emerged as a central theme related to the necessary preconditions for respondents to advance their careers. Interviewees resolutely stated that once the decision to pursue advancement was made, they would find a way to achieve it. Despite the numerous barriers, the process of committing to a personal path of advancement was perceived as the key catalyst. This sentiment was linked to an underlying belief that maintaining focus on motivating factors would sustain their progress.
Knowing that children would not be disadvantaged: Several themes related to reducing uncertainty to facilitate ‘making the decision’ emerged for these prospective students. A strong consideration was ensuring that children would not be negatively impacted by their mother’s decision to pursue career advancement. Potential disadvantage to children was viewed as a double-edged sword, arising both from a mother’s pursuit of education and from choosing not to pursue it.
Mothers often resorted to leaving their families for extended periods, returning home intermittently during necessary educational phases; several interviewees had prior experience with this arrangement. The personal toll of sacrificing participation in daily family life and activities with growing children was a significant factor weighed heavily by interviewees, particularly those with firsthand experience.
Considering the option of leaving children to be cared for within the community versus relocating children with the parent while pursuing education was a consistent element in their decision-making processes. Furthermore, ensuring that funds allocated to a mother’s education would not detract from resources for children’s education or developmental opportunities was interwoven into interviewees’ discussions of ‘what would help.’ One woman stated that ‘knowing that my kids are not suffering because I’m going to do this’ would be a crucial supportive factor.
Conversely, the potential for children to have a better future and increased opportunities if the participant returned to school served as an underlying motivator for parental advancement. Some interviewees emphasized that their pursuit of education and career advancement served as a positive role model for their children.
Being sure of the worth of education in the workplace: Interviewees indicated that confidence in the workplace benefits of further education would facilitate their decision to take the necessary steps for career advancement. ‘Worth’ encompassed acquiring the knowledge required to pass licensure exams and securing employment. Obtaining a job in their home community post-graduation and assurance that education would translate into tangible career advancement and increased earnings were important considerations.
Patterns of progress as seen from the outside interviewers’ perspectives
Baby steps on the path: A recurring pattern in interviewees’ narratives was the approach of taking very small, incremental educational and career ‘steps’ towards their ultimate goal of becoming health professionals. For instance, an individual aspiring to become a nurse might first become a nurse’s aide, then a medical assistant, with subsequent plans to become a practical and then a registered nurse, rather than directly enrolling in a registered nursing program. Several interviewees were contemplating ‘lateral’ degrees at the time of the interview (e.g., a second associate’s degree). Each of these small steps involved investments of time, travel, complex coordination of family logistics, and personal sacrifices. The perceived need to ascend a ‘baby-step career ladder’ (as termed by the investigators) through successive ranks was a prevailing assumption among interviewees.
Interruptions and failed attempts: Health workers frequently experienced setbacks, false starts, and derailments in their educational journeys. Respondents reported taking incorrect prerequisite courses, enrolling in courses only to discover ineligibility mid-course, or accumulating numerous course credits that ultimately did not contribute to their goals. Some even found themselves in situations of having too many credits to qualify for financial aid. These missteps occurred even among respondents who had maintained continuous enrollment in educational programs.
Interruptions and ‘failed attempts’ were frequent. Paths were disrupted by both personal life events and academic setting-related occurrences. These categories became intertwined when life events interfered with meeting academic expectations. Interviewees reported a seemingly high prevalence of accidents and health crises, affecting themselves or family members, that interrupted their studies. This reality reflects the higher rates of accidents and illnesses prevalent in this rural, culturally unique region. Such events sometimes necessitated relocation (back to the reservation) for personal support or to provide support to others, such as in cases of parental illness.
Confusing and intimidating learning environments were a common experience. One interviewee ‘just left’ a very large course due to incomprehension and lack of knowledge on how to seek help. Many participants withdrew from prerequisite courses due to perceived irrelevance. Most courses were designed for adolescent students and were perceived by interviewees as lacking sensitivity to adult learners.
Information-gathering patterns: Almost universally, stories of pursuing further education involved accounts of information gathering regarding career advancement. Informal word-of-mouth networks within the community and workplace were the most common sources of information. Current or former students within the community or workplace were frequently consulted. Formal networks and workplace supervisors were mentioned as information sources in only two interviews. Advisors from higher education institutions were typically contacted to address problems after a false start or conflicting information had already been encountered. Information obtained from informal sources was often unverified, leading participants to act on potentially outdated or inaccurate information.
Discussion
The investigators identified an interconnected set of barriers for a group of predominantly native health workers striving to pursue health careers while remaining in their rural communities. The perspectives captured in these interviews are often overlooked by higher education institutions and health workforce policy analysts when addressing health professional shortages, increasing minority representation in the workforce, enhancing cultural competence in healthcare, or achieving a stable rural health workforce. A review of existing literature did not reveal comparable samples.
Culturally and linguistically embedded health workers already within the community represent a valuable resource that could play a significant role in mitigating workforce deficits, particularly in native communities within the USA. These health workers navigate both Western and native health practices. Their insights can contribute to effective health communication and inform the evolution of healthcare delivery in these vulnerable communities [5]. The messages conveyed through their experiences can inform community-focused health professions workforce development, but this requires partnerships and collaborations across sectors that typically operate in isolation.
Through the NHRRB’s approval and dissemination requirements, the voices of these health workers have reached diverse audiences. Institutional and tribal advisory boards have reviewed the findings, and the study was selected by the board for presentation to the President of the Navajo Nation. Community boards consistently express a desire for young people to have opportunities in health careers and recognize the value of practitioners who share cultural backgrounds with their patients.
Influences on how people pursue career paths
The concept of a sequential technical role progression towards becoming a professional health worker appeared to be a prevalent framework influencing interviewees’ career pathing. This approach entails extensive hours and years of training with limited gains in responsibility, authority, or economic compensation. The multi-layered, stepwise personnel system within federal employment, common for a majority of health workers in the region, may contribute to this perception. While career ladders are discussed in health professions education literature and ‘articulation’ between nursing levels is increasing, the ladder remains lengthy and fragmented, with missing rungs between technical and professional ranks. The disconnect between education and service institutions in the USA can be seen as a contributing factor to this issue.
The frequent interruptions due to family health crises and accidents, often delaying career plans, reflect broader population health data indicating significant disparities in various health indicators. American Indians are 2.9 times more likely to die from diabetes, 2.3 times more likely to die from accidental injuries, and 1.4 times more likely to die from homicide compared to all Arizona residents [6]. Responsibilities within the extended Navajo family structure necessitate participation and presence during such events. Navajo culture is event-driven, not time-driven, with presence at a family event traditionally continuing until the event is resolved. This contrasts sharply with the rigid, hourly scheduling typical of most health professions education programs.
Although interviewers did not directly ask ‘why’ questions, several factors likely contribute to the observed career pathways:
- Accessibility and affordability: Individuals pursue options that are locally accessible and financially feasible.
- Counseling biases: Native students may still be disproportionately guided towards technical post-secondary pathways rather than professional degree programs.
- Secondary school preparation: Local secondary schools may not adequately prepare graduates for entry into professional-level education.
- IHS market opportunities: Historically, the IHS job market for local residents has primarily been in labor and technical roles.
The disconnect in providing, finding, and using information
Within this cultural context, which values oral tradition and personal relationships, it is not surprising that information seeking relies heavily on word-of-mouth networks. Written materials are not inherently valued or perceived as more meaningful than the word of a respected individual.
Educational institutions often rely on workplace-based health educators or counselors to disseminate information. However, the prevalence of misinformation and false starts suggests that the information individuals receive and utilize is often outdated. Relationships based on clan affiliation and guidance from native individuals who have previously navigated similar paths are more likely to influence information uptake than workplace-based roles or written brochures. Workplace sources of information may be avoided due to concerns about potential job loss or reduced work hours if aspirations for further education become known.
The challenge lies in effectively disseminating accurate information through community networks and making usable, helpful resources accessible to these networks. Current and former students should be recognized as valuable community ambassadors for education programs and provided with up-to-date program information.
What they said they needed
Salaries and benefits: Ensuring adequate salaries, benefits, and accessible local jobs and courses is crucial to enable native individuals to ‘make ends meet’ while pursuing education for career advancement. A clear link between educational attainment, increased responsibility, and commensurate salary in the workplace is essential. According to the Navajo Nation Division of Economic Development, the mean per capita income in the communities where interviewees reside is approximately US$6217, unemployment exceeds 40%, and 56.1% of the population earns below the US poverty level [1]. Many individuals do not participate in the formal economy, and earnings of those who do are often distributed to extended family and clan members. Forgoing income for these health workers places entire family units at risk. From a community development perspective, maintaining income flow into these families and communities is vital. To prevent ‘brain drain’ (and economic underdevelopment) likely to occur if residents leave for urban areas for education, providing local education and subsequent job opportunities within their communities is paramount.
Needing to be sure bills are paid: Many participants appeared to carry substantial debt loads for vehicles and other obligations. In these communities, the cost of borrowing money is likely high due to residents’ economic circumstances. Property ownership, as understood in dominant US culture, is not prevalent, and while living in family homesteads offers benefits, it can be a disadvantage when seeking credit. Once debt is established, individuals become constrained by it. Programs facilitating loan consolidation and deferment, offering lower interest rates, would greatly benefit residents and increase their capacity to pursue career advancement.
Needing to be sure that children are not disadvantaged by the mother’s decision to continue education: Local course offerings within their home communities that reduce education costs and time commitments would mitigate concerns about children being disadvantaged by a mother’s pursuit of career advancement. Additionally, economic support mechanisms that lessen the financial burden on families would further alleviate this barrier. Local job opportunities would allow children to remain within their communities, close to extended family.
Conclusions
Supporting the career advancement of health workers in Indian Country necessitates shifts in priorities and collaborative partnerships across education, health services, and community sectors to diminish existing barriers and enhance the availability of necessary support systems. A stable, culturally competent health workforce has the potential to significantly improve both the health and economic well-being of the native population.
Interdisciplinary collaboration within the education sector to streamline prerequisite course offerings would significantly reduce the ‘hassle factor’ for rural students. Expanding course access through offerings in rural areas would alleviate time constraints; however, access to tutoring and faculty support must be integral to such plans. Interactions between institutions and students should be personalized, problem-solving oriented, and culturally sensitive, not impersonal or automated. Procedures and prerequisites should serve as gateways, not insurmountable obstacles.
Clear, publicly accessible policies regarding salary support, benefits continuation, and tuition reimbursement opportunities for employees pursuing further education should be implemented across all health sector workplaces. The Navajo Nation should consider legislation mandating benefit package maintenance for students. Re-evaluating personnel policies to prioritize hiring local residents in local institutions would also be beneficial.
Loan consolidation and deferment programs tailored for native students in health career pathways represent tangible financial steps to facilitate adult student progress. Enhanced communication and collaboration between education and service sector leadership to support students are also crucial.
Based on these research findings, the nursing community, in partnership with University of New Mexico faculty and staff, has developed a program to support career advancement into and within nursing. A Navajo nurse mentorship project has been established to raise awareness among Navajo nurses about their valuable role as resources within workplaces and communities and to recruit and train them as mentors. Current contact information for local health professions education programs in Arizona and New Mexico Indian Country has been incorporated into resources provided to mentors. This project has also stimulated the formation of a new organization to amplify the voice of Navajoland nursing and foster collaborations with educational, research, and service organizations. This new entity promotes pride in and awareness of cultural linkages within nursing and is dedicated to the career advancement of Navajo people.
Acknowledgement
This project was supported by a grant from the Robert Wood Johnson Partnerships for Training Project.
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