Nursing in the North

Brenda Canitz

Hearth care in the North is largely dependent on the nurses who provide the care. The success of their work rests upon the individual and, in many cases, highly personal factors-who they are, how they perceive their job and their position within the community, and their approach to native people. The job is multi-faceted, and, at one time or another, most nurses assume varied roles.

The dynamics of the northern healthcare system, and their effects on the nurses who work within that system, can be both positive and negative. A few northern communities have some of the most comprehensive, accessible, and high-quality health care available in the world. Since health-care needs in the North are varied, and must be met using limited resources, the environment provides an excellent opportunity for nurses to fully utilize their education and past experiences without the restrictions present in the South.

On the negative side, northern healthcare costs have remained high, and over the past 50 years, only minor improvement has been noted in the traditional measures of health status-infant mortality and life expectancy-for the native population. Also, many nurses who come to the North for the first time have little experience in the various aspects of care given, and limited resources and personnel do not provide adequate time for orientation or ongoing in-service education. As a result, the new nurse is often left to "figure things out for herself ".

This is an insensitive and often dangerous practice, leading to a disjointed health care program with few innovations. The turnover rate for nurses practicing in the North is high. There are perpetual shortages of health-care personnel, and positions are often left unstaffed for long periods of time. Neither the health-care system nor its personnel can be tailored to the special beliefs or needs of the native population; consequently, little use is made of the native healers and midwives who could assume some of the burden.

The fact that most nurses are single women maintains a subtle, but effective, form of isolation and control. They are alone, with little social support and with little opportunity to separate themselves from the government's health-care apparatus and their professional posts. They go for long periods of time with little relaxation or sleep, yet continue to function with the intensity and compassion inherent in life-and-death situations. This leaves them vulnerable to the stress and strains of their work.

Nurses leaving their positions in the North often take many long-term problems with them. For example, many jump every time the phone or doorbell rings. It takes quite a while for the habits born of "being ready just in case" to gradually disappear. Those who may have been victim s of physical and/or sexual violence take even deeper scars with them when they leave the North. Considering that most nurses are already tired, stressed, and working with limited support and extended responsibilities, these attacks can be the final blow to an already fragile psyche.

If she is lucky, a nurse leaves the northern health-care system before becoming convinced that it can't function without her. She leaves while she still has the skills that are marketable in other areas of health care. She makes a career change while still possessing the capability to work with others in a non-supervisory role. She gets out while she still has the clarity of vision to look beyond race and social class to see the person who is sick and needs help.

Native health care remains in crisis. The current system is failing. Working at the grassroots level of the health-care system, nurses are in the best position to improve the health status of native people by cooperating with them on socio-economic and health-care issues. It is the only way we will improve a currently dismal situation.

To accomplish this, the direction of the health-care programs must come from the local level. Programs must represent native needs and native solutions. Equally important to all of this, we must become concerned for the well-being of health-care workers-for it is the nurses of the North who can pull the system forward to meet the future needs of native and northern people.

llrenda Canitz is a nurse who has worked in the N.W.T. for several years.