Sandy Littlejohn

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I am an enrolled member of the Mdewakanton Dakota of Lower Sioux Community, Morton, Minnesota. I grew-up on the Lower Sioux reservation where family was the center of my world. I attended a Native American mission school on the reservation until the fourth grade. When it closed, then I went to public school.

One memorable experience when I started public school was the requirement for all of the transferred Native American students to attend speech class. The speech room was located behind another classroom, which meant we had to walk (parade) in front of a class of students to reach the speech room. Not only was this embarrassing, but I never really understood why I had to attend; I thought my speaking skills were just fine! I remember begging my mom and dad to talk to the teacher so I wouldn't have to go there anymore.

Looking back at my formative years on the reservation, I see the different worlds my family and I lived within. I am of Dakota, Mexican, and German descent. My parents fostered a strong work ethic in our family. We actively participated in activities within and outside of the Native American community. The Episcopal Church, located at the center of the reservation, was the focus of many gatherings for our family. Family time was important for us to be with all our relatives living nearby.

All my growing-up years seemed to have a constant theme of being different. I had loving and supportive parents who encouraged education and hard work. I can still hear my father say, “It doesn't matter if you are an Indian or a female; you can be whatever you choose.” I am thankful that through it all, my parents and a few other adult mentors positively influenced my personal development by encouraging my learning and recognizing my potential.

How did you become interested in nursing?

My mother was a nursing assistant for years and encouraged me to enter nursing. My father's encouragement was that I would always have a job. While in high school and college, I worked as a certified nurse assistant in long-term care facilities. Upon graduation from high school, I entered the nursing program at St. Olaf College in Northfield, Minnesota. It proved to be a difficult transition for me to move from the reservation to a predominately Caucasian, middle-upper class, higher academic institution. My older sister was a student at St. Olaf at the time and was instrumental in giving me support and encouragement to stay in school. We were the only Native American students at St. Olaf at the time; the following year another one of my sisters transferred in as a student, as well as two other Native American students.

Additionally, while I was at St. Olaf, there were many family issues happening at home. After my father's death during my sophomore year, I took off a semester. The time I spent with my mother was invaluable. My mother developed cancer and passed on at the end of my junior year at St. Olaf. My graduation from college was a celebration and an accomplishment I shared with all of my family.

The first 10 years of my working life as an RN occurred in long-term care. I found satisfaction in working with the residents and their families over time, establishing a trusted relationship and creating a caring environment for the residents. Through the opportunities of career advancement, I began to understand the ability to influence health outcomes through influencing staff as a leader and through policy development. I came to recognize the affinity I have for relationship-focused care in my role as staff nurse and nurse leader. The reward for me is working with individuals over a span of time and then seeing them achieve their goal.

Over the past 14 years I have been within an acute care hospital, Gundersen Lutheran. My role has evolved and advanced within the organization. Being a curious person, I find myself taking on challenges and working to find solutions to improve outcomes. I've been blessed with mentors along the way who have pointed me in certain directions and offered support when I've taken on new ventures. Having received the sideline support, I'm conscious to also give it as I see potential in new and seasoned leaders.

Having enjoyed working in long-term care and hospital settings, I decided to expand my knowledge into community health care. Once again, one of my mentors surfaced and offered the suggestion to consider Augsburg College's master of art in nursing program in community care and its newly formed transcultural nursing focus, another area of interest for me.

The spark for my interest in transcultural nursing concepts began a few years ago with a personal experience when my daughter was hospitalized. Family visited and brought sacred objects to help in her healing. At one point, a hospital chaplain visited us and proceeded to offer a Christian prayer, not asking us how we might want to pray. While we welcomed any type of healing prayer, I was saddened that the hospital caring for my daughter, the same hospital I worked for, did not ask how we might want to pray. During the length of her stay and follow-up care, no one asked us about our healing beliefs or offered support to incorporate them with her care. Upon later reflection, I became concerned that assumptions were being made about my family and others who may have healing traditions different than western medicine. Being an employee within the organization prompted me to start talking and eventually teaching the concepts of cultural sensitivity within patient care practice.

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Describe what “Pathways to Leadership” is and how it began.

Pathways to Leadership is a minority nurse leadership development program based on a culturally competent curriculum created by and for Native American nurses. Native American nurse leaders Dr. Judy Goforth-Parker, Dr. Martha Baker, and Dr. Lee Anne Nichols explored the concept of Native American nurse leadership in comparison to general or mainstream leadership. They identified six general nursing leadership modules: knowing self, personal and professional communication and mentoring, group process, decision-making, change process, and being futuristic. Additionally, the cultural competent modules of being a leader in the Native American way, Native American nursing and tribal sovereignty, and Native American nursing and Native American health programs were created. Native American cultural concepts are interwoven throughout all the nursing leadership modules, providing a bicultural view of Native American and non-Native American health care systems.

How does being a Native American nurse differ from nurses in other cultures?

In 1998, I had the opportunity with Dr. Bette Keltner and the late Dr. Roxanne Struthers to ask Native American nurses, “What is the essence of Native American nursing?” (Transcultural Nursing, 4/99) What we found was a rich discussion and interweaving of cultural elements with that of nursing. The themes in order of importance were caring, traditions, respect, connection, holism/holistic, trust, and spirituality. What we discovered was the theme of caring was universal for both Native American nurses and mainstream nursing. The remaining six themes were proposed as distinctive to Native American nurses.

For me, it was coming home. My academic coaching to be more assertive, speak louder, and call attention to myself was not who I was. Within the Native American community, being quiet and listening shows respect, characteristics I would use when I cared for Native American patients. There was congruency for me once I was able to see the difference.

Through my involvement with the National Alaska Native American Indian Nursing Association (NANAINA), I have developed a wonderful network of native nurses across the country. I have found that it takes many voices from different areas of the country to join together to address the breadth of health issues of the Native American population. My work with NANAINA has also provided an expanded network of colleagues through the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), a national collaboration of the ethnic minority nurse associations to address equity and justice in nursing and health care for ethnic minority populations.

Utilizing transcultural care principles in my work has provided me an opportunity to continue to explore the intricacies of culture and health perspectives for the client and for the caregiver. As an educator, I find health professionals are at varying levels of comfort and knowledge regarding transcultural concepts. This has caused me to create opportunities for conversations that explore what it means to provide culturally congruent care. As a leader, one must stay attentive to who is being served and what that person's needs are to be effective. Understanding how an individual, group of staff, or department operates is essential to understanding behavior and facilitating change.

What leadership characteristics do you bring to your role?

First of all, a commitment to the people I serve, which includes patients and staff. As a leader in a health care setting, one cannot forget the first responsibility is to people; this is what brings us together in purpose and as an organization. There are many factors that can distract us in our everyday work, so leaders must stay connected with the people to hear what the issues are and address barriers for improving patient care.

Courage is another characteristic that I have grown to understand in myself. In my nursing career I have taken on many roles and in particular have stepped into departments with silent courage to address the issues that needed addressing. Courage is about asking questions in the midst of absolute certainty to ensure the best outcome for the whole. Courage is critical for a leader to stay connected to staff and listen during challenging times when it might seem easier to avoid the unrest. I have found that courage is not only in taking action steps but also knowing when not to take action.

Lastly, in my role I bring an appreciation and respect of the individual and one's uniqueness. As a leader, this provides an opportunity to foster connections and relationships within the organization that increases employee satisfaction and ultimately enhances productivity and patient outcomes. Marcus Buckingham and Donald Clifton note that great organizations capitalize on employee differences by leveraging the employee's natural talents into areas of strength.

What vision do you have for the future of nursing?

I see future changes in health care as the population ages and cost constraints continue for institutional settings. I believe this will impact growth within the community setting for alternative methods to deliver care. Nursing must continue to direct attention toward proactive strategies and continue to honor the sacred place we hold as we work with people along their path of healing. The institution of health care may continue to be unpredictable, but if we can remain centered and present with the patient, we can support the human spirit, a powerful source of healing.

I hope to see continued collaboration between professional nursing organizations. NCEMNA is an example of nursing professionals coming together to address ethnic minority health care in a new way. We need to be mindful of who isn't at the table for the conversation. Ask the courageous question in the midst of absolute certainty.

As I look toward the future of health care and my role as a Native American nurse, I see many opportunities and possibilities for health improvement of all people. Traditional native healing methods merged with modern technology and technological advances will continue to challenge us to modify our processes and translate the “new” and the “old.” While these changes occur, it continues to be nursing's role to maintain the humanness throughout this translation. We must not forget the individual or family we are caring for. Nurses will continue to problem solve cultural and traditional differences that may create problems in present day health care interventions.

Our emerging population demographics clearly demonstrate the changing “face” of Americans. We are seeing the minority become the majority, while the health care provider face has changed little. I have witnessed the dehumanization of a patient due to lack of cultural knowledge and sensitivity of a caregiver. There is a great deal of work ahead in transcultural education to change this all too prevalent occurrence. I choose to look at this work as an opportunity for positive change.

My life journey has taken me to a place from which I can effect change. I am thankful to continue to be in a position to influence and shape health care for individuals and groups of people. I will continue to use my voice and learning to contribute to improve health care for all people.

Do you think we will achieve that vision?

I believe this is possible with individual commitment and by working within our communities. As leaders we must set an example of inclusive behavior.

Mitakuye Oyas'in (All my relations)