NurseWeek: Arctic Commute: Public health nurse navigates Alaska’s skies to bring health care to villages

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PHN renaissance

There is renewed interest in and expansion of roles for public health nurses who traditionally focused on disease prevention and health promotion, according to Janet Schneiderman, MN, RN, assistant professor of clinical nursing at the University of Southern California.

"Today, public health is adding to that focus chronic illness and reducing risk factors, with an increased emphasis on community activation and partnership," Schneiderman said. "Today, there’s a bigger need for public health nurses, and their role within communities is enlarging."

California has 39,503 active registered PHNs, according to the Board of Registered Nursing Report for spring 2000.

"Public health nurses have done population health for a long time, but only now its seems people are realizing the importance of our work and how health promotion can save money," Schneiderman said. "Teaching people how to take care of themselves and how to prevent illness is what PHNs do best.

"There are a lot of vacancies for PHNs in many programs within California’s public health sector that hire nurses for tuberculosis control, childhood lead poisoning and new programs for visiting pregnant teen-agers and foster care – two new roles for public health nurses."

~ Nancy Devine

By Nancy Devine
June 22, 2000
Photo Courtesy of Rena Pace

Public health nurse Rena Pace takes off from Aniak, Alaska, flying in a six-seater prop plane to care for the 45 village residents of Stony River. A week later, she repeats her propeller express commute to Red Devil and, in the ensuing weeks, visits the 10 villages in her territory of about 30,000 square miles.

Pace, MS, PHN, RN, realized during her last job that she’s not a desk person, and pursued an itinerant nursing career.

"It’s a bit like working while you’re camping out," said Pace, who has traversed her villages for the past two years. "But I enjoy the challenges and the people, and want to do it as long as I can."

Pace is one of 25 public health nurses employed by the state who travel by air to a group of remote rural Alaskan villages, while 11 other nurses are partly itinerant, with fewer visits. Although public health nursing traditionally has emphasized disease prevention and health promotion, today’s PHNs wear different hats – and more of them – than ever before.

"You need to be a good generalist, but I’d say I act as nurse, epidemiologist, social worker, health educator, family counselor, dental assistant, women’s health provider, mental health coordinator and patient advocate," Pace said. "Plus, I encourage a lot, but you can’t force people. Some days, I’d like to put the people on the plane with me and just go."

Pace, who has lived in Alaska for 18 years but grew up in Montana on a reservation with Sioux Indian playmates, traces her interest in public health nursing back to her undergraduate days at Montana State University.

"I had a terrific public health professor who was inspiring, and I liked the philosophy of looking at the whole person in relation to the larger community," she said. "I’m more comfortable in the realm of prevention, wellness and population health."

On the road

Pace travels with eight duffel bags loaded with clothes, medicine, files, a sleeping bag, bottled water and food. "Some villages have a small bed-and-breakfast I stay in, but otherwise I just sleep in the health clinic," she said. "They all have a refrigerator so I bring fruit, yogurt, even lettuce. I’ve got it down to a science."

A day in Pace’s life starts with a flight from Anchorage 300 miles north to Aniak, a town of about 600 residents, her hub. She then takes a tiny propeller plane to a village, working in the field one week and in an Anchorage office the next.

"That’s my rotation ideally, although if something happens, the schedule’s outdated," she said.

Small flights are sometimes weathered in or delayed, so flexibility is crucial. "If you’re the kind of nurse who likes things all in a row, you can’t do this job," she said, and described what it takes: being patient, flexible and nonjudgmental, as well as a good communicator and listener with strong leadership skills who enjoys independence.

Once she arrives at the village health clinic, Pace meets with the health aide who has set up her appointments. Then she gets busy.

"I do lots of immunizations, well-child checks, women’s health and Pap smears," Pace said. "I do pretty extensive developmental screenings for children, and every fall we do tuberculosis investigation. If we have an outbreak, everything else gets put on hold and we have to go in concentric circles, testing the family, the neighborhood, the village.

"My biggest challenges in this job are convincing people TB is a serious disease, and completing all the follow-ups."

Numerous challenges

Village residents are mostly Alaskan Natives or American Indians who receive welfare and Medicaid, with high unemployment rates. Some homes do not have running water. Pace sees lots of hepatitis B, tuberculosis, diabetes, otitis media, substance abuse and tooth decay.

She works all day and tries not to see any patients after 7 p.m. so she can finish paperwork. "I do the bare bones as I go along, but I’d rather spend time with the families because the Yupik Eskimos and the Athabascan Indians are family-oriented. One of my real rewards is talking to a new mother and knowing she understands and appreciates what I’m saying."

Because Pace grew up amid diverse cultures, she understands the villagers are from different walks of life and, initially, did not trust a blue-eyed blonde. She believes if you’re patient and interested in people, trust will grow.

"They speak English to me, but knowing their culture really helps. Now, they’re very accepting," she said. "I overheard a child at one bed-and-breakfast saying ‘Grandma, is that lady related to us?’

"Sometimes, I feel like a princess when they bend over backwards to get me where I need to go. Doing this job with these people truly enriches my life. And when I’m 80 years old, I can say I had a real Alaskan experience."