While the nursing shortage appears to be an equal opportunity crisis, there are shortages in the nursing workforce that are less publicized because they pre-date the present grim staffing ratios, and are taken for granted. Nevertheless, the effects of these shortages on health care delivery are equally poignant, if less well-known.

Caring for an ethnically diverse population is taught in Nursing 101, but who better to care for a particular population than its members?

To address the unique needs of its American Indian population, Montana State University-Bozeman College of Nursing founded the Native American Nurses Caring for Our Own Project (CO-OP) in 1999.

Partnered with the Crow, Blackfeet and Northern Cheyenne tribes in Montana, the program soon will graduate its first class of 13 American Indian nurses, boasting a remarkable 100 percent retention rate and a rousing success for a program that almost didn't happen.

The project appears to be causing a stir in the world of nursing education.

Kay Chafey, Ph.D., MSN, RN, project director and founder of the program, fought long and vigorously to realize the dream and meet the needs she recognized when she first joined the MSU faculty 25 years ago.

"We tried and failed several times to get the funding for the program," Chafey said.

Eventually, a federal nursing workforce diversity grant was made available from the Health Resources and Services Administration's Division of Nursing and Chafey was able to make her dream a reality. The grant supports recruitment, retention and graduation of more American Indians from the nursing school.

The health problems that are more prevalent in-but not specific to-the American Indian population are tragic because they are preventable, treatable or both, Chafey said.

She points to the staggering incidence of premature death and disability brought about by a variety of chronic diseases, the high rate of infant mortality, accidents and suicide.

Chafey also notes that the underlying problems of poverty, inadequate nutrition, and alcohol and drug abuse are but a few reasons for the poor health of American Indians.

The program Chafey designed is multifaceted. "Coming from a tribal community college to a medium-sized research university was like moving to a foreign country," Chafey said. "The Native American students were faced with discrimination, racial and ethnic slurs. They were behind academically, they were isolated in classes, without the social structure other students enjoyed. They had no academic survival skills."

To ease the cultural and academic shock, the MSU-Bozeman College of Nursing introduced the Bridge to Success program.

Juanita DuBray of the Blackfeet tribe is a 34-year-old nursing student who will begin her upper-division placement in the spring. As one of the original 13 enrollees, she has attended two Bridge programs, or camps as they're sometimes called.

"I didn't know how to use the Internet or libraries for research," DuBray said. "The Bridge helped a lot and I'm better at these things now."

In this one-week program on the Bozeman campus, students are immersed in an academically enriched environment; they study anatomy using cadavers, health assessment and advanced academic survival skills. Students learn to cope with test anxiety; they network with classmates and form the support group that is the basic social structure of their lives in nursing school. They meet with each other at least weekly throughout the program to share information, problem-solve and come together in friendship.

"I directly credit the CO-OP program with my success in school. I was drifting from job to job. You can't do a whole lot without an education. I looked around and I'd worked as a home health aide, and nursing looked like a good thing," DuBray said.

"I receive a stipend of $250 a month [10 months per year] and that's a big help."

She wants to move home to Browning, Mont., after graduation and work with American Indians.

Lanell "Ellie" Rides at the Door, also of the Blackfeet tribe, isn't certain what kind of nursing she wants to go into but she shares DuBray's enthusiasm for the program.

"My studies are going OK and I'm trying to overcome test anxiety. I plan on leaving Montana to explore other reservations throughout the United States when I graduate in December 2002. Eventually, I intend to return to school to get my master's, and when I do begin a family of my own, I want to return to my own people, the Blackfeet," she said.

Rita Harding, MSN, RN, nurse consultant for the Indian Health Service in Billings, Mont., enthusiastically supports CO-OP.

"Tribes need Indian nurses. Changes are coming but the evolution is difficult; programs like CO-OP support the trend," said Harding, whose duties include nurse recruitment and retention.

In its second year, CO-OP enrollment swelled to 29 students, a 145 percent increase.

The program encourages nurses to return to their communities to practice-armed with the necessary knowledge and abilities-and maintains that good health for American Indians is a realistic goal.