When Peggy Willman, RN, started work at Southcentral Foundation in Anchorage, she wasn’t assigned a traditional role.
Instead, the University of Alaska nursing grad and part-Inuit Eskimo spent two years honing her skills with “hands-on” inpatient care, pediatrics, elder care, health education, and family medicine at a hospital and various primary care clinics.
“I got an overview of everything,” says Willman, the first RN to go through a two-year internship designed to enhance opportunities for Alaska Native nurses. When the training ended in 2003, she picked a field close to her heart.
“It was my choice, and I was drawn to women’s health, where there is a lot of one-on-one care,” says Willman, who handles Alaska’s southeast region as one of eight RN case managers at the Women’s Health Clinic.LaZell Hammons (right) and Peggy Willman stand in the Alaska Native Primary Care Center, where both women work on the Alaska Native Health Campus. Hammons is a nurse director in the primary care center administation. Willman is an RN case manager in primary care center women’s health services.
Willman is part of a 1,400-member workforce that is 60% Alaska native and provides healthcare services to more than 45,000 Alaska native and American-Indian people living in Anchorage and 10,000 living in 55 remote villages in the Cook Inlet region, a 150,000-square-mile area. Since assuming management of a consortium of health services from the federal government in 1999, the native-run network has transformed care delivery, making all eligible members of indigenous tribes customers/owners and embracing their medical, cultural and spiritual needs.
Federal to Family Care
LaZell Hammon, RN, CMC, nurse director for Quality Initiatives, started at Southcentral nearly 11 years ago as a case manager in family medicine and says a major redesign in access to care rejuvenated the organization under native Alaskan leadership.
“There was a family feeling to huddle up and say, ‘We’re now in the driver’s seat,’ ” says Hammon, a University of Alaska nursing graduate born and raised in the state but who is not of native descent.
She says customers throughout the region were asked what they needed, how they liked to be addressed, and what felt good to them. People who once waited weeks for appointments and often got different doctors were given same-day access to the providers of their choice.
“We reached out and made it possible for them to pick their primary care providers,” Hammon says. “We would ask, ‘Who have you seen that you feel comfortable with?’ “
Nursing Role Redesign
Some 60 RNs who might once have focused on a condition such as diabetes or heart failure are now case managers paired with a physician and typically sharing office access to a medical assistant and a behavioral health specialist with another nurse-doctor duo. Each team is given a panel of 1,000 patients, and emphasis is put on proactive instead of reactive care, Hammon says.
“Two teams cohabitate one office, so it’s very collaborative,” she says. “They share resources and can cover each other seamlessly because they know how the other team interacts and deals with their customers.”
Hammon says the team structure benefits providers and patients. “Families can stay together if they want the same primary care provider, so nurses get to know not only a patient, but the mother and the father and the new baby.”
Demand for Care
Katherine Gottlieb, president and CEO of Southcentral’s primary care center and co-manager of the hospital with the Alaska Native Tribal Health Consortium, says more than $100 million has been invested in expanding services since 2000. An 80,000-square-foot pavilion for primary care clinics is due to open in late 2009.
The space is needed because of a relocation trend to Anchorage of nearly 1,500 village people annually, Gottlieb says.
Willman says there are a lot of challenges associated with being in women’s health in Alaska, weather and distance being among them.
“There are some villages that can only be gotten to by air, so if a woman is in labor out there, it’s a problem,” she says. With weather an unknown factor, pregnant women are brought in early when possible, she says.
Other issues arise, such as the physical location of a woman who needs to increase fiber in her diet.
“She’s sometimes in a remote area where it’s hard to just go out shopping,” says Willman. “It’s different from someone who can go down the street to the grocery store.”
Even though programs focus on Alaska Native care, there’s still a challenge to getting people needing tests or treatments to come to the center. Ironically, when the sun breaks through is the time they stay away the most.
Summer is hard for scheduling because of hunting and outdoor activities, Willman says. “I have an 80-year-old lady I talk to on the phone who is staying out and fishing.”