Alaskan adventures – advanced practice nursing on America’s final frontier

20.8.2014

Nursing practitioners play a uniquely prominent role in health care provision in remote regions of the northernmost state in the US, where the majority of the population are native Alaskans (earlier known as “eskimos”), who still live largely from subsistence hunting and fishing.

by Fran Weaver

Lois Rockcastle, who has worked in Alaska for more than 20 years, explains that nursing practitioners look after more than 20% of primary health care in Alaska, and as many as 11% of Alaska’s nurses are advanced practice nurses. “We’re privileged to have total autonomy in our clinical practice, and many nursing practitioners even own their own clinics, which strive to provide accessible and affordable health care to all Alaskans,” she explains.

Isolated Alaskan communities have too few people to support the kinds of medical practice that are common in other rural regions of the US. Other nursing practitioners in rural Alaska are largely based at “sub-regional clinics” that each serve about 10 villages. They advise and work together with trained community health aides who work in rudimentary village clinics that have basic telemedicine connections. “The vast majority of these villages have no road connections, and they may be a thousand miles from the nearest hospital,” adds Rockcastle.

Third world health problems
“In the region I cover, 50% of homes have no running water or flush toilets, and we have to deal with third world health issues including hepatitis, tuberculosis, botulism and the highest rates of infectious disease anywhere in the US,” she says. “Native Alaskan communities unfortunately also have high rates of social problems including alcoholism and suicide.”

Simply getting carers to patients or patients to clinics can be a major challenge. Only about a tenth of Alaska is accessible by road. Elsewhere people largely travel by snowmobile in the winter, or by boat when lakes and rivers are ice-free. Nurses also use such transportation at times, though they more often have to find pilots to fly them into remote regions to provide care or supervise local carers.

Uniquely rewarding work
Despite all these challenges, Lois Rockcastle finds her work an exceptionally rewarding continual learning experience, especially when it comes to learning about the rich cultural diversity of Alaska’s native peoples – and exploring Alaska’s spectacular scenery with her horses and husky dogs in her free time.

“Life as a nursing practitioner in Alaska is full of a sense of adventure,” she says. “The thing I like best is the wonderful people, who are amazingly resilient and caring. Native Alaskans’ cultural strengths include incredibly supportive communities. It’s truly a pleasure and a privilege to get connected to these communities and build lifelong relations with their people.”

Lois Rockcastle gave participants at the international APN conference in Helsinki a colourful and inspiring presentation about her work as a nursing practitioner for native Alaskan communities living in remote arctic regions. Foto by Tuomo Antikainen.
Lois Rockcastle gave participants at the international APN conference in Helsinki a colourful and inspiring presentation about her work as a nursing practitioner for native Alaskan communities living in remote arctic regions. Foto by Tuomo Antikainen.