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Nursing On Reserve

IU Southeast nursing students practice culturally competent care at Pine Ridge Indian Reservation.
IU Southeast nursing students practice culturally competent care at Pine Ridge Indian Reservation. Photo by Melissa Vance.

Their cargo was health supplies, mostly. Screening equipment; miscellaneous sporting goods; an assortment of donations acquired throughout the year; and finally, the luggage of IU Southeast Assistant Professor Julia Mattingly and her two nursing students, all filling a van that was packed to capacity before departing on a spring break road trip.

“I prefer driving. Driving is easier because I can take a lot,” says Mattingly.

Like many spring break trips, the drive was a long haul—18 hours total. Uncharacteristic, however, was the destination: some 1,400 miles inland of the nearest ocean to Pine Ridge Indian Reservation in South Dakota, where the three would spend the week promoting health care in the community.

Pine Ridge is far from a tropical paradise, but its natural beauty is just as stunning.

The sky hangs low until coming to rest on the sloping shoulders of the countryside. The land is a dusty emerald and ocher patchwork spread across the heart of the Great Plains. To the north, the reservation rubs elbows with natural monuments of eroded earth called Badlands National Park. The area is idyllic.

Badlands National Park
A fractured landscape: The natural beauty of Badlands National Park (pictured) is backdrop to the poverty-stricken conditions of Pine Ridge Indian Reservation.

“It’s the most beautiful place I’ve ever been,” Mattingly will tell you.

It’s also devastatingly bleak.

Poverty. Unemployment. Alcoholism. Drug abuse. Diabetes. Obesity. Suicide. All at record rates.

Set against the scenic beauty, these problems become more apparent, more disparate. For visitors, the dichotomy can be shocking. For the nearly 30,000 American Indians who call Pine Ridge home, it’s commonplace. And for Mattingly, the setting is an opportunity to train future nurses and help a community severely lacking in health care resources.

Taking Good Care

Mattingly has made the trip to Pine Ridge annually since 2011, although typically in the summer with a larger group of students.

The visit developed from her longtime professional interest in helping underserved populations as a community health nurse. She felt the pull of Pine Ridge the first time she entered the reservation on a mission trip with her sister.

“As soon as I went, Pine Ridge just really spoke to me as a nurse. There were so many needs,” she says.

It’s hard to overstate the needs. But Mattingly is also quick to emphasize the reservation’s many assets. Pine Ridge is a community steeped in tradition, family, and the abundant generosity of people who often have very little themselves.

“It’s a place that wouldn’t exist if community members didn’t have a lot of things going for them,” explains Mattingly.

Still, poverty’s grip on Pine Ridge has made planning the trips difficult. The reservation’s anemic health care infrastructure makes coordination with Pine Ridge health providers difficult. Even so, Mattingly has made connections within the community and with other aid organizations along the way, building a small network that has made her visits more impactful for students and the people they help in Pine Ridge.

Field Training

The lure of Pine Ridge isn’t limited to Mattingly. Many of her students feel the same calling once arriving at the reservation. It’s one of the reasons student interest in the trip has grown so quickly.

For students, the trip is a real-world survey in clinical nursing. They come to the reservation as community and cultural outsiders, which presents interesting challenges beyond putting their medical training into practice.

“It’s an opportunity for them to give something as nursing students, but also get something in return: lessons in health equity; insight into another culture; and experience communicating with a culture that is quite different from their own,” notes Mattingly.

The culture can be so different, in fact, that cultural immersion has become a major emphasis of the trip. Prior to the visit, students are required to research the traditions and lifestyle of the Lakota Sioux. Once at Pine Ridge, they spend time learning the culture firsthand: attending community pow wows and parades; beading; horseback riding; and visiting historical landmarks such as the Wounded Knee cemetery. It’s this understanding that leads to trust when working with individuals in the community.

But if cultural research is the course’s prerequisite, then applying that knowledge in the field is its final. In preparation, students create their own health promotion plan ahead of the trip, first choosing a focus and then determining the most effective way to pitch the health information to those they encounter.

Approach is everything, especially when working with a sometimes-skeptical population.

A nursing student tests a child's blood pressure at Pine Ridge.
A nursing student tests a child’s blood pressure at Pine Ridge. Photo by Melissa Vance.

For nursing student Kaitlyn Hunt, the solution was to empower each individual:

“We had people sit for blood pressure, blood sugar, and cholesterol checks … [and] encountered a lot of people who just didn’t want to get tested because they didn’t want to know the results, fearing that they would be bad. One particular lady … said ‘no’ due to fear, but later came back. We learned that she was a diabetic who hadn’t taken her insulin. When we checked [her blood sugar], it was high and so she said she would call her husband so he could bring [the insulin] to her. It was exciting to know that we were a part of a person’s choice to take ownership of her health.”

The ability to quickly assess needs and offer solutions is invaluable in a field where thinking on your feet is a necessity.

“A student may only get five minutes with an individual,” says Mattingly. “What kind of seed can you plant? Can you offer some health advice? It takes creativity on the students’ part.”

One of the most difficult challenges may be confronting the reservation’s abject poverty, regarded as some of the worst in the United States, which exacerbates the health issues in the area. For example, Pine Ridge has only one Indian Health Services hospital, very few grocery stores, and hours of travel between them and some residents—if those residents have the gas money to make the trip. If not, they often must fend for themselves.

Many of the nursing students simply have not encountered these kinds of dire circumstances, and therefore leave Pine Ridge with a new perspective on basic health services that are often taken for granted.

Hunt notes, “I honestly didn’t think that this was the kind of nursing I would be doing when I went into school. I thought about a typical hospital setting. But this community and being with people who have little access to good health care is where a large gap has yet to be filled.”

Developing Pictures of Health

Hunt’s feelings illustrate why the program has become such a unique and fulfilling opportunity for students, even inspiring some to pursue their nursing careers in the Pine Ridge area or other locations with underserved populations.

Mobile care: Nursing students promoted health care to the Pine Ridge community during a pow wow event.
Mobile care: Nursing students promoted health care to the Pine Ridge community during a pow wow event. Photo by Melissa Vance.

But as the program’s popularity has grown, so has the need for support. Currently, students pay their own way. And going forward, the group will transition to air travel to be more efficient with the limited time they have at Pine Ridge. (Mattingly now ships many of the supplies and donations to her contacts at the reservation for storage.) This has made the weeklong course more difficult to afford for students with limited budgets.

“Philanthropic support would take the pressure off of students as far as travel expenses, as well as help fund supplies and other resources to promote health in the community,” says Mattingly.

It would also enable Mattingly and her students to devote more time and energy to enhancing the impact they can make at Pine Ridge, rather than fundraising.

“The experience for the student,” says Mattingly, “for that future nurse who can really understand firsthand about social justice or who has gained the experience of communicating with someone who is much different—this is a way to ensure that they can provide culturally competent care.”

To put it simply, the Pine Ridge visit provides health lessons to live by, both for nurses at the outset of their careers, and for a community at a critical juncture in care.

If you’d like to support the Pine Ridge program and help future nurses gain experience in providing more culturally competent care, simply use the button below, or contact Betty Russo, IU Southeast Vice Chancellor for Advancement, at 812-941-2661 or

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This article was originally published in the fall 2017 issue of Imagine magazine.


Written By

A. Price

A resident of the Hoosier state since grade school, Alex forged a friendship with “tried and true” IU upon becoming a writer at the IU Foundation.

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