Priorities and partnerships in Indigenous nursing

Source: Canadian Nurses

Marilee Nowgesic has been the executive director of the Canadian Indigenous Nurses Association since January 2018 and has more than 25 years of experience working on Indigenous issues. Originally from Thunder Bay, she is a member in good standing with the Fort William First Nation and is an Eagle clan member. Canadian Nurse sat down with her recently to get an update on what her association is working on.

Teckles Photography Inc.CINA executive director Marilee Nowgesic

What led you to take on the executive director role with CINA?

I have worked in various capacities for the federal government, private and public sector organizations, national Indigenous associations and non-profits. The knowledge collected in these positions over many years (along with my traditional teachings) is behind my interest in Indigenous health, continuous professional learning and supporting the voice of Indigenous health-care professionals in Canada.

I have several nurses in my family, and a number of my friends also work in various nursing roles. So, my admiration and respect for nurses has been part of my desire to connect continuous learning with knowledge exchange, data collection and corporate affinity partnerships — and to help Indigenous nurses integrate traditional health practices and have these recognized as part of their professional role.

What are CINA’s current short- and long-term priorities?

CINA is developing responses to the Truth and Reconciliation Commission’s calls to action, based on an Indigenous nursing perspective, to further their understanding and implementation. This opportunity has generated a series of partnerships with non-Indigenous stakeholders, while addressing issues and concerns of Indigenous leadership organizations such as the Assembly of First Nations (AFN), the Inuit Tapiriit Kanatami and the Métis National Council.

CINA has also identified the need to develop alternative approaches to increasing Indigenous membership in our organization. As well, we are working to better recognize Indigenous nurses’ professional contributions through our partnership with FNIHB on the Awards of Excellence in Nursing and by resurrecting the Jean Goodwill scholarship fund.

In June CINA will be in Regina for a collaborative conference/workshop with the Community Health Nurses of Canada — our first such event with this group — where we will learn about and share experiences and best practices in nursing. In early October, we will give a joint panel presentation with AFN in Montreal at the 22nd International Congress on Palliative Care.

We will also be working intensely with the Canadian Association of Schools of Nursing (CASN) on revising the nursing curriculum, which must include Indigenous content.

In CINA’s role as a member of Canada’s chief public health officer’s advisory committee, we are providing Indigenous nursing expertise related to the government’s efforts to protect and promote the health and safety of all Canadians.

What can you tell us about the relationship between CINA and CNA?

CINA and CNA have been able to amend their 2016 partnership accord to better address the changing Indigenous health environment, regardless of jurisdiction. To that end, both have reviewed current policy documents and position statements and have established a more collaborative approach on how we are responding to the TRC calls to action. The two organizations continue to develop research and project initiatives that draw on their extensive expertise, such as federal/provincial committee presentations on the opioid crisis, cannabis legalization and cultural competence. The accord now also contains provisions on accountability and transparency and includes indicators for measuring our success.

What other partnerships is CINA involved in?

CINA is working to develop several key partnership agreements with organizations that are addressing Indigenous health, such as the Indigenous Physicians Association of Canada. Alongside these agreements, we will lead the development of the National Indigenous Healthcare Providers Partnership (NIHPP), which is a response to a call from Indigenous Elders and the Indigenous community to design a process that takes a proactive approach to improving Indigenous health outcomes. NIHPP will facilitate discussion on specific health issues and identify approaches that are culturally appropriate while being mindful of the regulatory or legislative guidelines for the health professions involved.

CINA is also working with the private sector to design, develop and implement a business strategy to meet demands of the rising costs associated with Indigenous health, the professional development of Indigenous health-care providers and their recruitment and retention.

What health concerns are remote Indigenous communities having to deal with?

There is no singular concern but rather an accumulation of issues that add complications to health service delivery for remote or isolated Indigenous communities — in some cases, the issues relate to rural areas (such as municipal services, bus transportation). Of course, most Canadians are aware that the present conditions in Indigenous communities are less than adequate. We are seeing increases in boil water advisories, overcrowded housing and chronic diseases.

For the most part, these communities are faced with a severe lack of adequate health personnel to assist in health care, prevention and promotion and too few health clinics and nursing stations. In cases where clients must travel to a tertiary care facility, there is often a lack of support for travel escorts and others who can explain the procedures and tests a client must undergo.

The Non-Insured Health Benefits program, which provides health benefits to First Nations and Inuit populations, requires preapprovals for travel, examinations and prescriptions and contains other constraints. These bureaucratic processes tend to deter Indigenous patients from accessing health services. Under such conditions a patient will likely choose to abandon their treatment and/or simply live with an undiagnosed or untreated illness.

Are there gaps in data gathering that affect Indigenous health outcomes?

Effective data is essential for introducing and evaluating policies aimed at improving health status. These gaps prevent us from comparing health figures with those of the Canadian population, and they diminish our capacity to determine the best practices to improve Indigenous health outcomes. Because information in hospitals or clinics is not being tracked, it is difficult for Indigenous health-care providers to identify and respond to potentially reversible health status inequities. This area is just starting to change, as Indigenous health research is promoting the First Nations Principles of OCAP (ownership, control, access and possession). The aim of OCAP is to give Indigenous nations control over the data collection processes in their communities. Under these principles Indigenous people will own, protect and control how their information will be used and determine access to the data for external researchers.

What is needed to more effectively recruit and retain Indigenous nurses?

CINA is currently reviewing the recruitment and retention of nurses with federal partners as part of an effort to address the rapid changes in workforce trends. The Aboriginal Health Human Resources Initiative (first offered through Human Resources and Skills Development Canada) has declined over several years. CINA has identified an urgent need for an extensive analysis of Indigenous health human resources. Doing so will help nursing schools provide culturally competent and culturally safe practicums. Because there are insufficient financial resources to actively participate in career fairs and trade exhibits, CINA is developing alternative methods to stimulate recruitment, such as showcasing Indigenous nurse leaders at the community level as part of a mentor-mentee process.

Are nursing schools making progress on integrating cultural competence into their programs?

CASN has been a constant and supportive partner to CINA and is working to address the inequities and the urgent need to modify this curriculum to give students the information they need to make informed decisions about Indigenous health care.

CASN has committed to the mandatory inclusion of cultural competence in the curriculum, and CINA has recommended that CASN work to have the Blanket Exercise incorporated in all nursing schools — for both students and faculty.

In addition, we are working with CASN to identify emerging concerns that will be part of our responses to the TRC’s calls to action.

Can you give some examples of the impact of cultural competence?

CINA, along with Indigenous health-care providers, is working with programs, services and agencies to identify best practices that will support better outcomes for Indigenous health. However, the social determinants of health play a large role in these outcomes and add to the complexities. For instance, we know that when Indigenous patients are hospitalized, giving them access to country foods improves their recovery, since they may choose not to eat foods they aren’t accustomed to. We also know that developing and delivering health services in a language or setting that resonates with Indigenous cultures leads to better results in health promotion. This practice can be seen in midwifery, in combining the use of traditional medicines with western medicines and in the adoption of Indigenous languages in health treatment plans.

What supports are needed to encourage the next generation of Indigenous nurses?

We know that Indigenous nursing students have expressed an overwhelming interest in combining traditional practices with new technologies. We are planning a series of discussions with the Canadian Nursing Students’ Association to learn about some of the concerns and issues in nursing programs and practicums.

We are also organizing a national nursing leadership symposium for 2019 in collaboration with CASN. It will help determine what nursing schools know about Indigenous nursing, identify best practices in recruiting Indigenous nurses and ensure nursing programs are meeting the needs of the profession while fully incorporating Indigenous knowledge.

In addition, we are looking to provide more information on resources, scholarships, etc., that will assist students in professional development and in maintaining Indigenous connections. The next generation needs to know that they will be able to get their training closer to their communities and families. We are also examining the use of different kinds of apps to help Indigenous nurses meet their professional needs.

What needs to be done to make the TRC’s calls to action a reality?

This issue is too large to address in such a short space, but CINA’s goal is to respond to the calls to action, in collaboration with external stakeholders, in a way that will educate and promote better understanding in nursing.

The question then becomes: how do we ensure that the calls to action are recognized when the general Canadian population lacks basic awareness about the history of Indigenous populations? It was an arduous task to obtain the truth — imagine how long it will take to obtain reconciliation.




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Joint Statement of Support from CNA and CINA for Motion to Create National Suicide Prevention Action Plan

May 22, 2018— Mike Villeneuve, CEO of the Canadian Nurses Association (CNA), and Marilee A. Nowgesic, executive director of the Canadian Indigenous Nurses Association (CINA), issued the following joint statement of support for a motion that calls for the creation of a national suicide prevention action plan.

“CNA urges all MPs to vote in favour of this critical motion that was tabled in the House of Commons by Charlie Angus, NDP MP for Timmins–James Bay. The time is now to take action on mental health, particularly reducing ‘stigma associated with being a consumer of mental health, bereavement and other associated services’— one of the key provisions in the motion,” said Villeneuve.

“CNA recognizes that the Mental Health Commission of Canada (MHCC) is spearheading efforts to reduce the number of people in Canada who die by suicide and we would expect to see the commission play a key role in implementing the proposed motion. In collaboration with MHCC, CNA has recently co-developed and accredited a suicide prevention learning module for nurses and, in 2006, CNA endorsed the Canadian Collaborative Mental Health Charter. The principles and commitments reflected in this charter remain relevant and will continue to guide CNA’s activity on mental health,” said Villeneuve.

“CINA supports and encourages this motion to design, develop and implement a national suicide prevention action plan. We are confident that this will be a collaborative process that includes adequate funding for all parties to undertake meaningful engagement, to determine roles and responsibilities, and to establish regular meetings to co-develop bilateral process,” said Nowgesic.

“A number of Indigenous communities across Canada — especially those in remote, isolated and rural areas — are facing distressing levels of mental health and suicide crises,” Nowgesic added. “Too often, these communities lack basic and adequate access to vital services, supports, treatment programs and other services readily available to other Canadians. In some cases, the services or programs that exist are not always culturally appropriate and safe — nor are they properly aligned with the needs of the community. Therefore, the creation of a suicide prevention action plan will provide Indigenous (and non-Indigenous) health-care providers with effective, sustainable and culturally appropriate programs and services. These resources will address urgent challenges and establish realistic, community-based solutions.”

“CINA’s relationship with CNA is an exceptional professional partnership, with both organizations working together to address Indigenous nursing for better health outcomes of Indigenous people,” said Nowgesic. “This partnership is committed to advancing reconciliation through collaborative research and identifying cultural competency issues with respect to the delivery of health care. Most importantly, the partnership recognizes Indigenous nurses and respects them for their traditional knowledge and meaningful engagement with clients.”


The Canadian Nurses Association is the national and global professional voice of Canadian nursing, representing over 139,000 registered nurses and nurse practitioners in Canada. CNA advances the practice and profession of nursing to improve health outcomes and strengthen Canada’s publicly funded, not-for-profit health system.

The Canadian Indigenous Nurses Association is the longest standing Indigenous health organization in Canada and is governed by a board of directors whose mission is to improve the health of First Nation, Inuit and Métis Peoples by supporting First Nation, Inuit and Métis nurses and by promoting the development and professional practice of Aboriginal health nursing.

For more information, please contact:

David Granovsky
Lead, Government Relations
Canadian Nurses Association
Tel: 613-697-7497

Marilee A. Nowgesic
Executive Director
Canadian Indigenous Nurses Association
Tel: 613-724-4677, ext. 103


Déclaration conjointe de soutien de l’AIIC et de l’AIIAC à une motion pour créer un plan d’action national sur la prévention du suicide

Le 22 mai 2018— Mike Villeneuve, directeur général de l’Association des infirmières et infirmiers du Canada (AIIC), et Marilee A. Nowgesic, directrice générale de l’Association des infirmières et infirmiers autochtones du Canada (AIIAC), ont fait la déclaration conjointe suivante au sujet d’une motion qui recommande la création d’un plan d’action national sur la prévention du suicide.

« L’AIIC exhorte tous les députés à voter en faveur de cette motion déterminante qui sera déposée à la Chambre des communes par Charlie Angus, député du NPD pour Timmins–James Bay. Le moment est venu de prendre action en matière de santé mentale, notamment pour réduire la stigmatisation associée au recours des services en santé mentale et liés au deuil et à d’autres services connexes, soit une des dispositions importantes de la motion », déclare M. Villeneuve.

« L’AIIC reconnaît que la Commission de la santé mentale du Canada (CSMC) est à l’origine des efforts de réduction du nombre de Canadiens perdant la vie en raison d’un suicide et nous nous attendons à voir la Commission jouer un rôle de premier plan dans la mise en œuvre de la motion proposée. En collaboration avec la CSMC, l’AIIC a récemment élaboré et agréé un module d’apprentissage sur la prévention du suicide à l’intention du personnel infirmier et a endossé en 2006 la Charte canadienne de collaboration en santé mentale. Les principes et engagements figurant dans cette Charte demeurent pertinents et continueront d’orienter les initiatives de l’AIIC en santé mentale », explique M. Villeneuve.

« L’AIIAC appuie et encourage cette motion afin de concevoir, élaborer et mettre en œuvre un plan d’action national sur la prévention du suicide. Nous sommes convaincus qu’il s’agira d’un processus concerté qui comprendra le financement adéquat pour que tous les partis s’engagent véritablement, déterminent les rôles est les responsabilités, et établissent des réunions régulières afin d’élaborer un processus bilatéral en collaboration », précise Mme Nowgesic.

« De nombreuses collectivités autochtones de tout le Canada, surtout en régions éloignées, isolées et rurales, sont aux prises de taux alarmants de maladie mentale et de situations de crises suicidaires », ajoute Mme Nowgesic. « Trop souvent, ces collectivités n’ont pas l’accès de base et adéquat aux services, au soutien, aux programmes de traitement et à d’autres services vitaux auxquels ont facilement accès les autres Canadiens. Dans certains cas, les services ou programmes qui existent ne sont pas toujours appropriés et sûrs quant au plan culturel et ne sont pas non plus harmonisés aux besoins de la collectivité. Par conséquent, la création d’un plan d’action de prévention du suicide offrira aux fournisseurs de soins de santé autochtones (ou non autochtone) des programmes et des services efficaces, viables et appropriés sur le plan culturel. Ces ressources aborderont les enjeux urgents et apporteront des solutions réalistes et axées sur la communauté. »

« La relation qu’entretiennent l’AIIAC et l’AIIC est exceptionnelle sur le plan professionnel, les deux organisations travaillent de concert pour aborder les soins infirmiers autochtones afin d’en arriver à de meilleurs résultats cliniques pour les peuples autochtones », déclare Mme Nowgesic. « Ce partenariat est voué à faire évoluer le processus de réconciliation au moyen de la recherche concertée et de l’identification de problèmes liés à la compétence culturelle en ce qui concerne la prestation des soins de santé. Qui plus est, le partenariat reconnaît les infirmières et infirmiers autochtones et les respecte pour leurs connaissances traditionnelles et leur engagement profond envers leurs clients. »


L’Association des infirmières et infirmiers du Canada est la voix professionnelle nationale et mondiale des soins infirmiers au Canada représentant plus de 139 000 infirmières et infirmiers autorisés et infirmières et infirmiers praticiens. L’AIIC fait progresser la pratique et la profession infirmières afin d’améliorer les résultats pour la santé et de renforcer le système de santé public et sans but lucratif du Canada.

L’Association des infirmières et infirmiers autochtones du Canada est l’organisme voué à la santé autochtone le plus ancien au Canada et est régi par un conseil d’administration dont la mission est d’améliorer la santé des peuples des Premières Nations, inuits et métis en appuyant les infirmières et infirmiers des Premières nations, inuits et métis et en favorisant l’évolution et la pratique professionnelle des soins infirmiers axés sur la santé autochtone.

Pour obtenir plus d’information, veuillez communiquer avec :

David Granovsky
Responsable des relations gouvernementales
Association des infirmières et infirmiers du Canada
Tél. : 613-697-7497
Courriel :

Marilee A. Nowgesic
Directrice générale
Association des infirmières et infirmiers autochtones du Canada 
Tél. : 613-724-4677, poste 103
Courriel :