Professional practice is unique in northern health care. The work is often complex and demanding, with limited resources. Work hours can be long, with no alternatives in case of an emergency or high volume of patients. Health care practice can be isolating, with fewer opportunities for interprofessional collaboration or professional development. Stress and fatigue, leading to burnout, are common. For these and other reasons many northern regions face perennial shortages in nurses, physicians, mental health counsellors and other health care personnel.
Yet, those who practice in the North often express how rewarding it is. There is often a sense of real contribution to the well-being of the community and connection to patients that can be difficult to match in large urban centres. The range of duties and practice situations is broad and variable, offering new challenges and opportunities for competency development. And practitioners can experience a satisfying autonomy in their professional practice, while being an integral member of what is likely a small health care team. Working in the North means living in the North, with its recreational opportunities, vibrant cultures, strong sense of community, and access to nature. Northern health care is not for everyone, but for many it offers the best possible combination of professional satisfaction and lifestyle.
Much of the discourse on northern human health resources revolves around recruiting and retaining southern health professionals, and subsequently ensuring they can practice in a culturally competent manner. But the northern health care landscape has been evolving in the past two decades, with more and more northern post-secondary institutions offering health care education and more northerners filling health care positions in their own communities and regions. Making health education accessible in the North is an important trend that several chapters describe here. However, the growing presence of northern health care practitioners has added an additional layer of complexity in health care practice. Northerners who are health professionals in their own communities may face lateral violence from those who resent their success and influence; may feel pressure to assume additional responsibilities within the clinic or hospital as a ‘representative’ of the family or community; and may have difficulty isolating professional from personal relationships and obligations. Patients may prefer local health care practitioners, for cultural or language reasons; or may prefer practitioners from outside the community to safeguard privacy and confidentiality – for example, for sensitive issues such as sexual activity, substance abuse, or domestic violence. For these reasons, self-care is necessary to reduce fatigue, burnout, and stress, and ensure health care professionals are well enough to address their patients’ complex needs.
This theme is divided into two parts. The first examines the practice and regulation of health professionals in the North. Many similarities between northern and rural practice can be identified. Yet, due to its remoteness and culturally distinct character, northern practice entails a number of unique features.
Lois Berry articulates the importance of leadership in her chapter on Nursing Leadership for Northern Health. Registered nurses working in the north play a key role in addressing the challenge of quality and accessibility of health services for northerners. However, many will play additional roles in small communities including coach, municipal committee member, or campaign chairperson. Berry describes various aspects of leadership – critical, transformative, educative, ethical and inclusive – that are required to ensure nurses leverage their position to have the best possible impact on community health.
Martha MacLeod, Leana Garraway, Steinunn Jonatansdottir and Pertice Moffitt provide analysis from their Canada-wide survey on rural and remote nurses in their chapter What Does it Mean to Be a Nurse in Canada’s Northern Territories? They outline the themes and highlights in the northern nursing experience. Positive elements included the ability to practice to the full scope of their profession, a high level of autonomy, and the opportunity to make an impact in their community. Challenges include professional isolation, addressing the social determinants of health of their clients, and ensuring they provide culturally safe care.
Pertice Moffitt, Rachel Munday and Jan Inman outline the professional conduct considerations unique to the North in their chapter on Professionalism and Professional Conduct in the Northwest Territories and Nunavut, Canada. In Canada, nursing is a self-regulated profession. This means there is a designated professional body which oversees disciplinary actions for unprofessional conduct such as incompetence, bullying, and addiction. The authors describe the importance of responding to allegations and complaints to maintain the high trust of the public in nurses and other health professionals, especially those working in the North where responsibilities are high and supervisory oversight may be minimal.
Lastly, Brenda Dawyduk addresses the importance of recognizing job stress and burnout amongst northern health professionals and potential self-care strategies one can take to mitigate the hazards of stress and burnout. While self-care practices are personal, Dawyduk underscores the importance of recognizing the need for northern health professionals to find a balance between self-care and other-care.
The second part of this theme focuses on improving local capacity to educate health care professionals, administer health care systems and conduct health research, an important goal across the Circumpolar North. Several chapters describe particular efforts in that regard.
Lea Rättyä and Tiina Ervelius discuss the nurse-deaconess model of education in Finland and a new collaboration between the Diaconia University of Applied Sciences and the Sámi Education Institute in their chapter on Nurse-Deaconess Education in the Sámi Region. Graduates of the diaconal nursing program qualify both for registration as nurses and as a deaconess of the Evangelical-Lutheran Church of Finland, and provide holistic care encompassing both the spiritual as well as traditional health care. The program was established to increase the number of health professionals with a good command of the Sámi culture and culturally sensitive professional practices.
Kim Diamond and Susan Starks describe the supply side of health care personnel in their chapter Educating Health Care Providers in the Yukon. Yukon College in that Canadian territory has a long history of offering diploma and certificate courses in health careers such as Licensed Practical Nurses and Health Care Aides, with strong local and Indigenous uptake. They describe their efforts to indigenize their programming to ensure cultural safety in both education and health care delivery.
Rural regions around the world, and perhaps especially in the Circumpolar North, face particular problems in recruiting and retaining health professionals. Sirkka Saranki-Rantakokko, Eija Jumisko, and Outi Hyry-Honka discuss a project by Lapland University of Applied Sciences to address this issue in their chapter Off-Campus Nurse Education – An Education Model Impacting Regional Health Care Services in Finnish Lapland. Their model of incorporating nursing education into on-the-job training has resulted in positive outcomes including strong connections between the education and working life, adoption of new methods in the practice setting, and high employment and retention rates of graduates.
Gert Mulvad describes capacity building efforts in his chapter on Health Research and Professional Education in Greenland. Three initiatives stand out: the development of specialist medical education in Nuuk; the establishment of a nursing education program at the University of Greenland; and the creation of a Greenland Centre for Health Research. Combined, these efforts are having a huge impact on Greenlandic health care.
Pertice Moffitt and Grete Mehus outline a unique example of circumpolar relations in their chapter Northern Partnership between Two Schools of Nursing in Norway and Canada: A Historical Perspective. They developed a student mobility opportunity between their respective schools: Aurora College in Northwest Territories and Finnmark University College, later the Arctic University of Norway UiT, in northern Norway. Students learned about cultural similarities and differences and broadened their knowledge of nursing practice approaches.
Together, the chapters show a welcome evolution in northern health care and practice. Regions are producing more of their own health care practitioners, and in more contextually relevant ways; practitioners are assuming greater leadership roles; and the professions are advancing their standards of practice. Self-determination is a widespread and important goal across the Circumpolar North; developing uniquely northern health care systems with local health care professionals is an important step towards achieving it.