ArticlePDF Available

The Swampy Cree Tribal Council and Aboriginal Governance: A case study of nursing education in Northern Manitoba



This case study provides a historical account of the development of the Northern Bachelor of Nursing Program in the Canadian province of Manitoba through the lens of self-determination (governance) efforts in the fields of health and education by the Swampy Cree Tribal Council. Using records from the Faculty of Nursing archives at the University of Manitoba, the authors outline the chronology of the Northern Bachelor of Nursing Program in 4 phases: initiation (1982-86), development (1986-88), management (1986-90), and implementation and closure (1990-94). Contemporary implications of full partnership between universities and Aboriginal organizations are discussed.
Le conseil tribal des Moskégons
et la gouvernance autochtone :
une étude de cas portant sur
l’éducation en sciences infirmières
dans le nord du Manitoba
David Gregory, Mary Jane L. McCallum,
Karen R. Grant et Brenda Elias
Cette étude de cas offre un témoignage historique du parcours qui a caractérisé
l’élaboration du programme de baccalauréat en sciences infirmières en région
nordique, notamment dans la province du Manitoba. L’approche utilisée dans le
cadre de l’étude est axée sur les efforts d’autodétermination (gouvernance)
déployés par le conseil tribal des Moskégons dans les domaines de la santé et de
l’éducation.Ayant recours aux archives de la Faculté des sciences infirmières de
l’Université du Manitoba, les auteurs livrent les grandes lignes de la chronologie
du baccalauréat nordique du prog ramme de sciences infirmières, en quatre
phases : la conception (1982 à 1986); l’élaboration (1986 à 1988); la gestion
(1986 à 1990); la mise en œuvre et la clôture (1990 à 1994). Les répercussions
contemporaines générées par un partenar iat à part entière entre les universités
et les organisations autochtones font l’objet d’une discussion.
Mots clés: programme de baccalauréat en sciences infirmières en région nordique,
conseil tr ibal des Moskégons, Manitoba, gouvernance, autodétermination, parte-
nariat, sciences infirmières,éducation en sciences infirmières
CJNR 2008,Vol. 40 No2, 132–149
The Swampy Cree Tribal Council
and Aboriginal Governance:
A Case Study of Nursing Education
in Northern Manitoba
David Gregory, Mary Jane L. McCallum,
Karen R. Grant, and Brenda Elias
This case study prov ides a hi stor ical ac count of the develo pment o f the
Northern Bachelor of Nursing Program in the Canadian province of Manitoba
through the lens of self-determination (governance) efforts in the fields of health
and education by the Swampy Cree Tribal Council. Using records from the
Faculty of Nursing archives at the University of Manitoba, the authors outline
the chronology of the Northern Bachelor of Nursing Program in 4 phases: initi-
ation (1982–86), development (1986–88), management (1986–90), and imple-
mentation and closure (1990–94). Contemporary implications of full partner-
ship between universities and Aboriginal organizations are discussed.
Keywords: Norther n Bachelor of Nur sing Prog ram, Swampy Cree Tribal
Council, Manitoba, Aboriginal health, governance, self-determination, partner-
ship, historical research,nursing education
The quest for autonomy and self-government is a common phenomenon
among First Nations communities, as well as among the Métis Nation
and the Inuit peoples of Canada.1Regardless of their manifestations,the
objectives of this quest are always the same: to rebuild the nation and
reclaim nationhood, to liberate peoples from the effects of colonialism,
and to assume control over key sociocultural institutions and processes in
order to structure the nation’s own solutions.The creation of Aboriginal
health human resource programs, particularly in the area of nursing
education, exemplifies this effort to reclaim and restore self-government
with regard to health and healing. These processes are dr iven locally.
CJNR 2008,Vol. 40 No2, 132–149
© McGill University School of Nursing 133
1First Nations, Métis, and Inuit peoples as defined in the Canadian Constitution and
addressed by the Royal Commission on Aboriginal Peoples will be referred to collec-
tively in this article as Aboriginal peoples. Specific designations will be used where
necessary. Native is a contemporary term commonly used in the 1980s and 1990s to refer
to First Nations people in general.We use this term when referring to that era.
Although the outcome may not always be positive, the process itself can
foster relations of mutual respect and fair dealing, and eventually greater
participation by Aboriginal communities in the development of nursing
education programs.
To illustrate this dynamic, we trace the Northern Bachelor of Nursing
Program (NBNP) from its founding in 1982 to its closure in 1994. In
reviewing the trajectory of the program, we explore the self-determina-
tion efforts of the Swampy Cree Tribal Council (SCTC) with respect to
health and education. We identify barriers and challenges faced by the
SCTC. Our approach is to use a historical-interpretive lens to analyze this
nursing education initiative, part of the effort to decolonize health services
and nursing education in Canada,and to highlight the work of Aboriginal
communities in these endeavours. A case-study approach speaks to this
dialogue on Aboriginal governance.We then offer some perspectives
regarding current efforts to fully engage Aboriginal organizations in
nursing education partnerships.
Overview of the Northern Bachelor of Nursing Program
The NBNP was initially envisaged as a partnership between the SCTC,2
the School of Nursing at the Univer sity of Manitoba, and the
government of Manitoba. Manitoba is located in the centre of the North
Amer ican continent. According to the 2001 Canadian census, the
provinces of Saskatchewan and Manitoba have the fourth-highest per-
capita population of Aboriginal people in Canada (approximately 14%),
after Nunavut, the NorthwestTerritories, and theYukon.The SCTC is a
political affiliation of eight Cree Nations in northwest-central Manitoba
with a membership of over 14,000. Its mandate, since its inception in
1976, has been to advance and protect the interests, rights, and status of
its members and to facilitate the transfer of prog rams and services
(including those related to health) to local First Nations control. The
Council’s vision of creating a northern bachelor of nursing program thus
engages with contemporary struggles to improve health programming in
accordance with local objectives and needs. The program had several
important goals. First and foremost, it was intended to create a much-
needed cadre of Aborig inal health professionals. Related to this was
the goal of addressing the significant health needs of Aboriginal peoples
and other northerners. Therefore the program was ultimately about
David Gregory, Mary Jane L. McCallum, Karen R. Grant, and Brenda Elias
CJNR 2008,Vol. 40 No2 134
2The SCTC is a political affiliation of several bands in northwest Manitoba. It currently
comprises Chemawawin Cree Nation,Grand Rapids First Nation, Marcel Colomb First
Nation, M at hias Colomb, Mosakahiken Cree Nation, O pa sk waya k Cree Nation,
Sapotaweyak Cree Nation, and Wuskwi Sipihk First Nation.
governance and, in the language of the day, the self-determination of
Aboriginal peoples.
The NBNP, an enriched 4-year baccalaureate program, was endorsed
by the majority of decision-makers, including the SCTC, Manitoba
Keewatinowi Okimakanak, the Manitoba Association of Registered
Nurses, the Manitoba Indian Nurses Association, the Métis Federation of
Manitoba, and the University of Manitoba. These organizations
supported the program’s original objective of producing a workforce of
baccalaureate-prepared Aboriginal nurses. However, when the govern-
ment of Manitoba entered into the contracting process, it exercised its
political will to effect an outcome of its own liking. The province
supported the establishment of a nursing program that would appeal to
all norther ners in Manitoba and function as a post-diploma degree
program only.This was in keeping with its ideology regarding the
education of registered nurses in northern Manitoba.By September 1990
the original baccalaureate program, as envisaged by the First Nations in
northern Manitoba, ceased to exist. What was launched was a 2-year
post-RN program that appealed to northerners who already held a
diploma in nursing. Four years later, this program ceased to exist.
What did the demise of the program mean? The SCTC’s failure to
achieve self-determination? Something about the nature of the original
partnership or the nature of politics in Manitoba? On the face of it, one
might conclude that the program’s demise was indicative of the SCTC’s
failure to achieve self-determination. Although the program’s short life
and its fundamental prog ramming changes were disappointing, the
SCTC’s consistent efforts to pursue a respectful, equal partnership were
compelling.Using the NBNP as a platform for governance processes, the
SCTC directly influenced existing agencies,their policies, and their rela-
tionships with Aboriginal peoples. It engaged in concurrent and complex
self-determination processes and outcomes as a consequence of initiating
the nursing program.The SCTC challenged and managed to change
how it was viewed by the federal and provincial governments and the
University of Manitoba. The SCTC was now seen as a political entity
and a legitimate partner in the education arena. In this article we exam-
ine these efforts in a four-part chronology of the NBNP: Initiation of the
Program (1982–86), Development of the Program (1986–88), Funds
Management (1986–90), and Implementation and Closure (1990–94).
Study Design
Our project was one of many case studies funded by a Community
Alliance for Health Research grant from the Canadian Institutes of
Health Research and conducted at the Manitoba First Nations Centre
Aboriginal Governance and Nursing Education in Northern Manitoba
CJNR 2008,Vol. 40 No2 135
for Aboriginal Health Research at the University of Manitoba. Ethics
approval was obtained from the Health Research Ethics Board of the
University of Manitoba.The primary documents consulted were Faculty
of Nursing records held in the Archives and Special Collections of the
Elizabeth Dafoe Library at the University of Manitoba.These records,
generated from the SCTC and the university, included proposals, corre-
spondence between SCTC and the School of Nursing and other parties,
band council resolutions, and minutes of various committee meetings.
Our method was to sort NBNP-related archival documents chrono-
logically and by theme (for example, budget, letters from key individuals
involved in the program, program committees, and proposals).The data
were intact, comprehensive in scope, of superb quality, and well main-
tained. They dated from 1982 to 1995.
Initiation of the Program, 1982–86
First Nations, Métis, and Inuit people are recognized in the Canadian
Constitution as having distinct rights as Aboriginal people, including the
inherent right to self-government. Aboriginal people have consistently
had to fight to participate on their own terms in matters pertaining to
their territories and to people in the colonial context. Seeking control
over the health and education programs delivered to their people by the
Medical Services Branch (MSB) of the Department of National Health
and Welfare (now the First Nations and Inuit Health Branch, or FNIHB)
and the Department of Indian Affairs was an integral aspect of their
efforts to decolonize their experience and advance a self-government
agenda within First Nations communities (Barman,Hebert, & McCaskill,
1987; Boldt, 1993; Cardinal, 1977; Dickason, 2002; Little Bear, Boldt, &
Long, 1984; Peters, 1987;Wotherspoon & Satzewich, 2000). In the 1970s
and 1980s in particular, self-government efforts in the field of health care
were intensified, motivated in part by staggering inequalities in health
status. For example,the incidence of illness among Aboriginal Canadians
is, in most categories, double to triple that among non-Aboriginals, and
average life expectancy is 10 years shorter (Waldram, Herring, & Young,
1995;Young, 1994).
The under-representation of health professionals in Aborig inal
communities is such that in the late 1980s there was only one Aboriginal
nurse for every 2,100 Aboriginal people, compared with one nurse for
every 118 people in the general population (Morgan, 1987).There was a
high vacancy rate for on-reserve nursing positions (i.e., 40%) and a dire
need for more culturally responsive approaches to health care.There was
an intense desire for Indian control over health systems (Medical Services
Branch, 1980; Swampy Cree Tribal Council [SCTC], 1986).
David Gregory, Mary Jane L. McCallum, Karen R. Grant, and Brenda Elias
CJNR 2008,Vol. 40 No2 136
In the field of education, meanwhile, leaders sought to establish more
highly skilled training that would appeal to Aboriginal communities by
engaging both Aboriginal and non-Abor iginal education philosophies
and learning methods. In Manitoba, the SCTC brought these concerns
together through the NBNP (Connell, Flett, & Stewart, 1991; Lathlin,
1987;Thomlinson, Gregory, & Larsen, 1991). Indeed, it was the SCTC
that initially engaged with universities and colleges to develop programs
that would reach out to Aboriginal populations in unprecedented ways.
The Swampy Cree initiated a partnership with the School of
Nursing at the University of Manitoba, and their goals remained central
to the program’s initial defining principles. In 1982 The Pas Indian Band,
a member of the SCTC, first appealed to the MSB regarding the need
for Aboriginal nurses in the north. In March 1983 the Swampy Cree
board passed a resolution to “take action towards obtaining a Northern
Bachelor of Nursing Program” (Lathlin, 1987). In 1984 the SCTC
submitted a proposal to the Indian and Inuit Professional Health Careers
Development Program (IIHC)3through the MSB, Manitoba Region.
The funding was to be used to hire a coordinator to conduct a 4-year
feasibility study, documenting the need for and defining the conditions
by which a nursing education program might be implemented in The
Pas, Manitoba.
The SCTC obtained a $130,000 grant from the IIHC and hired Pat
Stewart as coordinator. Findings written up in the Nursing Feasibility
Study Report supported the need for a northern bachelor of nursing
program. Based on the outcomes of the study, the Swampy Cree entered
into a contractual relationship with the School of Nursing to develop a
proposal for the NBNP,the first of its kind in Canada.The only programs
available in nor thern Manitoba were a 10-month licensed practical
nursing (LPN) program at Keewatin Community College (KCC) in The
Pas and Thompson, a 1-year post-LPN RN program offered through
Red River College at KCC, and a 3-year diploma program in Thompson
delivered by Red River College. From the SCTCs perspective, these
programs did not offer nurses the education necessary to provide health
care in Aboriginal communities.
The implications of initiating a university/Tribal Council partnership
were enor mous. First, an outside Abor iginal group convinced the
education sector to enter into a partnership with a non-educational
agency and, in this case, an Aboriginal organization. Second, the SCTC
insisted upon principles that would directly serve its own interests,
namely access to nurses who were accountable to Aboriginal patients and
Aboriginal Governance and Nursing Education in Northern Manitoba
CJNR 2008,Vol. 40 No2 137
3The IIHC was an initiative of the MSB designed to support the education of Aboriginal
people in the health professions.
communities. Throughout, the SCTC remained committed to the
concept of a true partnership.This entailed full participation in decision-
making around the NBNP.The case study will demonstrate that while
the SCTC steadfastly advocated and claimed full partnership status for
the duration of the education and health initiative, it was not always
considered a full partner by the non-Aboriginal organizations.
Development of the Program, 1986–88
The SCTC chose to develop a baccalaureate program in nursing.
Although an enriched Bachelor of Nursing degree would have given
Aboriginal students the knowledge and skills needed to play a more
independent community nursing role, the SCTC also wanted to ensure
that the program addressed the needs of Aboriginal people seeking post-
secondary education at the university level.The SCTC worked tirelessly
to secure the participation of the greatest possible number of Aboriginal
students in the program.
Baccalaureate education, from the perspective of the SCTC, was
closely related to self-government, and it was directly associated with the
movement towards the transfer of health to the band level. The Swampy
Cree Tribal Council Bachelor of Nursing Feasibility Study Report noted the
commencement of the self-government movement
whereby control over health services, including nursing, is being trans-
ferred to Band control.This means a shift for the nurse of accountability
to the Band which has its own management procedures and regulations.
This of course forces the nurse into a closer working relationship with
community structures, which should improve effectiveness in her role.
However it does mean another whole set of tasks requiring administra-
tive time and skills.… This trend also has implications for preparing
nurses with a grounding in administration and supervisory skills, and
par ticularly, for administration in relation to Band and community
councils in the north. (SCTC, 1986, p. 23)
According to the SCTC, baccalaureate education would prepare
Aboriginal people for direct participation in the management of health-
care delivery. Moreover, it inherently critiqued the colonial legacies of the
MSB itself and argued for more control at the local level.The Feasibility
Study Report also commented on the BN Program:
It is consistent with the Native movement towards local control that
Native communities seek to provide their own health services using their
own per sonnel. This implies that they must also be concer ned with
education for their own Nurses. Aside from Communi ty Heal th
Representatives and office staff in the communities,and auxiliary staff in
hospitals,Native people are severely under-represented in the professions
David Gregory, Mary Jane L. McCallum, Karen R. Grant, and Brenda Elias
CJNR 2008,Vol. 40 No2 138
of health care, notably nu rsing. T he delivery of health ser vices by
Medical Services Branch, Health and Welfare Canada, is limited in its
capability and relevance in dealing with the complexity of health needs
in Native communities.As well, it is not structured to be accountable to
the community, without which true community development in health
will not occur. (SCTC, 1986, pp. 29–30)
Throughout this developmental period, the SCTC took the lead by
establishing and directing steering committees,contacting and motivating
the School of Nursing at the University of Manitoba, and soliciting
outside support, such as from Manitoba Keewatinowi Okimakanak, the
Manitoba Indian Nurses Association, the Manitoba Métis Federation, and
the Manitoba Association of Registered Nurses.The Feasibility Study
Report, released on April 15, 1986, positioned the NBNP to address
health problems in northern Native communities, encourage Native
people to pursue nursing education, and attend to the social and cultural
dimensions of health-care needs in A bor ig inal communities. The
program was viewed as part of the struggle for self-determination. It
spoke to a strong desire to “prepare our own people from the North, in
the North, with an education that would develop the skills to work with
our aboriginal people” (Lathlin, 1987).The report was accepted by both
the SCTC and the School of Nursing, and it led directly to program
The NBNP was also poised to influence the direction of nursing in
ways that would have immeasurably benefited the profession.The SCTC
argued that existing diploma programs avail able in the nor th, at
Thompson orThe Pas, were too urban-based (SCTC,1986,Appendix D,
p. 2) and had been parachuted into the north as satellites of southern
programming.The Tribal Council, through its advocacy for baccalaureate
education in northern Manitoba, also lent tangible support for baccalau-
reate education as an entry to practice in the province.
The SCTC insisted that the program be congruent with “Native
worldviews”and that it be built on a “holistic conceptual framework. It
argued that transcultural nursing skills and g rounding in cultural
awareness were not being offered in nursing education generally.The
new cur r iculum included such innovations as a traditional camp, a
mandatory Native Studies component, exposure to cross-cultural
communication, and enhanced primary care skills training for outpost
nurses. Such courses would serve to “prepare nurses to work more inde-
pendently of doctors,” Pat Stewart argued, as “nurses on a reserve must
be prepared to handle emergencies and accidents which are quite
common, and stabilize a patient in the same way an emergency ward
would” (Morgan, 1987).
Aboriginal Governance and Nursing Education in Northern Manitoba
CJNR 2008,Vol. 40 No2 139
Curriculum Development and Program Administration
A Working Group was established in 1986 to address four components
of the curriculum: Native content, cross-cultural communication, nurse
practitioner skills, and student needs and supports. It was believed that
these curriculum modifications would “produce nurses who are ethical
and accountable to the patient (and communities), are involved in
learning experiences relevant to the health care needs in the communi-
ties including health facilities, and which relate the various parts of the
program to one another in a holistic, integrated manner” (SCTC, 1986,
pp. 41–42). These modifications were significant, as it was the lack of
grounding in cross-cultural knowledge and traditional health care, as well
as the absence of primary skills to assess, diagnose, treat, and evacuate
patients, that had led to the high turnover rates and burnout among
nurses (Canitz, 1991;Thomlinson, 1995).The SCTC sought these alter-
ations to the baccalaureate curr iculum to ensure that the program was
consistent with principles at the core of their self-determination efforts.
The SCTC maintained a partnership in terms of not only curriculum
development, but also administration of the program. The Council
wanted to exercise influence over student recruitment, program
admission criteria, and approaches to student discipline. Entrance require-
ments were to be set jointly by the SCTC and the university, and the
administrative structure between SCTC and/or bands and the university
was to be negotiated (SCTC,1986, p. 37). Resistance from the university
regarding these administrative areas was a source of great frustration for
the SCTC. It was clear that the university acquiesced on issues of
curriculum development, but when it came to standards related to admis-
sions, student progression, and program governance, the university
invoked the provisions of the University Act, which had established the
University of Manitoba under provincial law and which dictated its
mandate and authority.
Program Funding:
SCTC and the Struggle for Funds Management, 1986–90
Throughout its sometimes tumultuous relationship with outside agencies,
the SCTC adhered to a concept of partnership that insisted on
Aboriginal monies being spent on Aboriginal students. Initially drawing
on federal funding from the IIHC Program, the SCTC envisaged a
program that would be based on the principle of supporting Native
health professionals. After the $130,000 in development funds was
exhausted, the SCTC was successful in positioning itself at the Northern
Development Agreement (NDA) table.The NDA is a funding arrange-
ment for co-sponsored northern development projects in various fields,
David Gregory, Mary Jane L. McCallum, Karen R. Grant, and Brenda Elias
CJNR 2008,Vol. 40 No2 140
under which the federal government provides 60% if the provinces agree
to provide the remaining 40%. In this case, the provincial component
comprised the Manitoba Department of Education and the Manitoba
Northern Affairs Department, with the federal funds coming through the
Department of Regional Industrial Expansion (DRIE). Although the
NDA did not accommodate the NBNP initiative, in the fall of 1987 the
SCTC secured a mirrored arrangement that reflected the principles of
the NDA, namely 60% federal and 40% provincial funding.
This funding arrangement brought the province more forcefully into
the partnership, and the province came with demands of its own, many
of which ran counter to the original goals of the NBNP. In the end, the
NBNP’s 4-year program was not deemed viable by the province.The
provincial government preferred to fund a 2-year post-RN program in
The Pas that would ladder or articulate with the existing diploma nursing
programs and be open to all northerners,Aboriginal and non-Aboriginal
alike. While the SCTC did not approve of these changes, it remained
in the partnership with the university and the province. The SCTC
continued to face struggles related to the principles and administration
of the program, and eventually concerning funding for the program as
In at least five instances, the SCTC fought for a fair measure of
control over funding arrangements.The first struggle came in April 1987.
While the SCTC was trying to negotiate for the continued development
of the program, the university attempted to create a tripartite agreement
by which the MSB would be a signatory to contracts, to the exclusion of
the SCTC (Dorion, 1987).The SCTC immediately rejected this
arrangement, arguing that the MSBs role was not defined and that, in
fact, the MSB was never intended to play a role in nursing education. It
characterized the action as a paternalistic attempt by the university to
appropr iate the SCTC’s involvement. This action suggests that the
university may have lacked confidence in its partner. Such a lack of
confidence was also expressed by the province, which in May 1987
requested that all funds flow through its offices (Storie, 1987).The MSB
also resisted the SCTC’s attempts to manage funds.In November 1987 it
expressed “discomfort” with allowing a Tribal Council to administer
funds (Larsen, 1987).
Again in February 1988 the province insisted that all funds bypass the
SCTC and flow instead through the university (Penner, 1988). In 1989
the province made its final attempt to resist a tr ue partnership in its
contracts with the SCTC. Just before the program began, the province
attempted to “broker” the services of KCC, thereby ensuring that provin-
cial funding would flow through the college instead of through the
Aboriginal Governance and Nursing Education in Northern Manitoba
CJNR 2008,Vol. 40 No2 141
SCTC (Norther n Bachelor of Nursing Program [NBNP], 1989).This
move was also rejected by the Swampy Cree.
Eventually, in 1990, the SCTC signed a three-way contract with the
government of Manitoba and the University of Manitoba. The MSB
directed funding to the SCTC, which then allocated program monies as
appropriate.The agreement, as explained in the NBNP Student Info-Pak,
was t he result of “several year s of work by the Tribal Council
(Thomlinson & Streit, 1990).
The Student Info-Pak also outlined the principles of the tr i-party
agreement. Students were advised of the shortage and high turnover rate
of nurses on reserves and in northern and remote communities, and were
informed that the NBNP would provide nurses with the high-quality,
unique education they needed to practise in northern and Aboriginal
communities. The program would endeavour to provide nur sing
education in an Aboriginal cultural milieu. All students in the program
would have an opportunity to acquire learning experiences with a
specific Aboriginal focus, and Aboriginal people would participate fully
in all aspects of the program through representation on the advisory
board and on appropriate committees. Finally, the partners in the NBNP
would actively recruit Aboriginal nurses, both on- and off-reserve, for the
Notably, the outline of principles concluded with a section on the
program’s adherence to the administrative rules, standards, and policies of
the university’s School of Nursing and Senate. But while the university
was still not ready to enter into a true administrative partnership,some of
the key self-determination principles of the original NBNP proposal
continued to be among the tri-party principles, and the SCTC — albeit
after years of struggle — achieved a fair measure of control over the
program’s funding arrangements.
Implementation and Closure, 1990–94
Although not the program originally envisaged,the NBNP was nonethe-
less implemented in 1990.The program had been so thoroughly altered
that, 1 month before it was launched, Oscar Lathlin (Chief of The Pas
band and Chairman of the SCTC board) stated, “It’s hard to recognize
the original program in the remnants” (Lathlin, 1990).
The Northern Nursing Program was based on a modified generic
post-RN model, allowing for some of the NBNP curricular develop-
ments, including a traditional camp, and added components in Native
studies, primar y health care skills, and emergency skills and triage.
However, the advanced clinical skills preparation of NBNP graduates was
not recognized by the MSB, and NBNP students still had to complete
David Gregory, Mary Jane L. McCallum, Karen R. Grant, and Brenda Elias
CJNR 2008,Vol. 40 No2 142
the Northern Clinical Program (Thomlinson, 1995), which met the
clinical scope of practice for MSB nurses working in outpost stations.
When the Northern Nursing Prog ram was evaluated by an outside
agency (Salasan Associates Inc.) in 199293, the resulting report
concluded that the nor th re quired a 4-year Bachelor of Nur sing
program. This had been the long-held view of the SCTC and Dr.
Jenniece Larsen, Director of the School, as well as others at the univer-
While the curricular shortcomings were a concern, it was the small
number of Aboriginal students in the program that was the foremost
indicator — and one that was foretold by numerous individuals involved
in the program — of the failure of the substituted post-RN program.
When the program was implemented, a 60/40 split in favour of the
Aboriginal students was advocated by Chief Lathlin, who also insisted
that students be able to enrol on a par t-time basis (NBNP, 1989).
Problems with meeting quotas became clear in 1990. Lathlin then
insisted that the “SCTC will not continue under this direction.We do
not want any students accepted into the program unless we have reached
the 50% Aboriginal nurse quota” (Lathlin, 1990). Moreover, according to
the 1991 Tribal Council Resolutions, the SCTC demanded that a
student counsellor of Aboriginal ancestry be hired to work with students
in the NBNP; that funding be withheld for the primary health skills
course until the feasibility of delivering the course in northern Manitoba
was fully explored; and that the 1991–92 student intake be restricted to
Aboriginal applicants (Dorion, 1991).
The problem of student quotas was tied to many issues, including a
lack of engagement with the SCTC in student recruitment and guidance.
Most significantly, however, the success of the program depended on the
supply of Aboriginal RNs. The KCC diploma program would also have
to maintain a quota of Aboriginal students, so that it could feed into the
NBNP. However, the KCC did not change its quota system for
Aboriginal nursing students until 1992.Therefore the program did not
serve Swampy Cree communities as had been envisaged (Salasan
Associates Inc., 1993, Section 2-23). Given the small number of
Aboriginal students, and the fact that the Aboriginal students who did
enrol in the program were already employed as RNs, the program evalu-
ation undertaken in 1992–93 confir med that none of the graduates of
the post-RN program filled positions at outpost stations (Salasan
Associates Inc., 1993, Section 2-25).
When, in 1994, it became clear that a true partnership in education
would not be possible and that the program was appealing mostly to
non-Aboriginal diploma nurses, the SCTC terminated its contract with
the University of Manitoba and the provincial government and withdrew
Aboriginal Governance and Nursing Education in Northern Manitoba
CJNR 2008,Vol. 40 No2 143
its support for the program.This was an act of resistance on the part of
the SCTC. Although it signalled the failure of the partnership, the
decision represented the exercising of authority and accountability
regarding the dissonance between the existing arrangement and a
program that would educate Aboriginal students to work in Aboriginal
In 1994 the Dean of Nursing at the University of Manitoba, Dr. Janet
Beaton, allocated funding to wind down the 2-year post-RN program at
The Pas. She stated that the monies committed by the MSB and “freed
up” as a consequence of the SCTC’s contract termination should be
directed to support the establishment of a 4-year northern bachelor of
nursing program (Beaton, 1994). Ironically, the SCTC ended up where
it had begun in 1983, advocating the need for a northern BN program
for Aboriginal students.
Eleven years of work contributed to self-determination and gover-
nance achievements on a large scale. The SCTC challenged the provin-
cial and federal governments to recognize and engage the Tribal Council
as a legitimate political entity. For example, the SCTC was a signatory to
the NBNP funding contract. In addition, the SCTC set a precedent by
secur ing partnership status with the University of Manitoba and thus
established a “footprint” for future educational partnerships with the First
Nations. An outside (non-educational) Aboriginal organization had been
instrumental in having a major provincial university engage in outreach
Many Canadian universities, including Dalhousie University, the First
Nations University of Canada, and the University of Saskatchewan, are
actively engaged with Aboriginal organizations in developing nursing
programming in response to the needs of Abor iginal communities
(Gregory, 2005). Because Aboriginal communities remain interested in
and committed to supporting the development of an indigenous health-
care labour force, the need to consider the restructuring of university-
Aboriginal relations is even more pressing today than it was when the
SCTC brokered a partnership with the University of Manitoba and the
province.The recent history of the NBNP points to several implications
for contemporar y nursing education in terms of governance and
curriculum, and it underscores the primary and secondary gains of
working in partnership with First Nations.
True partnership between universities and Aboriginal organizations
requires what Kirkness and Barnhardt (1991) call the four Rs: respect,
David Gregory, Mary Jane L. McCallum, Karen R. Grant, and Brenda Elias
CJNR 2008,Vol. 40 No2 144
relevance, reciprocity, and responsibility. Ignace, Boelscher Ignace, Layton,
Sharma, andYerbury (1996) indicate that where these are present, it is
possible to “foster an environment of compatibility and trust. Our
review of the documents surrounding the NBNP suggests that some of
these four principles were present; however, as the relationship between
the SCTC,the university, and the province evolved over time, reciprocity
and respect became increasingly compromised.As we have seen, it is clear
that there were many constraints imposed upon the Swampy Cree-
University of Manitoba partnership.True partnership requires models of
governance that actualize full participation of Aboriginal organizations.
Partnership can be achieved without undermining provincial statutes and
laws, university governing bodies, and policies. The consequences of
pseudo-partnerships in the NBNP case included fewer Aboriginal nurses
and the loss of opportunities to work in a fundamental way to support
Aboriginal self-determination.
Curr iculum development of the NBNP is still relevant in the
northern context, even though the program was scrapped in the shift to
the 2-year post-RN program. Since co-management of curriculum
development appears to be one of the most rewarding aspects of the
NBNP’s hist ory, further research in this area is to be encouraged
(McBride & Gregory, 2005). Discussions about Aboriginal nursing often
centre on statistics and epidemiological studies that point to the ill health
of Aboriginal communities without addressing inherent strengths and the
ability of communities to transcend epidemiolog ical illness profiles.
Nursing programs should include curriculum content that focuses on the
health-promoting aspects of norther n, rural, and urban Aborig inal
communities and should concentrate on the geographical, historical, and
cultural contexts of the lived experience of Aboriginal peoples.
The capacity of community organizations to enact change is real.
The SCTC was instrumental not only in founding the NBNP but
in changing the education landscape in Manitoba. It pressured the com-
munity college to change its quota system, thus introducing affirmative
action at Keewatin Community College. The NBNP also set the stage
for other partnerships at the University of Manitoba, such as the Norway
House program. In 1996 the School of Nursing commenced delivery of
an on-site community-based bachelor of nursing program at Norway
House. Many of the issues associated with the SCTC experience (e.g.,
admissions,student progression, and governance) were overcome because
of the full involvement and partnership of the Norway House Cree
Nation with support from Manitoba Keewatinowi Okimakinak. Other
positive consequences of First Nations collaboration include the support
of baccalaureate education, the strengthening of university Indigenous
Aboriginal Governance and Nursing Education in Northern Manitoba
CJNR 2008,Vol. 40 No2 145
programming, and the creation of meaningful relationships with
Aboriginal communities that challenge institutions to make changes that
foster the education of Aboriginal peoples.
We have explored nursing education as one manifestation of efforts
towards self-deter mination. In the shor t history of the Northern
Bachelor of Nursing Program, the Swampy Cree created a ground-
breaking program sensitive to the cultural, geographical, labour, gover-
nance, and health needs of Abor ig inal communities in nor ther n
Manitoba.The NBNP experience highlights the possibilities for nursing
programming when Aboriginal organizations influence key institutions,
and the consequences of discouraging the participation of such organi-
zations in institutions that affect them.This historical case study illustrates
the need for full partnership with Aboriginal organizations and the need
to consider Aboriginal peoples not as outsiders, to be “responded to, but
as insiders and as full participants in health-care education and delivery.
Barman, J., Hebert,Y., & McCaskill, D. (Eds.). (1987). Indian education in Canada,
Vols. 1 & 2.Vancouver: University of British Columbia Press.
Beaton, J. (1994, May 30). Correspondence. To Harold Turner [Grand Chief,
Swampy Cree Tribal Council] from Janet I. Beaton [Dean, Faculty of
Nursing]. Faculty of Nursing Archives, University of Manitoba Archives and
Special Collections.
Boldt, M. (1993). Surviving as Indians:The challenge of self-government. Toronto:
University ofToronto Press.
Canitz, B. (1991). Health care in cr isis: Understanding nursing turnover in
northern Canada. Circumpolar Health 90: Proceedings of the 8th International
Congress on Circumpolar Health,Whitehorse,Yukon, May 20–25, 1990 (pp. 177–
180).Winnipeg: University of Manitoba Press.
Cardinal, H. (1977). The rebirth of Canada’s Indians. Edmonton: Hurtig.
Connell, G., Flett, R., & Stewart, P. (1991). Implementing primary health care
through community control: The exper i ence of Swampy Cree Trib al
Council. Circumpolar Health 90: Proceedings of the 8th International Congress on
Circumpolar Health, Whitehorse,Yukon, May 20–25, 1990 (pp. 44–46).
Winnipeg: University of Manitoba Press.
Dickason, O. P. (2002). Canada’s First Nations: A history of founding peoples from
earliest times.Toronto: Oxford University Press.
Dorion, P. (1987, April 15). Correspondence.To Jenniece Larsen [Director, School
of Nursing] from Philip Dorion [Executive Director, Swampy Cree Tribal
Council]. Faculty of Nursing Archives, University of Manitoba Archives and
Special Collections.
Dorion, P. (1991, May 23). Correspondence. To Jenniece Larsen [Director, School
of Nursing] from Philip Dorion [Executive Director, Swampy Cree Tribal
Council]. Faculty of Nursing Archives, University of Manitoba Archives and
Special Collections.
David Gregory, Mary Jane L. McCallum, Karen R. Grant, and Brenda Elias
CJNR 2008,Vol. 40 No2 146
Gregory, D. (2005). Guest editor ial: Aboriginal health and nursing research:
Postcolonial theoretical perspectives. CJNR, 37(4), 11–15.
Ignace, R., Boelscher Ignace, M., Layton, M., Sharma, H., &Yerbury, J.-C. (1996).
Partners in success: The Simon Fraser University and Secwepemc First
Nations Studies Program. Canadian Journal of University Continuing Education,
22(2), 27–45.
Kirkness,V., & Barnhardt, R. (1991). First Nations and higher education: The
four R’s respect, relevance, reciprocity, responsibility. Journal of American
Indian Education, 30(3), 1–15.
Larsen, J. (1987, November 12). Correspondence. To Fred Stambrook [Vice-
Pre sident (Academic) Univer sity of Manitoba] from Jenniece Larsen
[Director, School of Nursing]. Faculty of Nursing Archives, University of
Manitoba Archives and Special Collections.
Lathlin, O. (1987). News Conference: Introductory Remarks – Chief Lathlin. Faculty
of Nur sing Archives, University o f Manit oba Archives a nd Special
Lathlin, O. (1990, March 2). Cor respondence. To Ar nold Naimark [President,
University of Manitoba] from Oscar Lathlin [Swampy Cree Tribal Council
Board of Directors]. Faculty of Nursing Archives, University of Manitoba
Archives and Special Collections.
Little Bear, L., Boldt, M., & Long, J.A. (Eds). (1984). Pathways to self-determina-
tion: Canadian Indians and the Canadian state.Toronto: University of Toronto
McBride,W., & Gregory, D. (2005).Aboriginal health human resources initia-
tives:Towards the development of a strategic framework. CJNR, 37(4), 90–
Medical Services Branch. (1980). Indian health discussion paper. Ottawa: National
Health & Welf are.
Morgan, R. (1987, January 30). Reserves seeking Native nurses. Brandon Sun,
p. 7.
Northern Bachelor of Nursing Program. (1986, November 7). Minutes. Meeting
with the Medical Services Branch. Faculty of Nursing Archives, University
of Manitoba Archives and Special Collections.
Northern Bachelor of Nursing Program. (1989, March 2). Minutes. NBNP Sub-
Committee. Faculty of Nursing Archives, University of Manitoba Archives
and Special Collections.
Penner, R. (1988, February 22). Correspondence. To Oscar Lathlin [Swampy Cree
Tribal Co uncil B oard] from Roland Penner [Minister of Education,
Province of Manitoba]. Faculty of Nursing Archives, University of Manitoba
Archives and Special Collections.
Peters, E. J. (1987). Aboriginal self-government arrangements in Canada: Background.
Kingston, ON: Institute of Intergovernmental Relations, Queen’s University.
Salasan Associates Inc. (1993). Evaluation of the Norther n Bachelor of Nursing
Program. Faculty of Nursing Archives, University of Manitoba Archives and
Special Collections.
Storie, J. (1987, May 26). Correspondence.To Oscar Lathlin [Chairman, Swampy
Cree Tribal Council] from Jerry Storie [Minister of Education, Province of
Aboriginal Governance and Nursing Education in Northern Manitoba
CJNR 2008,Vol. 40 No2 147
Manitoba]. Faculty of Nursing Archives, University of Manitoba Archives
and Special Collections.
Swampy Cree Tribal Council. (1986). Swampy Cree Tribal Council Bachelor of
Nursing Feasibility Study Report. Faculty of Nursing Archives, University of
Manitoba Archives and Special Collections.
Thomlinson, E. H. (1995). Northern Bachelor of Nursing Program: Issues in the
implementation of a curriculum to meet community and nursing needs.
Redressing the imbalance: Health human resources in rural and northern communi-
ties: Proceedings from a conference hosted by the Northern Health Human Resources
Research Unit,Thunder Bay, Ontario, October 21–24, 1993 (pp. 489–495).
Thunder Bay, ON: Lakehead University Centre for Northern Studies.
Thomlinson, E., Gregory, D., & Larsen, J. (1991). The Northern Bachelor of
Nursing Program: One solution to problems in health care provision.
Circumpolar Health 90: Proceedings of the 8th International Congress on
Circumpolar Health, Whitehorse,Yukon, May 20–25, 1990 (pp. 145–148).
Winnipeg: University of Manitoba Press.
Thomlinson, E., & Streit, S. (1990). Student Info-Pak. Faculty of Nursing Archives,
University of Manitoba Archives and Special Collections.
Waldram, J. B., Herring, D.A., & Young,T. K. (1995). Aboriginal health in Canada:
Historical, cultural, and epidemiological perspectives.Toronto: University of Toronto
Wotherspoon, T., & Satzewich,V. (2000). First Nations: Race, class and gender
relations. Regina: Canadian Plains Research Centre.
Young,T. K. (1994). Measuring the health status of Canada’s Aboriginal population:
A statistical review and methodological commentary.Winnipeg: Northern Health
Research Unit, Department of Community Health Sciences, Faculty of
Medicine, University of Manitoba.
Authors’ Note
The authors acknowledge the insights and critiques offered by Jocelyn
Bruyere (Cree Nation Tribal Health Centre) and the Jour nal’s two
anonymous reviewers.
The following financial assistance was received: Community Alliance
for Health Research g rant from the Canadian Institutes of Health
Research;Aboriginal Capacity and Development Research Environment
(ACADRE); Manitoba Fir st Nations Centre for Abor iginal Health
Research; and University of Manitoba.
Comments or queries may be directed to David Gregory, School of
Health Sciences, University of Lethbr idge, 4401 Univer sity Dr ive,
Lethbr idge, Albert a T1K 3M4 Canada. Telephone: 403 -329-2432. Fax:
403-329-2668. E-mail:
David Gregory, Mary Jane L. McCallum, Karen R. Grant, and Brenda Elias
CJNR 2008,Vol. 40 No2 148
David Gregory, PhD, is Professor, School of Health Sciences, University of
Lethbridge,Alberta, Canada. Mary Jane L. McCallum is a doctoral student in
the Department of History, University of Manitoba,Winnipeg, Canada. Karen
R. Grant, PhD, is Associate Professor, Department of Sociology, University of
Manitoba. Brenda Elias, PhD, is Assistant Professor, Department of Community
Health Sciences, University of Manitoba.
Aboriginal Governance and Nursing Education in Northern Manitoba
CJNR 2008,Vol. 40 No2 149
... Some documented initiatives in Canada [2][3][4][5], the United States [6], and Australia [7,8] focused on integrating Indigenous health content into the curriculum and made recommendations on program changes. However, authors emphasize the timeliness and sustainability issues of these initiatives as well as the lack of support from institutions. ...
... Rowan et al. (2013) noted that most internal (between university departments and faculties) and external (between hospitals and communities) partnerships are very often informal (unless they include a student placement program). They also noted the lack of financial resources for integrating desired changes into curricula [5]. In addition, while collaborative curriculum development can sometimes occur without significant tensions between Indigenous and academic partners, tensions can arise in program administration (e.g. ...
... admission standards) or if other funding partners (e.g. government) impose new constraints and requirements [5]. ...
Full-text available
Understanding how to create structural change by actively counteracting racialized ways of interacting with Indigenous peoples at an individual and organizational level within health care systems and health professions education is essential for creating a more inclusive, equitable, and healthier society. In health professions education, the primary means of teaching about health inequities has been to frame them as stemming from culturally or ethnically based issues. While attention to culturally specific practices can be valuable to health and healing in some contexts, education that solely focuses on Indigenous cultures risks perpetuating cultural stereotypes and othering, rather than focusing on how Eurocentric systems continue to exert oppressive effects on Indigenous peoples. We present an organizational transformation framework grounded in equitable partnerships from a comprehensive critical review of the literature on the integration of equity and social justice in undergraduate health professions education with a focus on Indigenous health. We did a thematic analysis of the results and discussions presented in the 26 selected articles to identify promising practices and challenges associated with the integration of equity and social justice in undergraduate health professions education. The framework resulting from this analysis is composed of three interrelated components: 1) adopt critical pedagogical approaches that promote Indigenous epistemologies; 2) partner with Indigenous students, educators and communities; 3) engage educators in critical pedagogical approaches and health equity issues. This framework could guide the development of contextually tailored interventions that contribute to decolonizing health professions education.
... We plan to incorporate further input from indigenous leaders, groups, and communities to formally advise the ANCI to ensure culturally relevant pedagogy and curricula (Anonson et al., 2008;Eschiti, 2004;Gregory, McCallum, Grant, & Elias, 2008). Graduates from the ANCI also will be invited to provide advisement. ...
Full-text available
To enhance recruitment and retention of indigenous peoples in nursing education, the University of Manitoba launched a cohort initiative in 2007. In this article, we describe the background, implementation, and evaluation of the initiative. Indigenous epistemology was integrated into the curriculum and pedagogy of prerequisite and beginning nursing courses. A cohort approach encourages peer support, which boosts individual and group strengths and academic success. Courses provide students with information about traditional indigenous knowledge, "Western" science, and how the history of colonialism continues to impact indigenous peoples in North America. Using the same instructors and advisors, in concert with tutoring, manageable course loads, and a culturally supportive environment, forges a path for success in indigenous students pursuing a baccalaureate nursing education. Key elements in the initiative may be adopted by nurse administrators and educators globally to inform the development of undergraduate nursing programs for indigenous peoples. [J Nurs Educ. 2013;52(xx):xxx-xxx.].
First published in 1993, First Nations: Race, Class, and Gender Relations remains unique in offering systematically, from a political economy perspective, an analysis that enables us to understand the diverse realities of Aboriginal people within changing Canadian and global contexts. The book provides an extended analysis of how changing social dynamics, organized particularly around race, class, and gender relations, have shaped the life chances and conditions for Aboriginal people within the structure of Canadian society and its major institutional forms. The authors conclude that prospects for First Nations and Aboriginal people remain uncertain insofar as they are grounded in contradictory social, economic, and cultural, and political realities.
Numerous studies, inquiries, and statistics accumulated over the years have demonstrated the poor health status of Aboriginal peoples relative to the Canadian population in general. Aboriginal Health in Canada is about the complex web of physiological, psychological, spiritual, historical, sociological, cultural, economic, and environmental factors that contribute to health and disease patterns among the Aboriginal peoples of Canada. The authors explore the evidence for changes in patterns of health and disease prior to and since European contact, up to the present. They discuss medical systems and the place of medicine within various Aboriginal cultures and trace the relationship between politics and the organization of health services for Aboriginal people. They also examine popular explanations for Aboriginal health patterns today, and emphasize the need to understand both the historical-cultural context of health issues, as well as the circumstances that give rise to variation in health problems and healing strategies in Aboriginal communities across the country. An overview of Aboriginal peoples in Canada provides a very general background for the non-specialist. Finally, contemporary Aboriginal healing traditions, the issue of self-determination and health care, and current trends in Aboriginal health issues are examined.
This book is about a just future for Indians in Canada. It defines justice in terms of the survival and well-being of Indians as Indians, that is, defined by their traditional principles and philosophies, not by the Indian Act or by their experience of colonialism. The first chapter reviews the roots and nature of Canadian injustice towards Indians, and proposes a paradigm for affording justice to Indians, based on the spirit and intent of the treaties and on the United Nations charters. Chapter two provides an analysis and critique of Canada's Indian policy. The third chapter assesses Indian leadership and politics, focusing on relations within Indian communities. Chapter four provides a discussion on the future of Indian cultures. The last chapter deals with Indian economic issues and evaluates present designs for Indian economic development. A number of appendices are included. -from Author
Native American college students often feel conflict between traditional holistic forms of knowledge and the compartmentalized knowledge encountered in college. University policies aimed at decreasing Native American student attrition must emphasize respect for cultural differences, education relevant to the Native American worldview, and reciprocity in teacher-student relationships. Contains 20 references. (SV)