Living-Wage, Living Healthy—A nursing pathway program for Native Hawaiians and other vulnerable groups to restore self-sustainability

Native Hawaiians have lost land, language, and lifestyle and have experienced devaluation of culture since the illegal overthrow of Hawai`i by the US. Today, many Hawaiians have low educational attainment and low-wage jobs without health insurance and experience a higher disease burden than other ethnicities in the state. We describe the Nurse-Aide-(NA)-to-Registered-Nurse-(RN) Pathway program at a community college aimed at getting disadvantaged Hawaiians into living-wage jobs while promoting cultural pride, healthy behaviors, and self-responsibility. Native Hawaiians and health care experts worked together to create the program, which reflect the culture's collectivist traditions in an “earn as you learn,” self-sustainability model. In addition to required NA skills training and clinical hours, components include self-assessment through Hawaiian drawing, training on Hawaiian healing and food traditions, coaching on study habits and time management, student governance, paid internships or job placement after graduation, and opportunities to show appreciation for scholarship support through service. We use Hawaiian collectivistic values to solidify mutual support among students in a cohort and from one cohort to the next to strengthen networks. $685,000 in extramural funding supports student tuition/fees. In 18 month, 79 students enrolled; 91% completed NA training and 91% passed the NA exam; 60% now work in health care (with insurance); 13% enrolled in RN programs and 63% in other college courses. Increases in cultural pride, self esteem, and health consciousness are remarkable. Social justice programs, like ours, need to work on multiple fronts, addressing economics, cultural pride, and healthy behaviors as well as knowledge/skill development.