Denise Palmer, MSN, RN, of the Cardiac Care Unit, and Steven Palmer, BSN, RN, of the Emergency Department

When Denise Palmer, MSN, RN, received an email from nursing leaders asking for volunteers to care for patients at the Northern Navajo Medical Center (NNMC) in Shiprock, N.M. through the Outreach Program with the Indian Health Service, she knew that she and her husband, Steven Palmer, BSN, RN, had to go.

“The timing couldn’t have been better,” said Denise, who has worked in the Cardiac Care Unit for 25 years. “Now that our three children are grown and I just completed graduate school, I was considering what comes next in my career. I’ve always been interested in volunteering in some capacity on an Indian reservation, but I wasn’t sure how to get involved.”

Steven, who has worked in the Emergency Department for 22 years, felt similarly. “As our kids are going off on their own, I have been thinking about the next chapter in my career, and the idea of traveling to underserved areas of the country and the world to work has been top-of-mind,” he said. “Traveling through a Brigham program made for an easy first step into the next phase of my career.”

The Palmers spent two weeks volunteering at NNMC at the beginning of October, an experience that they both found fulfilling and educational as they learned about Navajo culture and challenges that many Native Americans face, such as poverty and lack of access to resources.

In the NNMC Emergency Department, Steven focused on health care education for the community at large, with a collaborative balance of primary care, emergency services and specialty care.

“The Shiprock Service Unit is the largest in Navajo Nation, serving over 80,000 Native Americans, mostly Navajo,” Steven said. “Most prevalent are chronic health conditions like diabetes, hypertension, kidney disease and substance use disorder. Health education and teaching are a large part of the responsibility of caring for this community.”

Steven found that the primary care system at NNMC was extensive. “In many cases, patients who presented with issues in the ED were given a brief medical screening and instructed to return to their ‘assigned clinic,’” he said. “Patients who presented with more severe illness or injury were often transferred to hospitals with a high level of care capabilities.”

Denise, who worked in the four-bed intensive care unit, was initially nervous about learning a new computer system and method of charting than she was used to at the Brigham. “But by my second shift, I was taking full responsibility and had my own patient assignment,” she said.

Both Denise and Steven enjoyed the camaraderie and collaboration of their colleagues in the ICU and ED.

“The entire ICU works so closely together for the needs of their patients, all while treating them with the dignity and respect that they deserve,” Denise said. “There is no float pool, and there isn’t a staffing office to help fill sick calls, so staff members very rarely call out sick because they know it would be a burden to their co-workers. There are no part-time or per-diem nurses. All the nurses are full-time only. Many work overtime shifts every week.”

The Palmers left Shiprock with a deep sense of respect for the Navajo Nation’s health care approach: Although the hospital may not have an abundance of resources, staff are able to provide the community they serve with the care they need.

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