Page:LewisMeriam-TheProblemOfIndianAdministration.djvu/276

Their training has been of a specialized character, sometimes considerably in advance of the physician’s training in his field. Their viewpoints are at times widely divergent. Under these circumstances it is difficult if not impossible for the nurse to abandon her own standards. As a consequence, if she is to function at all effectively, she must work more or less independently. This procedure she believes is forced upon her though it is in direct violation of all public health nursing ethics, and it greatly curtails her work.

The generally accepted ratio to population is a minimum of one trained public health nurse per 3000 population for general public health work, and one per 1000 for school nursing. The Indian Service presents a problem vastly different from the average American community, and therefore these ratios would not necessarily apply on all reservations. Where the reservation covers a large geographical area, and the population is widely scattered, obviously one nurse could not begin to care for the same number as in cases where all are concentrated in one community, as, for example, in a Pueblo. The acute health situation among all Indians renders them a serious liability to the Service as well as to the state in which they reside, and consequently there is not a single tribe or group of Indians that does not need some public health nursing service. To make such effort effective, enough nurses must be available to cover any specified area adequately, which means follow-up service for her original contacts with great enough frequency to accomplish the desired results.

In various health demonstrations and in numerous experiences in community and rural health work, it has been found that a nurse working in a territory with a population of 3000 averages 1540 visits per year and budgets her time somewhat as follows:

To apply these factors to the various Indian reservations would require much time and thought in light of the marked variation in the different jurisdictions, Based on a minimum of one public health nurse for each Indian reservation, 100 nurses are needed, or 76 per cent more than are now provided for, and this ratio by