Margaret Moss

An Educator and Researcher with a JD

MargaretMoss_100p Margaret Moss, The Three Affiliated Tribes of North Dakota, DSN, RN, JD, will soon be Associate Professor at Yale University School of Nursing and Director of Nursing Management, Policy and Leadership Specialty Director. The following article was written when Moss was on the faculty of the University of Minnesota School of Nursing. An update follows.

Concern about the elderly

When Moss was a floor nurse at the Santa Fe Indian Hospital for five years in the 1990s, she was concerned about the very sick Elders who often traveled long distances to get to the hospital. “Some of the Elders with problems, such as diabetes, didn’t come to the hospital until they needed something drastic, like a leg amputation. When we did discharge planning and suggested that they go into long-term care at a nursing home or assisted living in the city, they refused. They would literally rather die than accept care off the reservation or care provided by others who were not their own people. I asked myself, ‘Why is this happening?’”

Moss began exploring this issue by doing a geriatric leadership fellowship at the University of North Dakota
National Resource Center on Native American Aging. Next she earned her master’s degree in nursing at the University of Phoenix in Albuquerque. Soon she began work on her DSN at the University of Texas Health Sciences Center in Houston. As part of her doctoral work, Moss needed a research focus. “I had noticed that the Elders who were most likely to refuse care were traditional people, I decided to study Zuni Elders because they are one of the most traditional pueblo tribes. It took me about 800 hours to gain entry into the pueblo to do the study. Then I spent about 1800 hours over the course of a year in the pueblo.

“While working with the Zuni elders, I got my answer, and I discovered what was needed.” Moss became more acutely aware that Elders could not practice their ceremonies in a mainstream long-term care facility. For example, she realized that if Elders living in a long-term facility go outside early in the morning to practice a ceremony, alarm bells might go off. Also, staff are not likely to understand the Elders’ need for fasting at certain times. Moss was also aware that some Elders refuse long-term care because of their understandable distrust of the non-Indian agencies and institutions, particularly given their generations’ painful experiences related to the federal government’s attempt to assimilate them into the dominant culture.

“These experiences taught me that Zuni Elders need to have 24-hour long-term care facilities on their reservations. I realized that many Elders around the country also needed long-term care on their reservations.

Upon completion of her DSN, Moss accepted a position as assistant professor at the University of Minnesota School of Nursing. While teaching nursing students, Moss pursued her interest in indigenous Elders by undertaking a two-year, post-doctorate fellowship at the University of Colorado
Native Elder Research Center.

Meanwhile, Moss explored the possibility of long-term care facilities on reservations. “I discovered that only 12 reservations have nursing homes,” she said. “But I ran into a problem. It’s very hard to build nursing homes on reservations. Thirty-two states, including Minnesota, have moratoriums on building new nursing homes. I sit on the Minnesota State Board on Aging. I know the intent is good. The trend is to move funds from nursing homes to home care. For the majority population that already has lots of nursing homes, that is good. But for Indian people who are often hit with chronic diseases in their 40s, this is not good. Indian communities can build their own nursing homes, but they need to use their own money. And they aren’t likely to get a state license, if they build it themselves, so their funding streams will be limited.

“All of these obstacles led me to my latest project, which was going to law school,” she said. “In nursing school, you hear about obstacles to care, such as poverty, lack of education, geography and culture, but you don’t hear about legal barriers. I decided I wanted a legal background so I could use legal words and concepts.”

Last year after attending weekend courses at Hamline University School of Law in St. Paul, Minnesota for 4 years, Moss earned her juris doctor( JD). In the same year she also received tenure at the University of Minnesota.

While attending law school, Moss continued to teach. She is still teaching two undergraduate nursing courses: one on research and theory, the other on transcultural nursing and global health. In addition, she teaches health policy and research dissemination to doctoral students. Moss sits on the doctoral committees of 3 students and is primary advisory to several masters students.

Moss is director of diversity for the School of Nursing. She also directs
Native Nurses Career Opportunity Program (NNCOP). Funded through the Indian Health Service, NNCOP provides a scholarship program for American Indian nurses (RNs) to earn their masters in nursing degree.

Moss has earned the respect of her peers. In 2005, she represented the
National Congress of American Indians as Delegate to the White House Conference on Aging. The National Alaska Native American Indian Nurses Associations honored her with the Nurse Competence in Aging award.

In the future Moss hopes to lobby for tribes around the issues of health, aging, and education. She feels that someone needs to monitor state and federal actions to make sure that the rights and needs of indigenous people are honored.

Moss is the mother of four children, ages 12, 13, 14, and 17. She describes her husband, who is a school social worker, as a “saint”. “I couldn’t have done any of this without him,” she declares.
This article was originally published in the Summer 2007 issue of Winds of Change. (The cover artist is Bunky Echo-Hawk, Yakama/Pawnee.)

Update 2010

Among her recent accomplishments, Moss completed the 2008-2009
Robert Wood Johnson Health Policy Fellowship. Her fellowship assignment was to the Senate Special Committee on Aging. She was also elected secretary to the National Interfaith Council on Aging, an interest group of the National Council on Aging.

Beginning August 1, 2010, Moss will be an associate professor at Yale University School of Nursing. She will direct the Nursing Management, Policy and Leadership Specialty.

To hear Dr. Moss giving a presentation about the complex issues surrounding the health and care of American Indian elders, go to
Faculty Learning About Geriatrics. You can also download a podcast of Moss giving a presentation entitled “Health Care Needs of Older Native Americans” at the John A. Hartford Center of Geriatric Nursing Excellence at Penn State.