Community Leader to Community Healer: The unconventional path of Bush Fellow Arlene Krulish

Former CEO turns to psychiatric nursing with focus on addiction and recovery

The journey from being a healthcare administrator to becoming a nurse practitioner may seem backwards to some. But for 2024 Bush Fellow Arlene Krulish, it’s her path forward. Krulish is from St. Michael, on the Spirit Lake Nation in North Dakota. Her inspiration for becoming a nurse practitioner came from the nurses she saw while growing up on the reservation at her local health care center.

She started nursing school together with twin sister Arliss, who encouraged her to join. After graduating from the University of North Dakota nursing program together in December 2001, her sister went on to become a traveling nurse. But Krulish’s nursing career didn’t quite go as planned; she was pulled in a different direction, toward executive leadership. She went straight into clinical administration on the reservation, where she has worked for 20 years to improve access to and quality of health on the reservation.

Krulish has held several positions in clinical administration, including chief executive officer for Spirit Lake Health Center. But her original calling as a nurse never came to fruition. In her third decade of administration, she saw the opportunity to make it happen through the Bush Fellowship. Krulish experienced first hand the need for addiction and recovery care on the reservation and felt it was time to make a transition.

She was awarded the 2024 Bush Fellowship after her third attempt. “What I realized is I wasn’t specific in what I wanted to do on past applications, and to dream and think outside the box. So this time, that’s what I did.”

For now, Krulish will keep her position as planner of the Great Plains area office of the Indian Health Service and while attending nursing school online to become a psychiatric nurse practitioner. She was awarded $150,000 over her two years to cover the costs of tuition, studying abroad and wellness.

Krulish’s application focused on the shortage of resources and staffing for addiction and recovery needs,a growing need on the reservation as it is throughout the country. She will use the fellowship to study how people can overcome addiction using a combination of Western medicine and ceremonial practices, something she witnessed for a short time working at an inpatient facility at the Indian Health Service Drug Dependency Unit located in Winnebago, Neb.

“When I was in Winnebago, we started out every morning with prayer, smudging. And then we went through our agenda and started our day that way. And in the evening, we tried to go to a sweat lodge. But we tried to end the evening with prayer and smudge as well. And that worked really well,” she said.

“I think that the people I see that are successful with treatment, first of all, it’s something that they want to do. But part of their plan has to include some type of spirituality, some type of prayer for them to really be successful. A lot of times they really struggle when they’re alone and they don’t have that connection.”

Additionally, she says, a major struggle in recovery is the lack of staffing available on the reservation. “I think that the biggest struggle is just having resources available because at Spirit Lake Health, we have a beautiful inpatient facility. Ideally there could be 16 patients, but we don’t have enough staff, so they never run it at 16 because of staffing.”

Linda Thompson, director of operations of the Minnesota Indian Women’s Sexual Assault Coalition and a professional colleague of Krulish, told Buffalo’s Fire she agrees there is a lack of support for those in recovery. “Not having access to the ongoing support and encouragement or the lack of safe affordable housing, high unemployment rates — all can contribute to feelings experienced by folks struggling with unhealed traumas and addiction.”

Krulish says ever since she was young she had wanted to be a healthcare provider, more specifically a nurse.

“I had seen many different doctors rotating through the local Indian Health Service clinic on the Spirit Lake reservation,” she says. “I wanted to provide a familiar face with consistent medical care. I felt this was important because it seemed you had to continue to explain your health history every time a new doctor was providing care. As I got older, I admired the role nurses played in the health arena. It seemed the nurse did almost all your care, and then the doctor came in for a few minutes. Nursing appeared to be a great field.”

Thompson says Krulish is a great example of selflessness and leadership in her community. “She’s a great example for her family and the larger community — holding positions of leadership while doing the ‘on the ground’ direct services to those she serves.”

Krulish will attend online classes through Herzing University in Minneapolis for a two-year master’s program in psychiatric nursing beginning this fall. The Psychiatric Mental Health Nurse Practitioner degree is an online graduate program that provides students with fundamental knowledge and skills in systems-based practice, improvement science, epidemiology, telehealth, psychiatric mental healthcare, counseling and psychotherapy.

Nurse Practitioners can practice independently in North Dakota, which is one of 27 states that have full practice authority for NPs, according to Barton Associates. This means that NPs in North Dakota can treat patients, prescribe medications, and make referrals for physical therapy without physician supervision or contracts. They can also sign death certificates and disabled person placard forms. NPs can prescribe Schedule II medications in limited authority and only after completing 30 contact hours in pharmacotherapy related to their scope of practice.

Krulish says eventually she would like her own practice on the reservation. “But I want to gain some experience working under either the Indian Health Service or a tribal organization,” she said.

Her fellowship will also consist of traveling around the world observing and documenting how other Indigenous cultures are taking care of their own in addiction and recovery programs in places like New Zealand and the Phoenix Indian Medical Center.

“I believe for a person to be successful in recovery they need a combination of treatment and spirituality and exercise,” Krulish says. “I would like to combine Western medicine with ceremonial practices.”

She says there also needs to be a lifestyle change for the person to be successful in recovery. “Sometimes this means making new friends and redefining your circle of supporters and learning your triggers. There are triggers that need to be identified early on in the recovery process. But I feel there are many behaviors that can be traced back to the boarding school abuse.”

Krulish will also explore the importance of physical exercise while in recovery. “I think somebody’s recovery plan is not only spirituality and treatment, but to also have some type of exercise,” she said. “In Winnebago, where I was volunteering, we had the gym open for an hour before dinner for workouts. Trying to incorporate that into a treatment plan is important.”

Self-care and wellness play a big role in the Bush Fellowship as well. Krulish incorporated buying a treadmill and gym fees in her fellowship plan. After her son died in an automobile accident in 2010, she was in a dark place.

“I was like walking the Earth, but not really living, not really taking in what was around me, just day-to-day operations,” she recalls. “I really had to learn to heal and move on and work through that. Part of my healing is exercise. I’ve found that I feel the best when I exercise, so I always try to incorporate exercise into what I do.”

She and her family ran a 14K in June in remembrance of her son.

Thompson says Krulish is a leader in her community already. “She is committed to working with her community and has stepped forward and led the way for others to follow for best outcomes in health and wellbeing — emotionally, physically and spiritually. She even made public recordings during the pandemic on how easy it was to get your vaccination, and as the CEO of IHS she worked with the community to coordinate testing sites and then the drive-through immunization sites.”

Fellows are required to meet once a year, write a public log and journal their experiences. Then after two years are complete, fellows will write a final report.

Krulish says the fellowship is not just about building leadership and helping her community but providing hope by becoming the first nurse practitioner of her tribe to work in her community. “To be the first nurse practitioner from this community that’s going to be able to help with addictions, on the reservation, that will be a first. I hope to make a great impact for the whole tribe, to help with part of the addiction problem. I know that it’s something that we need.”

References:

BSN to DNP - Psychiatric Mental Health Nurse practitioner. Herzing University. (2024, June 12). https://www.herzing.edu/nursing/dnp/bsn-to-dnp/pmhnp 

Where can nurse practitioners (NPS) practice independently?. Barton Associates - The Locum Tenens Jobs & Staffing Leader. (2024, January 3). https://www.bartonassociates.com/blog/best-states-for-nurse-practitioner-nps

Zbrog, M. (2023, December 8). Can nurse practitioners prescribe medicines? NP authority by State. NPSchools. https://www.npschools.com/blog/np-prescriptive-authority-guide

Treatment and recovery best practices: Best practices in use. Methamphetamine and Suicide Prevention Initiative. (n.d.). https://www.ihs.gov/mspi/bppinuse/treatmentbp/ 

North Dakota Health and Human Services. (2021, November 16). Arlene Krulish speaks on the importance of getting the COVID-19 vaccine. YouTube. https://www.youtube.com/watch?v=SWPpJFPJapQ