‘When you’re connected to people and when you’re connected to the place, it reaches you spiritually’: a qualitative study of the experiences of providers working with Indigenous communities in the U.S.

Recruiting and retaining healthcare providers is a persistent challenge in the Indian Health Service (IHS) and Tribally operated healthcare settings in the U.S. Existing recruitment and retention strategies primarily consist of financial incentives, which may be insufficient given the range of factors influencing rural provider turnover. This study explored the experiences of providers working in these settings to inform contextually relevant strategies to strengthen provider retention and wellbeing. Study staff conducted key informant interviews with seventeen ( n = 17) healthcare providers working in IHS and Tribally operated healthcare settings. Interviews explored providers’ values and motivations; relationships with people, physical place, and work; and influences on wellness, fulfillment, and intention to stay or leave. Using an interpretive descriptive approach, interview transcripts were thematically analyzed. Participants described intentional efforts to build relationships with the Indigenous communities they served, which enhanced commitment to their work and patient care. In the workplace, autonomy coupled with support, as well as opportunities to learn and grow, enabled participants to pursue impactful roles of interest. Participants’ sense of fulfillment and intention to stay were shaped by their relationships with the Indigenous communities they served; alignment between personal motivations, values and roles; supportive relationships with coworkers; autonomy and support in their work; and opportunities to learn and grow. Place-related influences on stay and leave intention consisted mostly of family considerations. Inadequate staffing and work-life balance undermined wellness and contributed to intention to leave. The results highlight the importance of provider motivations and values, social relationships, and supportive workplace processes in shaping a sense of fulfillment and intention to stay in their positions. Intention to stay was also influenced by place-related considerations. Policies and workplace designs encouraging relationship-building, work-life balance, autonomy and support, and learning opportunities, may strengthen provider wellbeing and retention and complement existing interventions.