Registered nurses (RNs) are one of the nation's top in-demand occupations. The Bureau of Labor Statistics expects the field to grow from 3 million in 2019 to 3.3 million in 2029, an increase of 7%. For Native communities, the demand for RNs is particularly important. Often located in rural areas where there are already shortages of medical facilities and healthcare personnel, Native Americans suffer from chronic conditions such as diabetes and high blood pressure at disproportionate rates. Salish Kootenai College (SKC) in Montana became the first tribal college to offer a four-year registered nursing degree program in the Fall 2020. The four-year program at SKC is a direct admit model. Interested students take a pre-admission exam and must earn a certain requisite score to demonstrate a strong probability of success in their first college class. The cohort-based program has only one point of entry. Once the students are admitted to the program, they do not take general education classes and then wait to take nursing classes in years three and four, like students in other state institution programs.