Introduction: The Council of Deans of Nursing and Midwifery of Australia and New Zealand has delivered a national apology acknowledging the role of nursing and midwifery in contributing to the harm and ongoing suffering of Aboriginal and Torres Strait Islander nurses and midwives and their communities.
This article is published by Croakey Professional Services as part of a series of sponsored content covering the recent Congress for Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) annual meeting, which celebrated the organisation’s 25th anniversary. See the campaign portal.
Croakey Professional Services writes:
Aboriginal and Torres Strait Islander nurses and midwives have welcomed an historic apology from Australia’s peak body for nursing and midwifery education and research for the harm and trauma caused by the profession to Aboriginal and Torres Strait Islander people since colonisation.
The apology from the Council of Deans of Nursing and Midwifery (CDNM) was delivered amid deep emotion on 19 August 2022 at the 25th anniversary meeting of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) in Sydney, on the lands of the Gadigal Peoples of the Eora Nation.
Founding CATSINaM members and others at the milestone event hugged each other, held hands and shed tears as CDNM Chair Professor Karen Strickland acknowledged the role played by non-Indigenous nurses and midwives in racist policies and practices in Australia, often under the guise of care.
Professor Strickland said the CDNM, as national leaders, “apologise to Aboriginal and Torres Strait Islander peoples, for the past harms and injustices” and acknowledge “the profound hurt and harm nurses and midwives have caused through their practice in the professions, and we say sorry”.
The apology acknowledges that nurses and midwives have acted as “agents of the government” in harmful policies, such as those creating the Stolen Generations.
It also acknowledges their roles in creating culturally unsafe workplaces for Aboriginal and Torres Strait Islander colleagues whose cultural practices and contributions to the professions and healthcare have been ignored or minimised through the privileging of colonial approaches.
Professor Strickland, who is Executive Dean of the School of Nursing and Midwifery at Edith Cowan University in Perth, told conference delegates there is widespread agreement in Australia that “the wrongs of the past should never be repeated”.
But, she said, “for nursing and midwifery, there still needs to be truth telling, historical acceptance, acknowledgement of professional and institutional racism, and justice before we can begin on the road to healing and building the future”.
Flanked on stage by Deans of Nursing and Midwifery from across Australia, Professor Strickland said the apology itself would “not erase the pain of the past nor the intergenerational trauma that has occurred”.
But she said it was a “vital first step in our future, a vital first step towards healing”, with the CDNM committed to working with CATSINaM to support culturally safe spaces for education and research and enable Aboriginal and Torres Strait Islander academics and students to flourish and take their place as leaders in nursing and midwifery.
“This is our moment of truth, this is where we make our stand to stop repeating the wrongs and make space to build a new way,” Professor Strickland said, ahead of a standing ovation.
Watch the apology: https://www.youtube.com/watch?v=cMTdWqHfYO4
Read the apology: https://irp.cdn-website.com/1636a90e/files/uploaded/apology_signed.pdf
Movement of change
The CDNM apology was formally accepted on behalf of CATSINaM at the Sydney event as both “welcomed and long-awaited” by Dr Lynore Geia, a Bwgcolman woman from Palm Island, a leading nursing and midwifery academic, and member of CATSINaM’s Elders Circle.
In a powerful speech in response, Dr Geia evoked the role of “our Old People” as watchers for change in the spiritual and natural worlds as she called on nurses and midwives to be alert and responsive to “a quickening…a movement of change” being birthed for the professions through the apology.
Dr Geia said it was right and fitting that the apology was made in Sydney, “at this place where so much has transpired spiritually, cognitively, and physically over thousands of years for the Eora nation, and just over 200 years ago for descendants of Britain’s First Fleet who settled in Australia”.
“This was the beginning of contact, clashes, convergence, and the colonisation of Country. It was the beginning of profound change for Australia’s First Peoples,” she said.
It was also where the first five Western-trained nurses to the colony, trained by Florence Nightingale, disembarked in 1838, she said, marking the beginning of the Australian nursing profession, which has long included strong First Nations nurses and midwives.
The professions developed over time, to where nurses and midwives held positions of authority. Regrettably, she said, many became part of government mechanisms of control, and were complicit in harmful policies and practices including the removal of Aboriginal and Torres Strait Islander children from their families and communities, and racial segregation in hospitals and health services.
Dr Geia, who is Academic Lead of Aboriginal and Torres Strait Islander Health in the College of Health Care Sciences at James Cook University in Townsville, said there are oppressive behaviours and systems in mainstream nursing and midwifery towards Aboriginal and Torres Strait Islander nursing and midwifery students that have often stopped them pursuing or furthering their careers.
She said the apology must result in “purposeful action which includes working together in real partnership for reform, recognising the unique knowledge and skills that Aboriginal and Torres Strait Island nurses and midwives bring to the professions in developing reforms for better education, research, and clinical practice outcomes”.
Watch the response: https://www.youtube.com/watch?v=7IdgVUlS1r0&t=164s
Two months after the apology was delivered, Dr Geia and Professor Strickland attended a two-day CDNM meeting in Naarm/Melbourne. Afterwards, they talked with Croakey Professional Services about their combined efforts to bring about change.
They came close to tears as they recalled the powerful emotions present on the day of the apology and take heart from the strong relationship that has been built between CATSINaM and the CDNM over the past year.
Videos of the apology have already been shared widely, Professor Strickland said, across disciplines and tertiary settings, used in nursing and midwifery teaching, and attracting global attention – “capturing that moment in history”.
Professor Strickland said being able to stand in an Indigenous space to deliver the apology on behalf of the CDNM was “an incredibly humbling experience”, made more profound by the presence of some of the founding CATSINaM Elders, including Aunty Emily Marshall, a Kaurareg woman and Lifetime Achievement member of CATSINaM.
Many had shared their stories in CATSINaM’s In Our Own Right exhibition, which opened the day before the apology ahead of a national tour, documenting their successes in the face of daunting and distressing interpersonal and institutional racism.
“I could see when I was [delivering the apology] the strong emotions that this was invoking and it just felt like it was such the right thing to do”, Professor Strickland said, noting that it was a powerful moment also for non-Indigenous professionals there, with a number of the Deans “sobbing as they came off the stage”.
Strickland remembers CATSINaM Chair Marni Tuala, a proud Bundjalung woman, coming up to her after her speech and saying “hold on to how you felt when you did that”.
“Even talking about that now, it does bring back the emotion because you could see that this meant so much to the people that were there in the room,” she said.
Dr Geia was struck by the total silence of the conference room as Professor Strickland spoke, with “everyone hanging off every word because it meant so much”, a sense that “something profound was going on”, of it being “a critical time, a spiritual time”.
“For the Elders who started CATSINaM — they experienced a lot of that trauma from their non-Indigenous nursing colleagues and through the system, so for them to hear Karen stand up there, representing the non-Indigenous sector, and say sorry to them, it was a balm,” she said.
For Dr Geia, it was equally moving to have been invited to make the formal response, “carrying generations of wounded people” with her, to say “yes, we are going to accept this apology”.
She was honoured to present two sets of message sticks to CATSINaM and CDNM: one gifted by Traditional Owners of the Gadigal Nation, and the other from the Traditional Owners of her grandmother’s people, the Birri Gubba nation, “representing the new sound we are making”.
Dr Geia sees the apology as a turning point not only in nursing and midwifery but also for the nation, coming as Australia finally plans a referendum on embedding a Voice for Aboriginal and Torres Strait Islander people to Parliament in the Constitution.
But both Professor Strickland and Dr Geia said the urgency of the need for change was underscored even in the week of the apology, with reports emerging from a coronial inquiry into the untimely deaths over 12 months of three Aboriginal women who all suffered from rheumatic heart disease in the remote Queensland community of Doomadgee, amid concerns of institutional racism within local healthcare.
“It’s not about saying sorry and then doing nothing. It is about changing the patterns, the conduct of the past,” Professor Strickland said, adding that she believed the CDNM apology should inspire similar reflections from other professions, particularly medicine, allied health, social work and teaching.
Long awaited breakthrough
CATSINaM, under the leadership of former CEOs Adjunct Professor Janine Mohamed and Professor Roianne West, had been calling for some years for an apology from nursing and midwifery, in the wake of the landmark apology in 2016 by the Australian Psychological Society for its role in causing trauma and harm for Aboriginal and Torres Strait Islander people.
The breakthrough came last year at the Western Australian Forum of CATSINaM’s #BackToTheFire conference series, attended by Strickland in one of her first acts as newly appointed CDNM Chair.
Professor West spoke at the forum about the unified call to action to Australian nurses and midwives that had been led by Dr Geia and published in Contemporary Nurse a few months earlier, written in the wake of the death of George Floyd and the eruption of #BlackLivesMatter protests.
Signed by more than 100 Indigenous and non-Indigenous nursing and midwifery leaders, the call to action said it was time for nursing and midwifery in Australia to “metaphorically take to one knee”, as had people from all walks of life across the globe — from English footballers to New York police officers — to acknowledge and challenge racism in its midst.
Professor Strickland, who moved to Australia five years ago from Scotland, said she had been shocked to witness the impact of ongoing racism and injustice experienced by Aboriginal and Torres Strait Islander people.
She made it her business to learn more and was lucky, while at the University of Canberra, to work with Elder in Residence and Ngunnawal woman Aunty Ros Brown — “such a beautiful woman who gave really generously of her time and helped guide me in the early days”.
Also crucial was working with Associate Professor Holly Northam, head of nursing at the University of Canberra, and a founding member of Muliyan, a collaboration of researchers and practitioners led by CATSINaM that aims to decolonise health, particularly nursing and midwifery.
“Holly guided me on how to walk with Aboriginal and Torres Strait Islander people: how to help give voice, not to be the voice.”
At the WA Forum, Professor West asked Professor Strickland how the CDNM would address the inequities faced by First Nations nurses and midwives – from students to academic leaders – and how it would respond to the now seminal call to action.
Professor Strickland made a commitment “there and then, that we had to start with a program of meaningful engagement and that should begin with a formal apology from Council for the place nursing and midwifery education has in contributing to the harms and intergenerational trauma of Aboriginal and Torres Strait Islander people”.
From that time, she said, Professors West and Geia had generously helped to guide the work of the CDNM, “working on a program of reform that will ensure we take positive action to supporting and privileging the voices and place of First Nations students, scholars, and academic leaders”.
Dr Geia believes that commitment was part of a confluence of events, a coming together of work and individuals, including Strickland’s arrival with “new, different eyes”.
“Anybody within the Australian nursing and midwifery profession could have done this a long time ago, but it didn’t happen,” she said, adding that it took courage to challenge the profession.
The timing finally was right. Professor Strickland said she did not face any resistance, with all members of the CDNM “overwhelmingly” supporting the apology and the commitment to a broader program of reform through two of the four pillars of the CDNM Strategic Plan.
Pillar one looks at increasing the number of Aboriginal and Torres Strait Islander nursing and midwifery students, in a culturally safe way, as part of an overall focus on inspiring nursing and midwifery careers through education, practice, research, and diversity.
Pillar four commits to a sustained plan of action in conjunction with CATSINaM and Wharangi Ruamano in Aotearoa/New Zealand to improve the health of Aboriginal, Torres Strait Islander, Māori and Pacific peoples. It promises that CDNM will lead the reform process, develop and support First Peoples academics, and ensure CDNM is a culturally safe space.
The CDNM and CATSINaM are working together on a paper about the apology and response, as a published response to Dr Geia’s call to action and, echoing national work on the Voice to Parliament, CDNM is also looking to privilege First Nations voices in its own governance structure.
The reform agenda includes curriculum reform to address the deficit focus that is still too often found in Aboriginal and Torres Strait Islander health education, and to work closely with CATSINAM on the ‘gettin em n keepin em n growin em’ report (known as GENKE II), to address the significant shortfall of Aboriginal and Torres Strait Islander nurses and midwives in the workforce and in leadership.
“This is big change,” said Dr Geia, who feels “very positive” about the road ahead, and is also acutely conscious of the need for the trans-Tasman body to also walk closely with Māori nurses and midwives.
“What we’re trying to do is bring repair and healing into a huge tear within the profession,” she said.
“I’m not going into this with rose coloured glasses but the unity we have now at the Council of Deans: this is a very important and effective foundation we are laying.”
This article was funded by CATSINaM and edited by Professor Roianne West. It was written on behalf of Croakey Professional Services by Marie McInerney, and also edited by Dr Tess Ryan and Dr Melissa Sweet.