Introduction by Croakey: The COVID-19 crisis is underscoring the critical importance of the Indigenous health workforce and Aboriginal Community Controlled Health Organisations (ACCHOs), as well as wider community organisations and networks.
In a timely call, Professor Roianne West, CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), is advocating for a big increase in the number of Aboriginal and Torres Strait Islander nurses and Midwives.
When presenting recently to a University of Sydney Distinguished Lecture Series marking International Day of the World’s Indigenous Peoples, West said an eight-fold increase in the number of Aboriginal and Torres Strait Islander nurses and midwives was necessary.
West, who is currently working from Kalkadoon Country at Mt Isa in north-west Queensland, delivered the lecture online and in the presence of her mother and other family members and colleagues. Below is an edited extract.
Roianne West writes:
The International Day of the World’s Indigenous Peoples was established by the United Nations in 1994, and on this day, I choose to promote and raise awareness of the plight and rights of Indigenous peoples world-wide, living with colonisation.
The United Nations Declaration on the Rights of Indigenous Peoples has a strong focus on the right to be free from discrimination across its 46 articles. Australia, after initially voting against the Declaration, now supports it, and the Declaration remains the most comprehensive international instrument on the rights of Indigenous peoples.
The 2021 theme for this day is “Leaving no one behind”: Indigenous peoples and the call for a new social contract. Indigenous leaders in the UN define a social contract as an unwritten agreement that societies make to cooperate for social and economic benefits of everyone.
My address is a call for nursing and midwifery professionals to work with us in dismantling and re-mantling the nursing and midwifery social contracts based on the United Nations Declaration on the Rights of Indigenous Peoples, inclusive of Aboriginal and Torres Strait Islander voices.
Only then can nursing and midwifery legitimately transform and lead the Commonwealth Government’s promise of “better health and wellbeing for all Australians, now and for future generations” into a reality for our Nation’s First People.
My address draws on a legacy and values and principles that I’ve inherited from my Aboriginality and my family who collectively have 200 years of nursing experience and thousands of years of nursing experience as carers and healers. Connected by blood, tied to the destiny of all our people whose veins pulse with sixty thousand years of connection to this land. This is not something to be taken lightly, nor something I think I could ever walk away from.
This legacy and cultural obligation is what has guided my critical reflections and observations over 25 years in nursing.
Currently, we have 415,433 practising nurses in Australia – an increase of 8.3% from 2018/19. Nurses are 51.8% of all registered health practitioners.
At present, 1.3% of nurses and midwives identify as Aboriginal and/or Torres Strait Islander, that is 5,037 nurses and midwives.
Currently we have 92,145 nursing students in Australia at 39 universities – up 2.8% from last year – and we have 3,985 registered midwifery students (up 0.9% from last year).
Of those, 1.3% of nurses and midwifery students identified as Aboriginal and/or Torres Strait Islander, that is 2,500 students.
An estimated 798,400 Australians identify as Indigenous (3.3% of the total Australian population).
The under-supply of the Aboriginal and Torres Strait Islander nursing and midwifery workforce is and has been a persistent and long-term problem in Australia.
I acknowledge the work of the Australian Health Practitioner Regulatory Authority (Ahpra) spearheaded by another Mt Isa product Professor Gregory Phillips of the Waanyi Jaru Peoples.
This work includes the establishment of the Aboriginal and Torres Strait Islander Health Strategy Group; and advocacy for Health Practitioner Regulation National Law Act 2009 to make cultural safety both a guiding principle and objective. When cultural safety is enshrined in the National Law, nurses and midwives who do not adhere to the practice standards and codes can be reported to Ahpra.
Another part of the work includes establishing a cultural expertise panel for these types of notifications. Given nurses and midwifes make up the greatest proportion of the regulated workforce, Aboriginal and Torres Strait Islander and Nursing and Midwifery cultural expertise is paramount.
Role of Indigenous knowledges and leadership
The role of Indigenous knowledges in policy, education, training, and practice is critical.
Every time our profession begins a meeting or a symposium or any forum with an Acknowledgement of Country, we are making real a rightful intersection of an ancient land and our planet’s oldest human cultures with a modern Australia, combining to give effect to our national culture and way of life.
In acknowledging the Kalkadoon at the beginning of the address, I show my respect to them and their ancestors for their continuing leadership and for their ever-evolving economic, social, cultural, spiritual and religious bequest to this region. It opens the way for Indigenous knowledge to be recognised as critical in delivering on the promise of closing the gap in health outcomes between Indigenous and other Australians.
My experiences in education have led me to recognise the importance of utilising the strength of the professions of nursing and midwifery in improving the circumstances facing our people and how designing and delivering services responding to the Indigenous health crisis, requires the input of our people.
This is not just an “Indigenous thing”, this is best practice program design and implementation in any field – to involve the people affected most so as to maximise the outcomes.
Indigenous knowledge is not possible without Indigenous people. Indigenous nursing and midwifery knowledge is not possible without Indigenous nurses and midwives. Our ways of utilising these knowledges must be respected and enabled.
Our profession has already started to build a recognisable Indigenous nursing workforce but growing and nurturing this workforce continues to be a challenge for us.
So how many Indigenous registered nurses do we need?
Based on population parity of 3%, we require 5,400 Indigenous registered nurses in Australia; this is four times the number we currently have.
However, when we factor in burden of disease – and I have done this conservatively, only allowing for twice the burden of disease – we require at least 10,800 Indigenous registered nurses.
This is 8.5 times the number we have currently.
If we are serious about better health and wellbeing for our nation’s First People, an Indigenous nursing workforce is essential. We have to increase the participation of Indigenous people in the nursing workforce and in order to achieve this we have to increase the number of Indigenous people completing university nursing programs.
We seem to be getting much better at attracting Indigenous students into nursing courses; however, our retention and completion rates are problematic, resulting in minimal traction in the goal of increasing our Indigenous nursing workforce.
This is again a result of the systems not trying or listening to our strategies for ‘gettin em n keepin em’ report.
Given the low Indigenous nursing numbers and the disproportionate representation of Indigenous people in the health system, unless we make increasing our Indigenous nursing numbers a national nursing priority we will continue to grapple with this issue.
This goal is so possible to achieve. We have the intelligence and the resources to figure this out.
Education and training needs to make a commitment to include Aboriginal and Torres Strait Islander Health and cultural safety education and training in our repertoire of nursing skills.
It’s clear that the professions ‘gets’ the importance of education. We demonstrated that in the transition from hospital to university education, we demonstrated that through the expansion of our schools of nursing into postgraduate studies and the ever-increasing number of nurses and midwives with PhDs and of our peak nursing bodies having nursing and midwifery education as a priority.
Now, we have to ‘get’ that Aboriginal and Torres Strait Islander Health and cultural safety needs to be added to nursing and midwifery education and training.
It is important to acknowledge the significant work already undertaken in this area by nurses, for example the ‘gettin em n keepin em’ report produced by the Indigenous Nursing Education Working Group, and the Nursing and Midwifery Aboriginal and Torres Strait Islander Health Curriculum Framework.
We need more exemplary nursing leaders like those who are leading us through the pandemic, and we need them more than ever before.
For those of us who work in Indigenous affairs, we have learned that leadership is most effective when it respects culture and is deliberately and consciously committed to learning about and building solutions from the best of both cultures.
We need nursing leaders, Indigenous and non-Indigenous, proficient at navigating the two-way learning space towards new and more sophisticated ways of working together.
Through strong nursing leadership the profession has successfully navigated some of the profession’s most challenging times. For example, leadership has helped us traverse COVID, Bushfires, Floods, Black Lives Matter, religious influences, guided the transition from hospital to university based education, steered significant contribution to the national debate on the quality of our health system, and conceptualised, developed and implemented National Registration.
This same leadership is required to rise to this challenge of improving the health outcomes for our Nation’s First People; leadership that demonstrates that the health of Aboriginal and Torres Strait Islander people is a concern for all nurses and midwives.
We need nursing and midwifery leaders from practice, policy, and academia to collaborate to strategically build the cultural safety of the nursing and midwifery workforce to this end. We need leaders who can unite us and inspire us and continue to model the required behaviours for future nursing and midwifery leaders.
My vision is for my grandchildren and their children to not be at risk when they visit a hospital, to uphold the legacy my grandmother left, and for Aboriginal and Torres Strait Islander Health and Cultural Safety education and training to be given the same level as consideration as has been given to other areas of nursing and midwifery education and training and that this occurs because the professions recognise it as a priority and aligns policy, education and practice accordingly.
Our unique Indigenous knowledges have so much to offer, for how our people have lived and survived in this Country, this unique opportunity is here to apply to education and training. All we ask is that you listen, truly listen, with your hearts as well as your minds, and work together.
I encourage nursing and midwifery leaders and organisations to lobby for CATSINaM to be resourced accordingly to lead this important work, and to become a member of CATSINaM!
Also, identify Aboriginal and Torres Strait Islander Health and Cultural Safety as a priority in your nursing and midwifery organisations’ strategic plans.
We all have the ability to learn and do better; in teaching the next generation of nurses and midwives, it’s about being respectful of two-way learning. I look forward to the future and to seeing a profession with new and more sophisticated ways of working together in the future – that my grandmother would be proud of.
Croakey acknowledges and thanks CATSINaM for the photographs accompanying this article.
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