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Amid momentum for change, now is the time for system reform to embed cultural safety

Croakey is closed for summer holidays and will resume publishing in the week of 15 January 2024. In the meantime, we are re-publishing some of our top articles from 2023.

This article was first published on Wednesday, February 1, 2023


Introduction by Croakey: The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) celebrated its 25th anniversary at a special annual meeting in August 2022.

As well as marking the organisation’s many achievements, the meeting challenged Australian governments and the health sector to boost numbers of Aboriginal and Torres Strait Islander nurses and midwives, and to address racism.

Published by Croakey Professional Services, this is the final article in a series of sponsored content celebrating CATSINaM’s 25-year history of collective and individual activism. See the campaign portal.


Croakey Professional Services writes:

For Marni Tuala, the 25th anniversary meeting of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) in August 2022 was an emotional and historic tribute to the enduring strength and power of those who founded the organisation.

Tuala, a proud Bundjalung woman, midwife and CATSINaM president, hopes the anniversary event – and the cultural and intellectual firepower, relationships and partnerships it showcased – will also stand out in history as a marker for momentous change.

“In the next 25 years, I hope we can look back and see this as a momentous occasion that really shifted the discourse around Aboriginal and Torres Strait Islander health and specifically for nursing and midwifery,” she said.

The two-day event was held in Sydney, on the lands of the Gadigal peoples of the Eora Nation, where CATSINaM was founded in 1997 by a small group of Aboriginal and Torres Strait Islander nurses and midwives.

Those founding members were intent on addressing racism experienced in health services and the health workforce, on improving care for their families and communities, and ultimately on creating and finding a culturally safe space for themselves.

Interviewed at the event, founding member Aunty Lynda Holden talks about having met up there with members of CATSINaM’s Elders Circle, seeing in them an enduring passion for Aboriginal and Torres Strait Islander health.

“It’s like a fire in their bellies,” she said. “It hasn’t been extinguished at all with time.”

She recalled CATSINaM being born out of the racism that its founding members experienced in their work and of being criticised in the early days of her career for being “too political”.

“I think all nurses should be very political,” she said.

Founding member Aunty Lynda Holden

Collective leadership

More than 300 past, present and future Aboriginal and Torres Strait Islander nurses and midwives attended the two-day event, including members of CATSINaM’s Elders Circle and of the Muliyan consortium, a national collaboration of Aboriginal and Torres Strait Islander nursing and midwifery practitioners, educators, researchers and allies to address racism.

Amid much emotion they witnessed an historic formal apology from Australian nursing and midwifery educators for the harm and trauma caused by the profession to Aboriginal and Torres Strait Islander people since colonisation.

Conference participants also called on the Australian Government and key nursing and midwifery organisations to work in partnership with CATSINaM to address the “negligible” rise in the number of Aboriginal and Torres Strait Islander nurses and midwives over the past two decades, despite evidence of their crucial role in improving health outcomes for Aboriginal and Torres Strait Islander people and communities.

The anniversary events and celebrations that took place over 12 months have been built on CATSINaM’s cultural framework of collective leadership, that recognises that “everybody holds knowledge, nobody holds all the knowledge”, Marni Tuala said.

And now it is seeing momentum for change building through its powerful cultural connections with its members, past and present, and in the strength of new partnerships: having “the right people in decision-making” and a new Federal Government committed to embedding a Voice to Parliament in the Australian constitution, she said.

Reflecting on the milestone event, Tuala said she has a sense that Aboriginal and Torres Strait Islander nursing and midwifery in Australia is “on the edge of something incredible”.

Tuala is one of a number of leading Aboriginal and Torres Strait Islander nurses, midwives and academics who reflected on CATSINaM’s anniversary and ongoing work at the event.  

Another who did so was Professor Gracelyn Smallwood AM, a Birrigubba, Kalkadoon and South-Sea Islander woman who was awarded an Order of Australia in 1992 for service to public health, particularly HIV-AIDS education.

At the conference she said that in her wildest dreams back in those early days of CATSINaM, she could not have imagined that the organisation would be marking its 25th anniversary in such a way, reflecting on so many achievements, and “seeing this moving and shaking going on…in the presence of First Nations royalty”.

Professor Gracelyn Smallwood AM

Dr Carmen Parter, a proud descendent of the Darumbal and Juru clans of the Birra Gubba Nation of Queensland with South Sea Islander heritage – Tanna Island of Vanuatu, spoke after going with her family to see the “In Our Own Right” exhibition, created by CATSINaM for the anniversary to share the stories of its founding members and ancestors, and their successors.

“To be honest I’ve walked away feeling extremely emotional,” Dr Parter said.

“I think hearing those stories of oppression in the nursing profession…knowing from those stories are the strength that we can stand on to make the changes that need to be made”.

Dr Carmen Parter

CATSINaM’s goal from the start had been to create a safe space for Aboriginal and Torres Strait Islander nurses and midwives who felt isolated, sidelined, and subject to racism in their work, said CATSINaM Board director, Professor Karen Adams, who is Wiradjuri and Director of the Gukwonderuk Indigenous Health Unit at Monash University in Naarm/Melbourne.

She enjoyed watching nursing and midwifery students attending the anniversary event, seeing them take in the organisation’s leadership role and its founding stories, and how it was still providing “a place to be, and belong, to be who you are” that most do not get in any other health space, she said.

Ensuring more Aboriginal and Torres Strait Islander nurses and midwives were safe and able to join their ranks and to boost their numbers, influence and recognition of their cultural knowledges was “the next step” in CATSINaM’s work, she said.

New report

To that end, the then CATSINaM CEO Professor Roianne West launched the highly anticipated report: ‘gettin em n keepin em n growin em’ (GENKE II) by CATSINaM – Issuu, known as GENKE II, at the conference.

It follows up on the seminal 2002 ‘gettin em n keepin em’: Report of the Indigenous Nursing and Education Working Group (GENKE I) report, led 20 years ago by Wiradjuri woman and CATSINaM founder Dr Sally Goold.

GENKE I argued that many more Aboriginal and Torres Strait Islander nurses and midwives were needed to make the health system safer for Aboriginal and Torres Strait Islander people – urging that their numbers reach at least population parity of around three percent, up from just 0.4 percent of the registered nurse workforce at the time.

But progress has been slow and disappointing, Professor West, a descendant of the Kalkadoon and Djunke peoples, told the launch session at the anniversary event.

Despite those clear calls two decades ago, Aboriginal and Torres Strait Islander nurses and midwives still only make up 1.4 percent of the Australian nursing and midwifery workforce.

“Worse still, in 20 years our registered nurses occupy just 1.16 percent of the greater registered nursing workforce, only a 0.76 percent improvement since 2002,” Professor West said.

Professor Roianne West, launching the report

CATSINaM has long argued that the under-supply of Aboriginal and Torres Strait Islander nurses and midwives is a persistent problem in Australia that challenges hospitals and health services, as well as in academic settings, including nursing and midwifery schools, to improve cultural safety and healthcare.

Aboriginal and Torres Strait Islander nursing and midwifery students are still 30 percent less likely than non-Indigenous students to complete their studies, with a completion rate that is only rising one percent per year. Aboriginal and Torres Strait Islander people make up only around 170 of the nation’s 9,000-plus nurse educators.

Behind those numbers is the “ugly disease of racism”, said Professor Smallwood, adding that she has worked as a nurse, midwife and academic around the world and “it’s the only disease I can’t come to terms with”.

Indigenous leadership, strong partnerships

Leading non-Indigenous nursing academic Professor Kim Usher worked with Dr Goold on GENKE I, not knowing then how important the report would become: a seminal piece of work that led to many changes in nursing and midwifery.

But many of its recommendations had been “left on the shelf”, so she accepted an invitation from CATSINaM to review progress 20 years on.

That review determined that Aboriginal and Torres Strait Islander nursing and midwifery numbers were “nowhere near parity”. While all Australian Nursing and Midwifery Advisory Council (ANMAC) nursing and midwifery teaching programs now include mandatory units on Aboriginal and Torres Strait Islander peoples’ history, culture and health, there is “great variation” in how that was done.

“Unfortunately, in many cases, even though the content may be there, it’s being taught from a deficit lens…that positions Aboriginal and Torres Strait Islander people poorly,” she said, reflecting that having such content “may have done more harm than not having it there”.

The review’s third major concern was around clinical placements, where some nursing and midwifery students felt “treated very badly”, shamed and embarrassed, underscoring the evidence that “racism is still systematic across health care in this country and that must change,” Professor Usher said.

Those findings have gone on to inform a series of clear strategic recommendations in GENKE II, where CATSINaM calls for national partnerships and strategies that privilege Aboriginal and Torres Strait Islander nursing and midwifery knowledges and embed cultural safety across all the domains of nursing and midwifery education.

It’s a call that is being heard and supported by a number of key organisations, including the Nursing and Midwifery Board of Australia (NMBA), ANMAC and the Council of Deans of Nursing and Midwifery.

“We absolutely, fully endorse GENKE,” said ANMAC Board Chairperson, Professor Wendy Cross, telling Croakey it was critical for nurses and midwives, and all health professionals, to understand Aboriginal and Torres Strait Islander health and history and to recognise the role and impact of dominant culture and unconscious bias.

Building momentum

Professor Cross agreed there is momentum for change now, through the work of CATSINaM, the Council of Deans Apology, Federal Government support for a Voice to Parliament, and the 2020 #BlackLivesMatter call to action for nursing and midwifery issued by CATSINaM founding member Dr Lynore Geia and colleagues.

“Wherever you look at the moment, there’s a groundswell and I think that the time is right, and of course there is no other group to lead it from a health perspective in nursing and midwifery other than CATSINaM,” she said, urging other mainstream health organisations, including those working in primary and community care and mental health, to also step up.

Such change has not been easy to achieve in the past. This was demonstrated in an orchestrated backlash to changes to new codes of conduct for nurses and midwives that accepted the advice of CATSINaM, then led by Adjunct Professor Janine Mohamed, that cultural safety should be recognised as an integral part of ethical and competent professional practice.

That’s a risk also for the GENKE II reform agenda, Professor Cross acknowledged, but she said the profession needs to be able to explain how important the reforms are for Aboriginal and Torres Strait Islander health and the health workforce.

Like CATSINaM, she is confident the Federal Government will also support GENKE II, but she said buy-in from states and territories will also be critical, given they run health services.

“We’ve got to change the way practice occurs,” she said, observing that, no matter what their training, health workers become enculturated into the health service they work in, and that could be risky for Abor