Aboriginal and Torres Strait Islander health professionals bring a wealth of expertise to their roles, according to members of the National Health Leadership Forum (NHLF), a peak body representing the views of 12 Aboriginal and Torres Strait Islander organisations working in health and wellbeing.
However, many mainstream health services could be doing far more to provide culturally safe workplaces that are committed to addressing racism, they say.
This article is published by Croakey Professional Services as sponsored content.
Croakey Professional Services writes:
When Kuku Yalanji man Karl Briscoe told his mother he had a job as an Aboriginal Health Worker, he was surprised to find out that she had once been a health worker. Until that moment, he had only ever known her as a “housewife raising seven children”, when in actual fact, his mother was one of the first two Aboriginal Health Workers in Queensland.
Briscoe – now CEO of the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP) – didn’t start out in healthcare right after school. It wasn’t until he had been working in the hospitality industry in Cairns for about seven years that “something started to churn inside him”.
“You’re serving all these tourists. What about your people?”, he thought – and subsequently went on to find work as a trainee health worker in a multipurpose health service on Kuku Yalanji country, in the Mossman-Daintree region, north Queensland.
For Meriam, Erubam and Wuthathi man Dr Ali Drummond, recently appointed as CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), the desire to work in the health sector had always been present. His mother is a Torres Strait Islander health worker and when James Cook University opened a campus on Thursday Island – offering nursing and teaching – she encouraged him to enrol in nursing.
Drummond developed a keen interest in delivering healthcare and valued the diversity that nursing offered, beginning his graduate year in orthopaedics at Princess Alexandra Hospital in Brisbane.
“Nurses are present throughout the entire care continuum,” he said – from admission through to rehabilitation and nursing care in between. Nurses are essential to primary healthcare, he told Croakey.
Leadership matters
Briscoe and Drummond are now in senior leadership roles in the Aboriginal and Torres Strait Islander health sector, at NAATSIHWP and CATSINaM respectively.
Established in 2009, NAATSIHWP is the peak body for Aboriginal and/or Torres Strait Islander Health Workers and Practitioners in Australia. A member-based organisation, its members work in the Aboriginal community-controlled health sector, other Aboriginal and Torres Strait Islander medical services, mainstream and private health services.
Briscoe told Croakey that he values the opportunity to influence how program initiatives and policies are shaped. The practical experience working as an Aboriginal Health Worker provided a solid grounding for the policy roles he has undertaken, he said.
In addition, Briscoe has enjoyed working to raise the profile of the profession. While there’s a long way to go, he said a range of stakeholders within the health sector, including the Australian Medical Council and RACGP, recognise the role of Aboriginal and Torres Strait Islander Health Worker and Practitioner.
In particular, the cultural expertise of the profession is being “respected and recognised”, Briscoe said.
CATSINaM is the peak advocacy body for Aboriginal and Torres Strait Islander nurses and midwives in Australia. Celebrating their 25th anniversary in 2022, they embed a membership-centred approach strongly focused on Aboriginal and Torres Strait Islander nurses, midwives and students. “That focus is so important,” Drummond said.
One of his key priorities as CEO is to continue the legacy of engaging members in things they’re interested in, he told Croakey. This includes engaging members in advancing their practice, supporting pathways, and giving “them opportunities to optimise their knowledge but also sharing of their experience”.
In addition, Drummond said it is important to build the influence of the nursing-midwifery profession in health service delivery in Australia.
Cultural expertise
One of the strengths of the Aboriginal and Torres Strait Islander health professions is their cultural knowledge, understanding and personal experience.
The Aboriginal and Torres Strait Islander health workforce “holds a diverse range of experiences of being a First Nations person in this country, and the knowledge of their family and communities, and how this may influence a person’s interaction with the health system,” according to Fiona Cornforth, a Wuthathi descendant and Chair of the National Health Leadership Forum (NHLF) and CEO of The Healing Foundation.
She said this “provides important insight for a [mainstream] health service to learn and harness to inform the way they provide care”.
Briscoe added: “Our profession is the only culturally raised health profession with national training and regulation, and we think it’s a source of national pride that should be celebrated every day.”
However, working in the health sector is not without its challenges.
Addressing racism
Briscoe told Croakey that he has seen many Aboriginal and Torres Strait Islander health workers leave the sector due to working in culturally unsafe spaces.
Structural reform and embedding cultural safety into entire operations – “not just a couple of days training” – is needed to help retain the Aboriginal and Torres Strait Islander health workforce, he said.
Culturally unsafe work environments for Aboriginal and Torres Strait Islander health professionals within mainstream services is a major concern for the NHLF, according to Cornforth, and leads to “low retention rates”.
The lack of safety comes from patients as well as other staff members challenging Aboriginal and Torres Strait Islander health professionals their qualifications, she said. In addition to behaviours and attitudes, workplaces have culturally unsafe policies and procedures that are rigid and “diminish the provision of good person-centred care”.
NHLF – a collective partnership of national organisations, including The Healing Foundation, NAATSIHWP and CATSINaM – represent a united voice on Aboriginal and Torres Strait Islander health and wellbeing, and provide leadership, insights and advice to members on what needs to be done to address racism.
However, according to Cornforth, it is the responsibility of those who work within health systems across Australia to implement national policies endorsed by governments.
Additionally, it is up to the 97 percent of the non-Indigenous health workforce to “start to address institutional discriminatory practices that exist within the health system”, and for creating a better health system and outcomes.
While the current “social and political environment is ripe for change” with government, health and education sector leaders more willing to talk about racism, Drummond says that barriers remain.
Echoing Briscoe’s sentiments, Drummond called for structural change within workplaces and the education environment.
Qualified nurses and midwives, and students on clinical placements experience racism in the workplace, he said.
Drummond suggested multiple approaches are required to address racism, including leadership from the top, education and academic lessons around the “operations of racism and what needs to be done about it”, and better coordination around understanding the size of the problem.
“It’s so easy to be superficial about committing to address racism. Getting people to acknowledge the harms of racism is one thing, getting things to change is something else,” he said.
Cornforth said that to address racism, individuals need to understand what racism is and the impact it has on people. By undertaking cultural safety training – which can be uncomfortable – people learn about the “harms done by policies that specifically targeted Aboriginal and Torres Strait Islander peoples”.
She said that learning Australia’s true history – that it was not established on “fair, equal, respectful or just grounds” – and becoming comfortable with the discomfort can be enlightening.
“It isn’t about individuals apologising for past practices of our governments, but to learn, understand and inform individual practice and accept change within health services,” Cornforth said.
Membership support
NHLF members all provide support to their own membership of health professionals “through the sharing of experiences, providing informal and formal mentoring and leadership in the sector”, Cornforth told Croakey.
Drummond encourages members to engage with the CATSINaM organisation and other members, particularly for younger members starting out.
“There’s strength in yarning about some of the challenges experienced, whether it’s racism, financial matters or trying to juggle obligations between studying, family and community,” Drummond said.
“These are all things that other Aboriginal and Torres Strait Islander nurses and midwives have experienced before, so they can offer advice and support and suggestions around how you navigate these obstacles.”
NHLF workforce members also advocate and work with their respective educational institutions, professional colleges and associations to address racism and other retention issues, according to Cornforth.
Inconsistent national scope of practice
Another challenge for the Aboriginal and Torres Strait Islander health workforce is inconsistent scope of practices across the country, Briscoe told Croakey.
For example, in one state a person qualified as an Aboriginal Health Worker can do a blood pressure test. In another state, the same person or an Aboriginal Health Worker with the same qualifications cannot do a blood pressure test, according to Briscoe.
This was particularly challenging during the early days of the COVID-19 pandemic – at this time, Briscoe and NAATSIHWP called for a standardised minimum scope of practice to allow Aboriginal and Torres Strait Islander Health Workers and Practitioners to “have the same basic rights to supply and administer medications in their communities”, and thus minimising stress on the workforce.
The inconsistent scope of practice also makes strengthening the workforce a challenge – for some workers who move interstate, they are “actually de-skilling themselves,” Briscoe told Croakey.
National consistency would enable Aboriginal and Torres Strait Islander Health Workers to go back and work in their traditional homelands without losing skills, he said.
Listen, learn and act
Many strategies exist for mainstream health services to improve recruitment and retention of the Aboriginal and Torres Strait Islander health workforce, according to Cornforth.
Strategies and actions outlined in the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan 2021-2031 were co-designed and informed by the workforce peaks within the NHLF membership, as well as the community-controlled health sector.
Six overarching strategic directions are included in the Framework to support the ongoing development of the Aboriginal and Torres Strait Islander health workforce:
- Aboriginal and Torres Strait Islander people are represented and supported across all health disciplines, roles and functions.
- The Aboriginal and Torres Strait Islander health workforce has the necessary skills, capacity and leadership across all health disciplines, roles and functions.
- Aboriginal and Torres Strait Islander people are employed in culturally safe and responsive workplace environments that are free of racism across health and all related sectors.
- There are sufficient numbers of Aboriginal and Torres Strait Islander students studying and completing health qualifications to meet the future healthcare needs of Aboriginal and Torres Strait Islander people.
- Aboriginal and Torres Strait Islander health students have successful transitions into the workforce access clear career pathway options.
- Information and data are provided and shared across systems to assist health workforce planning, policy development, monitoring and evaluation and continuous quality improvement.
Additionally, the National Safety Quality Health Services Standards includes six action areas specific to creating culturally safe workplaces and improving better care.
“If a mainstream health service is genuine about wanting to improve their service, then the guidance is available for them to tap into and utilise,” Cornforth said.
Whatever a health service does, she said, it is critical to listen, learn and act on the advice given if asking Aboriginal and Torres Strait Islander staff for input.
“Ignoring any consultation process only damages relationships and is an insult to those who willingly gave of themselves. Ignoring advice from staff because it is not liked or too hard to implement is a failure of the leadership and management within the health service.
“It is hard work to change but it can be rewarding,” Cornforth told Croakey.
From Twitter
• This article was funded by the National Health Leadership Forum (NHLF) and edited by Forum members. It was written on behalf of Croakey Professional Services by Alison Barrett, and also edited by Dr Summer May Finlay and Dr Melissa Sweet.
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