Introduction by Dr Tess Ryan: Addressing racism and taking human rights-based approaches are fundamental to improving the health and wellbeing of Aboriginal and Torres Strait Islander people, and all health professions and organisations have a responsibility to step up.
These issues have been centre stage throughout the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) #BackToTheFire national conference series, which kicked off in April and concluded last week with three online events.
Also on the conference agenda have been critical national issues for Aboriginal and Torres Strait Islander nursing and midwifery, including growing the workforce, and the COVID-19 vaccination rollout to Aboriginal and Torres Strait Islander people.
At the conference, nursing and midwifery professions were urged, again, to respond to calls for truth telling and a national apology for the harm their professions have caused to Aboriginal and Torres Strait Islander patients, nurses and midwives through racism and culturally unsafe practices.
Marie McInerney reports below for the Croakey Conference News Service. See all of the #BackToTheFire conference coverage to date.
Marie McInerney writes:
Aboriginal and Torres Strait Islander health leaders are hopeful that longstanding calls for a national apology from Australian nursing and midwifery leaders for the impact of historic and ongoing racism may finally get momentum.
Professor Karen Strickland, newly appointed chair of the Council of Deans of Nursing and Midwifery Schools (Australia and New Zealand), has backed the need for an apology and committed to placing racism and cultural safety in Aboriginal and Torres Strait Islander healthcare on the peak body’s strategic agenda.
Strickland’s support, just weeks after she took up the role, came at last week’s Western Australian Forum of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) #BackToTheFire conference series.
CATSINaM CEO Dr Roianne West, who earlier this year co-authored an editorial in the Australian Journal of Advanced Nursing on the need to decolonise nursing and midwifery research and education, said it was a “welcomed and timely commitment”.
“What she exemplified is the shared responsibility, and what we really want is non-Indigenous leadership stepping up,” West told Croakey.
In 2017, CATSINaM, then headed by Dr Janine Mohamed, called on the profession to follow the lead of the Australian Psychological Society, which apologised for psychology’s role in colonising practices that have had caused trauma and harm for Aboriginal and Torres Strait Islander people.
The Australian Nursing and Midwifery Federation (ANMF) said at the time it was considering the call but CATSINaM has not heard back since.
Earlier this year, on National Sorry Day and at an earlier #BackToTheFire event, CATSINaM repeated the call for an apology, given the role of nurses and midwives in the forcible removal of Aboriginal and Torres Strait Islander children from their families and communities.
It followed a presentation by Associate Professor Cath Chamberlain on the “catastrophic” impact of ever increasing rates of removing Aboriginal and Torres Strait Islander children from family.
Mohamed, now CEO of the Lowitja Institute, also welcomed news of Strickland’s support, saying she had not heard back on any progress from the Council of Deans or the ANMF.
“Like the Uluru Statement, when things go unresponded to, that silence does a lot of harm,” she said.
Mohamed said she had “understood and respected” that people in the profession may have wanted to make sure that an apology was not empty symbolism, “that they want to do something deeper than that”.
But she said, “the momentum has to be with them, not with us”, adding that it would be a shame to stall the ground breaking work that had been done in nursing and midwifery, embedding cultural safety into codes of conduct and curriculum accreditation standards.
West said CATSINaM would next year mark its 25th anniversary, after being founded to address racism within nursing and within the healthcare system.
“An apology at this time opens the way for a future based on mutual respect, mutual responsibility and shared decision making,” she said.
Asked about the ANMF’s position, Lori-Anne Sharp, assistant federal secretary, told Croakey an apology was an important issue for nursing and midwifery in Australia to address, but “regrettably our work on it has been disrupted, particularly by COVID in the past two years”.
“It’s good to be reminded that it should be high on our agenda, so we can get moving on a process of consulting with our members and branches,” she said.
The Australian College of Nurses said it was unable to comment in time for publication of this article.
Time to heal the profession
The CATSINaM WA Forum heard a powerful presentation from Bwgcolman nursing leader Dr Lynore Geia, who said it was the responsibility of every nurse and midwife to “recognise, confront and challenge racism”, to practise safe care, and to deeply reflect on the culture of the profession.
Geia last year led a unified call to action to Australian nurses and midwives in the wake of the death of George Floyd and the eruption of #BlackLivesMatter protests across the globe.
Published last year in Contemporary Nurse, the call to action was signed by more than 100 Indigenous and non-Indigenous nursing and midwifery leaders, including two members of the Council of Deans.
It is time for nursing and midwifery in Australia to “metaphorically take to one knee”, as many sporting teams do, to acknowledge and challenge racism in its midst, the paper says.
“Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning and practice,” Geia told the CATSINaM conference.
Currently on sabbatical from her role as Academic Lead – Aboriginal and Torres Strait Islander Health at James Cook University, she urged non-Indigenous nurses and midwives to stand up and help “dismantle the old systems of oppression and build new systems of therapeutic health justice”.
“It is time to heal our profession,” she said.
The conference heard through multiple presentations and discussions how ongoing racism and culturally unsafe education and practices in the profession not only impact on health outcomes for Aboriginal and Torres Strait Islander people but also the Aboriginal and Torres Strait Islander nursing and midwifery workforce and students.
Geia’s speech prompted one of the WA participants to share what it is like for her as the “only Aboriginal nurse on my ward”, and how she deals with the hurt and distress caused by patients and colleagues.
The nurse’s experience was a “clear example” of the need to acknowledge the colonial roots of the nursing and midwifery professions and “that racism still exists in the professions”, said Strickland who was attending from hotel quarantine in Perth on her way to take up her new role as Executive Dean of the School of Nursing and Midwifery at the Edith Cowan University.
Asked by Roianne West to respond to Geia’s presentation, Strickland said she was conscious that the Council of Deans strategic plan was currently silent on how to address the issues raised by the call to action.
“I’ll be taking carriage of that going forward, to make sure the future Strategic Plan of the Council of Deans does address the issues laid out so well in the paper,” she said.
That would include working to increase the number of Aboriginal and Torres Strait Islander nursing and midwifery students who complete their studies, increasing the number of Indigenous faculty numbers, and developing a pathway for future Aboriginal and Torres Strait Islander Deans of Nursing and Midwifery, she said.
Currently 750 Aboriginal and Torres Strait Islander students commence nursing and midwifery each year, but only around 250-300 graduate, a completion rate that is 30 percent lower than for non-Indigenous students and rising only one percent per year, CATSINaM says.
Speaking later to Croakey, Strickland, who moved to Australia four years ago from Scotland, also raised her support for a national apology from the profession, saying she was unsure what was delaying progress on CATSINaM’s call “because to me it seems like a no brainer”.
“There has been harm done and harm that has continued to happen, and we are supposed to be a caring profession, so I’m not sure what is holding us back,” she said.
Strickland met with the CDNM Executive Committee on Friday and said she has “their full support in taking this forward”.
Geia also welcomed Strickland’s commitment, saying the growing support for the issues raised in the call to action paper indicated that nursing and midwifery had matured enough to “start looking at our own house”, to examine what has happened and continues to happen, and to apologise for “wrongs committed and harms inflicted from the profession”.
Geia said she would like to see a formal process involved in an apology, that worked with Aboriginal and Torres Strait Islander nurses and midwives, but also engaged with communities and heard from them about their experiences, in a process which is both cathartic and healing.
She predicted it may be tough, recalling the backlash and misleading media reports when cultural safety was introduced in 2018 to codes of conduct for nurses and midwives, and will be an uncomfortable space for both Indigenous and non-Indigenous nursing and midwifery professionals.
“Because it’s going to take a lot of self reflection, a lot of looking at our history of nursing in Australia, looking at some of those oppressive practices that have happened, reflecting on that, and how it reflects on us as a profession,” she told Croakey.
“It won’t be a smooth journey, it will have a lot of ups and downs in it, but it’s a good journey to take,” she said, adding that the timing was right but keeping up the momentum would require “work and will”.
Addressing COVID and workforce risks
Dr Roianne West is a Kalkadunga and Djaku-nde woman hailing from her grandmother’s ancestral lands near Mount Isa, who told the conference that her twin daughters had become the fifth generation of her family working in healthcare.
“This is more than a job for us, it’s a legacy,” she said.
Soon after her appointment to head CATSINaM, West’s team launched the #BackToTheFire conference series, so it could get out to all states and territories “to engage, reconnect and mobilise local members to address local issues” and to connect to its founding members.
Disrupted by the Delta COVID-19 outbreaks after five conferences (on Yirrganydji and Yidinji Country in Cairns, Larrakia Country in Darwin on Larrrakia land, Kaurna Country in Adelaide, in nipaluna/Hobart and Bunurong Boon Wurrung and Wurundjeri Woi Wurring lands in Naarm (Melbourne), its final three events — for WA, New South Wales, and the ACT — were held online last week.
West opened each of the online events with a “moment of silence” for founding members and other Aboriginal and Torres Strait Islander nurses and midwives who have died in recent times, as well as for community members lost from COVID-19 in the Delta outbreak.
Amid concerns about low vaccination rates in some Aboriginal and Torres Strait Islander communities as Australia opens up, West told Croakey the Federal Government had yet to respond to a CATSINaM proposal for a targeted strategy to engage the Aboriginal and Torres Strait Islander nursing workforce in the vaccination rollout.
This “would have gone a long way to addressing some of the trust issues of the Aboriginal and Torres Strait Islander communities in Australia’s healthcare system and the COVID response”, she said.
“CATSINaM put forward a proposal identifying specifically how many Aboriginal and Torres Strait Islander nurses were within close vicinity of the high-risk communities and potentially could be deployed to carry out vaccine clinics,” she said.
The Federal Health Department told Croakey this week the proposal from CATSINaM was “currently under consideration within the Department”.
Workforce has been a big issue for the conference series. Despite calls over decades for an eight-fold increase in the number of Aboriginal and Torres Strait Islander nurses and midwives, West told the conference there was “a long way to go”.
The landmark 2002 ‘gettin em n keepin em’ report had aimed to boost the number of Aboriginal and Torres Strait Islander nurses and midwives to population parity levels – three percent of the total workforce.
Yet they still make up just over one percent.
Preliminary results from a 20-year follow-up and evaluation of the report will be released in January, after having had significant buy-in from nursing and midwifery academic leadership, including 37 out of the 39 Deans of Nursing and Midwifery.
West said the evaluation will shift focus from “operational” to the “systemic and structural” issues underlying persistent workforce concerns.
The role of Indigenous knowledge was critical in addressing inequities in First Nations health, West said, but “Indigenous knowledge in nursing is not possible without Indigenous nurses”.
See this Twitter thread from last week’s #BackToTheFire forums by Dr Tess Ryan.
Further reading: ‘Let’s talk about racism’, article featuring Dr Roianne West in the Australian Nursery and Midwifery Journal‘s latest edition.