The material on this page was written by the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM). Nurse Midwife Support are grateful for the input of CATSINaM to inform this content
Aboriginal and/or Torres Strait Islander nurses, midwives and students work across the health system, including in hospitals, primary health care, aged care, community care and Aboriginal Community Controlled Health Services. Understanding Aboriginal and/or Torres Strait Islander nurses, midwives and students cultural and health needs can help support them in their careers and improve services for all Aboriginal and/or Torres Strait Islander people.
If you are an Aboriginal and/or Torres Strait Islander nurse, midwife or student, you can chat to someone through our confidential support line 24/7 on 1800 667 877. If you are a manager or colleague of an Aboriginal and/or Torres Strait Islander nurse, midwife or student, you can also call for guidance on how you can better support your staff members/colleague.
Throughout their careers Aboriginal and/or Torres Strait Islander nurses, midwives and students will experience the same range of challenges as their colleagues. However, they are also frequently faced with additional challenges due to low representation in the workforce and cultural isolation, cultural loads, and a lack of cultural safety due to Australia’s historical and contemporary context of racism.
As a result, Aboriginal and/or Torres Strait Islander nurses, midwives and students can face higher stress in what are often already stressful work contexts. Access to support within and beyond the workplace or clinical placement is important to ensure they can continue with their chosen profession and career path. This is particularly critical given the urgent need to increase the Aboriginal and/or Torres Strait Islander nursing and midwifery workforce, which is currently only just over 1% of the workforce.
Aboriginal and/or Torres Strait Islander nurses and midwives are frequently the only Aboriginal and/or Torres Strait Islander nurse, midwife or staff member in a ward, unit, program or the whole service. This can be very isolating, especially when they often face an expectation from colleagues to be the person who responds to the needs of Aboriginal and/or Torres Strait Islander patients, residents or clients, even if this is in addition to their primary role or workload. This additional level of responsibility is not usually placed upon non-Indigenous nurses and midwives, and may contribute to higher rates of burnout for Aboriginal and/or Torres Strait Islander nurses and midwives.
When Aboriginal and/or Torres Strait Islander student nurses and midwives are on clinical placements, they are there to learn and develop their knowledge and skills, just like any other student. Frequently, they are the only Aboriginal and/or Torres Strait Islander student and there may be no Aboriginal and/or Torres Strait Islander people on staff in the placement.
It is unhelpful and inappropriate to ask them to provide advice about, or do additional tasks to address Aboriginal and/or Torres Strait Islander patient/client needs, when that is the responsibility of qualified staff. Unfortunately, this can occur on placements yet is not asked of non-Indigenous students. Along with experiencing racism, this situation places additional pressure on students at a critical time in their learning, and is known to result in students withdrawing from their nursing or midwifery studies.
Racism remains a common experience for Aboriginal and/or Torres Strait Islander Australians; recent research indicates that almost all experience racism, often on multiple occasions. Racism also happens in the health system, to Aboriginal and/or Torres Strait Islander staff and to patients and clients. The research indicates that this has serious consequences for health care and health outcomes. It is distressing for any Aboriginal and/or Torres Strait Islander person to experience, and is exacerbated for Aboriginal and/or Torres Strait Islander nurses and midwives when they witness it happening to their patients/clients.
This is consistent with what Aboriginal and/or Torres Strait Islander nurses and midwives tell CATSINaM when they consult with their members. Racism is a major contributor to the higher stress that Aboriginal and/or Torres Strait Islander nurses, midwives and students experience. It is what leads them to change jobs or not pursue career opportunities; for students, it leads them to withdraw from their studies.
The existence of racism in the health system has now been acknowledged in national health planning documents, such as the National Aboriginal and Torres Strait Islander Health Plan. The need to develop and implement strategies to address racism has been recognised. While these strategies are being put in place, it is occurring at very different rates across the breadth of the health system. Aboriginal and/or Torres Strait Islander nurses and midwives may work in locations where this is not yet occurring, or this is only in its early stages.
It is important for non-Indigenous peers and management to know they can play a significant role in supporting Aboriginal and/or Torres Strait Islander nurses, midwives and students. It is vital they listen and acknowledge experiences of racism shared by Aboriginal and/or Torres Strait Islander nurses and midwives; failure to do this makes the situation worse and increases the likelihood of ongoing stress and its consequences. They can also participate in cultural safety training to learn how to identify and address racism, but more importantly, to prevent it. For more information about how to access cultural safety training, contact CATSINaM.
Cultural load refers to the additional responsibilities that some Aboriginal and/or Torres Strait Islander nurses and midwives hold in supporting their family and community. These include obligations to provide support and leadership for and on behalf of their community. There is a very inclusive approach to who is defined as family for many Aboriginal and/or Torres Strait Islander people, so these responsibilities can be quite high. Aboriginal and Torres Strait Islander nurses and midwives in these situations can face dilemmas in looking after these obligations while also meeting their work responsibilities. At times, their health and wellbeing can be compromised in trying to do this.
Colleagues and management can play a valuable role if they are willing to discuss these dilemmas, and adopt flexible approaches that assist Aboriginal and/or Torres Strait Islander nurses and midwives meet family/community as well as work responsibilities. This can contribute to improved and/or better managed health and wellbeing. However, it may also be useful to encourage Aboriginal and/or Torres Strait Islander nurses and midwives to seek external support if their combined workload and cultural load is difficult to manage and they need better strategies.
The Nursing and Midwifery Board Codes of Professional Conduct (2008) for nurses and midwives require that nurses and midwives “respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues”, and therefore, the care they provide “is not compromised because of harmful prejudicial attitudes about race, culture, ethnicity”. This position is mirrored in the Code of Ethics (2008) for nurses and midwives, where several clauses emphasise the requirement to eliminate attitudes and care that is based on prejudicial attitudes about race, culture and ethnicity.
Any nurse or midwife that believes that a colleague or manager has breached the codes, can raise this in accordance with their organisation’s policies and procedures. Alternatively, they can contact the Australian Health Practitioner Regulation Agency (AHPRA) directly.
In addition to this, there are four pieces of national legislation and policy that are important to consider if Aboriginal and/or Torres Strait Islander nurses, midwives or students experience racism.
This Commonwealth Act was the first piece of legislation created to specifically address racism, and remains the only one that is solely focused on racism. Over time, each state and territory has brought in an equivalent piece of legislation that includes the other grounds on which people are discriminated against. These pieces of legislation are:
- Australian Capital Territory: Discrimination Act 1991,
- New South Wales: Anti-Discrimination Act 1977,
- Northern Territory: Anti-Discrimination Act 1996,
- Queensland: Anti-Discrimination Act 1991,
- South Australia: Equal Opportunity Act 1984,
- Tasmania: Anti-Discrimination Act 1998,
- Victoria: Equal Opportunity Act 2010,
- Western Australia: Equal Opportunity Act 1984.
The Australian Human Rights Commission (formerly the Human Rights and Equal Opportunity Commission), was established under the Human Rights and Equal Opportunity Commission Act 1986. Its role includes investigating discrimination and human rights complaints, including those based on race, i.e. contraventions of the Racial Discrimination Act 1975.
Making a complaint through this mechanism is an option that Aboriginal and/or Torres Strait Islander nurses and midwives may wish to consider, particularly if appropriate action is not being taken under health services human resources, code of conduct, anti-racism and/or other relevant policies.
The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 was established by the Australian Government in 2011 to assist in closing the gap in Aboriginal and/or Torres Strait Island health inequality.
The Plan’s stated vision is as follows:
“The Australian health system is free of racism and inequality and all Aboriginal and Torres Strait Islander people have access to health services that are effective, high quality, appropriate and affordable. Together with strategies to address social inequalities and determinants of health, this provides the necessary platform to realise health equality by 2031.”
The accompanying Implementation Plan outlines strategies for enhancing cultural safety. This is relevant to every hospital and health service across all jurisdictions, where they should be taking steps to be consistent with these plans.
The National Health Safety and Quality Standards (NSQHS) drive the implementation of safety and quality systems and were developed by the Australian Commission on Safety and Quality in Health Care to improve the quality of health care in Australia. This includes a specific provision for improving care for Aboriginal and/or Torres Strait Islander people.
The 10 NSQHS Standards provide a clear statement of the level of care patients should expect from health service providers. Linked to the Standards, the Commission has developed the following six guides to support health services to improve the quality of care provided to Aboriginal and/or Torres Strait Islander consumers:
- Setting safety and quality goals for Aboriginal and/or Torres Strait Islander people in health service organisations;
- Cultural competence in caring for Aboriginal and/or Torres Strait Islander consumes;
- Improving identification rates of Aboriginal and/or Torres Strait Islander consumers;
- Creating safe and welcoming environments for Aboriginal and/o Torres Strait Islander consumers;
- Effective and safe communication with Aboriginal and/or Torres Strait Islander consumers; and
- Comprehensive care for Aboriginal and/or Torres Strait Islander consumers.
For further information in relation to the Standards or the above guides, please go to https://www.safetyandquality.gov.au/
As of mid-2018, accreditation of hospitals and health services will be based on the second edition of the standards, which include clearer requirements in relation to quality and safety of Aboriginal and/or Torres Strait Islander staff and patients/clients. These changes are designed to improve cultural safety and reduce the likelihood of racism.
For further information in relation to the services available to Aboriginal and/or Torres Strait Islander Australians, please use our service finder.
Our service provides free and confidential support 24/7, to nurses, midwives and students Australia wide. If you would like to speak to someone call 1800 667 877, or you can request support via email.
If you would like to know a bit more about the service before getting in contact — take a look through accessing support.