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The future of nursing and midwifery – Where are we heading?

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1 The future of nursing and midwifery – Where are we heading?
Leadership and Issues in the Workforce for Aboriginal and Torres Strait Islander Nurses in Australia Faye Clarke Congress of Aboriginal and Torres Strait Islander Nurses Greetings Thank chairperson for introduction and acknowledge how honoured I am to be speaking with you in my home state of Victoria as an Aboriginal person.

2 Acknowledge welcome to country.
I would like to offer the following words from poet Jonathon Hill who wrote: ‘Today we stand in footsteps millennia old. May we acknowledge the traditional owners whose cultures and customs have nurtured, and continue to nurture, this land, since men and women awoke from the great dream. We honour the presence of these ancestors who reside in the imagination of this land and whose irrepressible spirituality flows through all creation’ I also offer you today this beautiful artwork by Mandy Thomas entitled “Bunjil" who is the creator of the Kulin Nations and who keeps watch over his people and country

3 My qualifications Gunditjmara, Wotjobaluk, Ngarrundjeri
Victorian Director for CATSIN Community Health Nurse, Baarlinjan Medical Clinic GCTE 2007 GCDE 2011 I am an Aboriginal Australian of mixed descent – with an Aboriginal mother and Australian father (of English/Scottish descent). My heritage includes that of my Grandfathers people, the Wotjabaluk and Gunditjmara of Victoria, and that of my Grandmother, the Ngarrendjeri of South Australia Explain about possum skin cloak

4 Congress of Aboriginal and Torres Strait Islander Nurses
I am here representing the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSIN). I first joined CATSIN as a nursing student and now represent the state of Victoria on CATSIN’s Board of Directors. CATSIN was set up by a group of Aboriginal nurses who attended a forum in 1997 with the help and support of some incredible non-Indigenous women from the Australian Nursing Federation. It has been led since that time by Dr Sally Goold, who has this year decided to retire. Sally has done an amazing job as a leader in nursing and Aboriginal health, ensuring the voice of Aboriginal people was heard by the peak bodies in Australian nursing and Government. Sally will be greatly missed by CATSIN and by many of her colleagues around Australia. I would like to thank her for her tireless work over the years and for her contributions to the South Pacific Nurses Forum which she has attended on behalf of CATSIN for many years and I’m sure she will be missed by many of you at the forum this week. We certainly wish her well in her retirement and hope she enjoys some well earned rest. CATSIN is now reshaping, and is on the look out for a new CEO. We have a newly elected President in Ann-Maree Maher, a midwife from the Australian Capital Territory. In the interim we’re very fortunate to have Robyn Coulthard acting as our CEO. Robyn is one of those incredible women I mentioned earlier, who was involved in getting CATSIN up and going and has been our Project Officer for some time now. We are very lucky to have such a capable woman who works so hard for CATSIN and believes in what we stand for.

5 Baarlinjan Medical Clinic
Over the last ten years I have had plenty of opportunities to develop, not just in nursing, but as a leader in nursing, as a result of being involved with CATSIN. Through CATSIN’s recommendation to involve local Aboriginal nurses with nursing education I was supported to undertake studies in teaching, so I could teach Aboriginal health, history and culture for undergraduate nurses in Ballarat and Melbourne. I currently work as a Community Health Nurse at my local Aboriginal Medical Service called Baarlinjan which is in Ballarat, an hour or so west of Melbourne on Wauthaurong land, a part of the Kulin nation. In the course of doing community based work I found myself drawn to an interest in type 2 diabetes. Last year I undertook a Diabetes Education course and now incorporate this into my everyday work.

6 Aims To define Australia’s Indigenous people
To describe the role of CATSIN in Australian health care system To demonstrate the need to increase the recruitment and retention of Aboriginal nurses and leaders Barriers to developing leaders in nursing in the workforce and in the education setting Programs designed to assist in Australia Where are we heading? Today I am here to talk to you about leadership issues in the workplace, with the specific focus on Aboriginal and Torres Strait Islander nurses and midwives. My aim today is to define who are Australia’s Indigenous people; To look at the role of the Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN); To review some of our recruitment and retention issues here in Australia, and ponder our leadership aspirations; I plan to also cover some of the barriers that we face in both the workforce and educational environment; and review an example of a program being run in Australia. These aims are all in light of where we are heading as a nation and as a profession.

7 Aboriginal and Torres Strait Islander people
I would like to acknowledge the two cultures that make up Australia’s Indigenous peoples. The mainland of Australia is home to many different nations of Aboriginal people. At the top of Queensland between Cape York and Papua New Guinea sits more than 200 islands of the Torres Strait. 17 of these islands are home to more than 6000 Torres Strait Islanders. There are two main languages spoken on the islands (Meriam Mir in the East and Kala Kawa Ya in the Central and Western region; The latter consists of four dialects). Torres Strait Islanders live all over Australia The flags of both people’s are shown here, along with an example of traditional dress highlighting differences in our cultures. (Many Torres Straits Islander people have close family ties with Pacific Island nations. Black birding (the abduction of Pacific Islanders to work as fishermen in the Torres Straits and labourers on the cane fields of Queensland) saw the forced arrival of Pacific men from the Solomon Islands and Vanuatu to name a few who married into Torres Strait Islander and Aboriginal families)

8 The islands

9 This map is to give you an idea of how many different Aboriginal groups there are across Australia. Prior to colonisation it is thought that there were up to 700 different language groups. Currently about 145 languages are still in use (in some capacity, however at least 110 of these are at risk of declining use. Aboriginal people who still use their traditional languages often speak several languages of their neighbouring groups. In many ways the continent of Australia is more like Europe in the many different nations that it comprises rather than one homogenous nation of Indigenous people).

10 Indigenous Population By State
This chart gives you an idea of where the majority of Aboriginal and Torres Strait Islander people live. The largest population is in NSW which is home to around Aboriginal and Torres Strait Islander people. One third of Aboriginal people live in cities which is contrary to popular belief that we all live in rural and remote Australia. Those in remote areas constitute one tenth of our overall population.

11 Life Expectancy ABS - 2009 Indigenous Non-Indigenous Women 72.9 82.6
67.2 78.7 2009 ABS estimates of life expectancy for children born during The reason CATSIN exists is because of the huge difference in life expectancy for Indigenous people compared to the rest of the population. The state of Indigenous health in this country is still a far cry from being equal to that of the rest of the country. If you are an Indigenous person born in , you would be expected to live at least 10 years less than a non-Indigenous person born at that time.

12 Mortality causes: The most common reasons for mortality are on this table – the rates are always higher than for non-Indigenous people. (Cardiovascular diseases – 2.5 x the rate Cancers – 1.5 x the rate Respiratory diseases 3 x the rate Endocrine disorders – 6.3 x the rate, digestive disease 4.7 x the rate Injury 2.6 x the rate Kidney disease 5.1 x the rate. Overall the state of Indigenous health is quite poor with infant mortality rates at 2-4 x the rate of Non-indigenous during the period ) Some of you may be wondering what it is about Australia that has such inequality amongst its people. A rich nation; a leader in many fields; yet it has these shocking statistics. Our history is one of colonisation perhaps familiar to many of you. Colonisation has a way of continuing to impact when the dominant society fails to adequately cater for the needs of its first nation people.

OUR FORWARD DREAMING The numbers of Aboriginal and Torres Strait Islander peoples in nursing and midwifery reflects the National Aboriginal and Torres Strait Islander population. OUR REASON FOR BEING To increase the recruitment and retention of Aboriginal and Torres Strait Islander peoples in nursing and midwifery. It is that history and ongoing issues with colonisation that has led to the development and ongoing need for an organisation like CATSIN. Dr Sally Goold’s, research into why there were so few Aboriginal nurses, led to the first forum back in CATSIN was developed with the aim to match the number of nurses in the workforce, to the number of Aboriginal and Torres Strait Islander people in Australia – about 2.5%

14 CATSIN’S Major Focus Areas
To develop strategies aimed at increasing the numbers of Aboriginal and Torres Strait Islander peoples into nursing and midwifery, and to retain them in the profession To ensure non-Indigenous nurses and midwives have education and training in our history, health and culture CATSIN contributed to the Indigenous Nursing Education Working Group (INE Working Group) which produced the report :”Gettin em and keepin em” in Out of that report came a number of recommendations which have become the platform of CATSIN. our 2 major focus areas are to increase numbers of indigeous nurses and midwives, and retain them, and also to educate non-Indigenous nurses and midwives.

15 Number of Aboriginal and Torres Strait Islander Nurses (Registered and Enrolled)
Year Total Nurses 2001 791 2006 1135 2011 2212 It is difficult for us to track how many Indigenous nurses we have working in Australia. We know historically that many people do not openly identify as Aboriginal in the workplace for many reasons, and to compound this issue we don’t have a clear way of recording Indigeneity within our registration system because we only ask on a non-compulsory work force survey, not on our registration documentation. In 2006 numbers we had 1135 Indigenous nurses - from a total of nurses Australia wide - which is about 0.6%. If we really want to match our population size then we need to achieve something like 4500 Indigenous nurses. We have currently have around 2200 Indigenous nurses, with many more enrolled in nursing or midwifery courses at this time. Some of our people are employed as Aboriginal Health Workers, who are not nurses, but form an integral part of our health workforce. (2006 figures indicate there were around 1000 AHW’s). Apparently the medicine stream boasts 2.5% of its first year students are Indigenous – but they too are effected by a high drop out rate of around 30% that they too are yet to resolve. So from a very small pool, we then look to find leaders………………..

16 What is leadership? Cultural safety Understanding
Commitment and passion Persistence Respect Hopefully the first speakers have provided sufficient definition of the term leadership…… Who are our leaders, and what do we ask of them? General leadership qualities include things like trust, clarity of purpose, the ability to align an organisation’s systems with values and goals. A good leader empowers people to fully use their intelligence, their creativity, and their resourcefulness to reach their full potential. As Indigenous leaders, we can do that but we can also do more. Having Indigenous people as leaders brings cultural knowledge. We know how to navigate two worlds, black and white. We understand what the Aboriginal person is going through, we know their family experience, we know their cultural obligations and the pressure this brings. This is important in all aspects of health care but especially in Aboriginal health care. We have a strong connection to helping our community, our mob. It drives us, and makes us strong in our convictions that what we are doing is worth it. It makes us push that much harder in the face of adversity. We are persistent, with every difficult thing that happens, we keep coming back. We have faced tough things, so we are prepared to keep facing tough things. We juggle many commitments, family, cultural obligations, professional obligations, work pressures, racism, barriers, obstacles… we keep going. We have respect – for our elders, for our people, for each other, for those that have gone before. We respect what our people have gone through and what we are still going through - so we try even harder to make it better for our families, our community, our country. If we don’t have Indigenous leaders our needs may not be heard, and as a minority, our needs might be swallowed up. We must nurture our Indigenous leaders to ensure our voices are heard. In researching the topic of leadership I wondered how do we actually make leaders? What does Australia do?

17 How are leaders made? Emerging Nurse Leaders Motivating Factors
Role modelling A cause A desire for a better future What I found was that really Australia has not done very much up to this point. A leader in nursing was often made from a manager. A manager was made quite often by just being there.. For the longest time. Wards are often run by nurses who stay there the longest. However, this role is often more about management than it is about leadership. We know through the work of Duffield that bad leadership at this level is what makes nurses leave the profession (Duffield 2007). But, do we train our leaders in nursing to be leaders? We look to our Directors of Nursing for leadership, but in my albeit short hospital experience they were elusive people, whose name was shrouded in mystery, and faces rarely seen by those of us ‘ground-dwellers’. Not exactly inspiring. Who were these people? In my search for answers however, I was pleased to find a new program called Emerging Nurse Leaders. I note that our speakers this morning have already told us all they can about their program and I applaud its mission. The simple fact that the College of Nursing saw fit to create such a program shows vision and inspiration. It seems to me that prior to this program I don’t think the profession had much of a coordinated effort to create leaders and perhaps it is the changeover to a national system that is having an impact on the creation and availability of programs like this. I think the Nursing profession has been somewhat tardy in formally planning training for its future leaders. But in the spirit of ‘its never too late’ I hope the program is well supported, well funded and effective. I would call on the students and teachers in this program to develop in its leaders a commitment to improving the health of Australia’s disadvantaged such as Aboriginal and Torres Strait Islanders. My own personal experience in becoming a leader and advocate for Aboriginal issues arose out of the strong mentoring model offered by CATSIN. At each and every annual conference I got to rub shoulders with some of our best nursing leaders both black and white, and in doing so, was encouraged to get in there and do it. Opportunities were plentiful for someone who was willing to give it a go. An eagerness to learn, a dedication to my chosen field of improving Aboriginal health and a feeling of responsibility to do so is what gets me there, and in fact what brings me to meet you all here. I wanted to make a difference to families by changing our future. I don’t want people to have to deal with premature death, grief, loss and illness amongst family, like I did. (Explain further if appropriate). I was certainly encouraged, pushed and cajoled into all sorts of roles by our former fearless leader Sally Goold, or for those who know Sally, the one who you can never say no to! I am now a leader to anyone who wants to use me as a role model, especially in my community, and I am a leader in terms of being prepared to help design and develop our future as Aboriginal and Torres Strait Islander people and as nurses and midwives. Like many of my Indigenous colleagues, those of us who can, are often called upon to speak on behalf of our people, and often whether we feel ‘ready or not’.

18 Indigenous leaders Education and research
Support from regulatory authorities Recognising the voice of community Many nations Aboriginal activism is good practice Learning from elders There is little research relating to Indigenous leadership in nursing. Our Indigenous nurse leaders are people like Sally Goold and Lowitja O’Donoghue who earned their stripes through many years of hard work. The Minister for Tertiary Education, Senator Chris Evans said "A university education has the power to break down barriers and empower Indigenous people to take leading roles in their professions.” This is supported in a study by Kim Usher who showed that Aboriginal and Islander students in higher education found that what they were learning set them up to be nursing leaders. Skills like ‘higher level thinking, analysis, organisation, time management, writing and public speaking’ were what they needed for this role. Being represented on various advisory bodies and regulatory authorities is crucial to having our voices heard. Sally Goold paved the way to ensure that Aboriginal people had a seat on these various committees and Boards. I currently represent CATSIN on the Australian Nursing and Midwifery Accreditation Council which enables us to have a say on the regulation and accreditation of courses in nursing and ensuring that Aboriginal health, history and culture is included. The excellent support of our national authorities has been crucial to seeing this become a mandatory requirement of nursing courses. Whilst this is still a slow moving beast, it is the support from the top that makes it a most achievable goal. Without the support of Australia’s current nursing leaders this might not have been achieved. These people can be credited with having the vision and wisdom to plan for a future where our new graduates will better understand the complexity of our Indigenous health issues. After all, we will never be able to resolve them without everyone’s commitment. Having friends like this who are willing to share the path has been invaluable. We need Indigenous leaders to advocate for the needs of our communities. You can’t have good primary health care if you don’t listen to the community. How does one speak for a people that has so many different nations. How does one remain inclusive, and not have to dilute ideas to suit everyone. Indigenous peoples are hugely diverse and it is inappropriate to aim for one leader. We must nurture and develop leaders in every community. Even our student nurses find they need to be advocates and leaders and they are not yet even finished their course. But it follows on quite naturally in many cases, given a life time of advocacy, fighting against injustice and just fighting for survival sometimes. Perhaps many of us are just born into that life, encouraged to lead just through our sheer persistence and resilience. They often have a ‘ never say die attitude’. Indigenous students feel they have something extra to offer with the skill to ‘walk in both worlds’. They say ‘we don’t have magic wands but we do have a lived experience that we have partnered with a passion for improving Aboriginal and Islander health’. The importance of caring for community is often paramount to the Indigenous nurse. After all it is our families that are affected. One student stated that it was ‘important to them to model to their family and community, that no matter what obstacles you face, you can achieve what you set your mind to. They say, ‘it takes time’ and that ‘with patience, faith, passion and a strong desire to get where you want, it will happen’. The degree either teaches them ‘grit and determination’ or maybe just lets them show theirs. Finally I can’t mention enough the importance of following the path of our elders. Recognising the difficulty of the barriers our elders faced in this country when really it is not that long ago that we were not even properly acknowledged as fully fledged citizens, we realise the enormity of what has gone before us. In our day to day experience we are constantly reminded of the losses and hardship that our elders and our families face. The poor state of health that our people suffer, is there for us to see every day. We have constant reminders that tell us what we are here for………… and that is to look after our people. But for us, our dreams and visions for our people are now more in sight than ever. We are gaining in many ways, through education through human rights, through community support and through a combined will of all of our nations to care for each other better. Our elders can still provide wisdom and inspiration to keep plugging away. And they certainly can always come up with a story that starts with ‘back in my day…….’ As funny as this sounds, I really do think we need to learn from the past, live for today and plan for the future.

19 Barriers in the education sector
Successfully completing university Risks to success Issues and difficulties Tackling the barriers: Tjirtamai But how do we get more Indigenous leaders if we are stymied at the first step by not getting through Uni. Studies by one Indigenous Nurse academic and aspiring leader, Roianne West, is showing that Australia is much better at getting Indigenous people enrolled in University courses, after all, they get points for doing so, however even though we get the enrolments, Universities are not being assessed on their ability to get students through successfully. We must change this. Universities need to be accountable for what happens to their students during the 3-4 years of their course, or longer. Our students generally come from difficult circumstances, with lives already complicated by housing, financial and emotional wellbeing risks, so we need to support and nurture students through the difficult path of their studies. The Gettin em and keepin em report argued for more scholarships, more streamlined admission processes, support from Indigenous staff and Support Centres, collection of data on identification, better financial support, and access to appropriate mentoring and tutoring. It argued for the training of academic staff to properly support its students, and involvement of local Aboriginal people in the development of health history and culture coursework. All of these recommendations aim to keep students in their courses to completion. Universities need to monitor the effectiveness of their student support. Higher education students found that being educated did not mean they were accepted as being equal to their peers. Kim Usher states that ‘unless or until non-Indigenous health professionals want to become culturally competent and willing to challenge their thoughts and perceptions of Aboriginal people, change will not occur and we will not move forward’. One of the students interviewed in Usher’s article did report that there was a ‘minority of non-Indigenous brothers and sisters fighting our cause for equality and re-empowerment’. It is those people we need to foster. Cultural safety has to live both in the education sector and the workforce in order to facilitate the growth in Indigenous nurses, midwives and leaders in the field so we need people in the system who get it! Other considerations are the lack of clinical placements available, and the lack of graduate program places. If our students have to compete on the basis of academic results alone then we might be the ones to miss out before we have even started. In Mt Isa in Queensland, Roianne and her community, started a program called Tjirtamai. The program is designed to get Indigenous people into nursing. A specific course was developed to prepare participants for entry into nursing. 38 Indigenous people enrolled and were given intensive support to prepare them for University nursing courses. Participants were able to exit the course as Assistants in nursing, or enter a Diploma or Degree course in nursing. Results so far were impressive with 26 people completing the course. 18 students commenced the Degree course, 4 the diploma course and 4 became AIN’s. The program offered a leadership component delivered by the Dept of Families, Housing, Community Services and Indigenous Affairs who run the National Indigenous Leadership Program (NILP). Students identified that this was one of the best aspects of the program and specifically targeted issues of racism and discrimination by building confidence, self esteem and strengthening identity of the participants. They also benefited from the strong role models of their local elders who are included in the delivery of this program. One of the issues identified in the report of this program was the need for courses to be sufficiently flexible to deal with the issues of its participants including things like dealing with ‘sorry business’ such is the regularity of funerals occurring in the community. It was, most commonly, poor health and family commitments that caused people to pull out of the course.

20 Barriers in the workforce setting
Identification Cultural safety Stresses associated with nursing as a profession Costs of further education Horizontal hostility Workload in Aboriginal health setting Limited number of Aboriginal nurses creates pressure Training opportunities Over-commitment Again there is little research into the barriers for Indigenous nurses in the workplace but what I can tell you about is what we hear from our members. Aboriginal and Islander nurses often work in isolation from each other. We are so few that it is most common to be the only Indigenous nurse in a work area. If you happen to work in an Aboriginal health specific area you may be surrounded by other Aboriginal workers but essentially nursing numbers are low. Remember that we are less than 1% of the nursing workforce. Some people might not be comfortable to identify within the workplace for many reasons. This is a complex issue that will improve once work places can offer a more culturally safe environment, and numbers of Indigenous nurses increase. Cultural safety is something that we as Indigenous nurses understand as a core issue that is deep in our hearts and experiences, yet in my experience, non-Indigenous nurses often struggle with the idea of what this means. Nurses I’ve asked who were trained prior to the last say 5 years have never even heard of it. It is our nurses and midwives who are out in those workplaces facing racism, stereotyping and ignorance every day. It is those nurses who answer the questions of patients, of staff of management about what it means to be Aboriginal or Torres Strait Islander in todays health settings. It is those nurses who live the double life of being ‘black’ in a predominately ‘white’ world. There are many tales of hardship out there. Nurses and midwives tell us of the racism, workplace issues, stress and difficulty navigating a system that is predominated by another cultural group. Working with ‘white nurses’ can be a challenge, for both parties as they seek to find ways to overcome cultural difference. If they want to of course, and therein lies one of the many difficulties. A desire to change the status quo is essential. The stresses of every day nursing issues to do with insufficient staffing, increasing workloads, worsening patient acuity, inadequate skill mix on shifts, burnout and injuries, can lead to nurses leaving the profession. (anf – ensuring quality report). The job can be emotionally challenging, physically demanding and dangerous according to Duffield (2007). Morale can sometimes be low, nurses may feel they lack autonomy in their jobs, and may feel poorly valued by the health system. Pay rates are poor in comparison to other professions, and experience can go unrewarded financially. For many their career prospects are limited. This on top of cultural alienation does not help our cause. Also what of the cost of training. Limited scholarship opportunities exist for training in leadership and management skills. The issue of horizontal hostility or of ‘nurses eating their young’ is important. It is not uncommon to hear stories of nurses attacking each other. Research from the US confirms that 60% of graduates leave their first position within 6 months because of some form of horizontal hostility. I was certainly glad to finish my 3 month rotation on one particular ward due to a very nasty supervisor. We need to stop this culture. We have to demand a culture that practices collegial support. Australian student nurses talk of the difficulty they have with their clinical placements when nurses treat them as a burden. How do we create a workplace that fosters and facilitates its students learning. What is the matter with our work practices when nurses feel they have to do it all on their own and don’t work together well. My personal experience with developing leadership skills in the workplace is in having difficulty managing a huge workload. I am in a small Aboriginal medical service where we need to do everything ourselves. Our small team is responsible for every aspect of our service, and we are often called upon to present our example to outside organisations in the name of cultural awareness training. This is on top of providing health care to our community with complex health needs. There are also challenges with the fickleness of our funding which is very reliant on government support and policy. The workload is very onerous. There aren’t that many of us in the pool to draw from so those of us that do feel able to speak up, get called on a lot. Also what training opportunities are offered? I was lucky enough to receive some training by my workplace in management issues. I have picked things up along the way through my work in community – ie being a Board member. Opportunities to participate in strategic planning for several organisations gets you thinking about the realms of possibility. Being a member of CATSIN for a long time has allowed me to see the bigger picture. I feel like I can see everything ‘like a bird’ when I am doing CATSIN business. I ‘like a lizard’, close to the ground when I work in my clinic. I like the opportunity to be both, it helps me stay informed. It makes it quite difficult to have time for other things… like my family though when I have such a heavy workload. People who get involved in Aboriginal affairs in a voluntary capacity (such as CATSIN) provide their time. This too can lead to overload and burn out. My job is stressful enough without having enough time to rest and recover.

21 Working collaboratively
Create a critical mass Join forces with other Indigenous organisations in health Work with our non-Indigenous colleagues Improve training opportunities and career paths Mentoring Be creative and always inspire Roianne West has called for the need to reach a critical mass - where we have enough Indigenous students, nurses and health professionals that would allow the culture of Universities and workplaces to change significantly enough to better cater for the needs of our people in both our health services and education sectors (West 2010). Perhaps the best answer at the moment is to join forces with other Indigenous health professionals so we have a stronger voice to advocate for our issues. The Australian Indigenous Doctors Association, the Indigenous Allied Health Association and the National Aboriginal Health Workers Association can all be allies in the health field. We can work with our non-Indigenous colleagues who also want the best health care for all Australians and who support social justice and equity. We can work on better training opportunities that encourage nurses and midwives to direct health care more in this country. Health care should not remain focused in the medicine sector, nor the AHW sector. Government should also seek the advice of Indigenous Nurses and Midwives in regard to Indigenous health as we have much to contribute. We need to be creative in our approaches by working with community and multi-disciplinary teams to build excellent approaches to health care. Mentoring is the tool with which CATSIN can help its developing leaders. Encouraging the up and coming, the young, the less experienced nurses to step up, be heard, feel their voices are heard and that what they are saying matters is important. We can do that for each other. As we have always done, we bring the mob with us, we don’t have to do it alone. Above all be inspired and be inspiring!

22 Conclusion Australia’s diverse Indigenous population includes Aboriginal and Torres Strait Islander people CATSIN’s aim is to increase numbers of Indigenous nurses and midwives Indigenous people face many barriers in the education setting Indigenous nurses and midwives also face barriers in the work place that can impact on their development as leaders Leadership programs are essential to develop our future workforce In summary then I want to reiterate the difficulty we have in Australia dealing with the huge diversity of needs and cultures amongst our Indigenous population which currently represents about 2.6% of the overall Australian Population. CATSIN’s aim is to increase the number of nurses and midwives to more closely represent our population, but we face many barriers both in the education sector and in the workplace. However we do have a good model in CATSIN that promotes and grows nurse leaders, but we need to expand that and develop leaders in every community. It is a new area for us to look at, but essential for us to get right and soon.

23 CATSIN representatives at NZ SPNF
So where are we heading. Well hopefully towards a better future that encourages Indigenous nurses and midwives to become leaders in the nursing field, in all areas and share in the decision making that affects the health care of our people. Just as Sally has shown us the way, we too can show others.

24 References Aboriginal Australia Map, 2009, Australian Nursing Federation, 2012, Ensuring Quality Australian Indigenous Health Infonet, (2012) Summary of Australian Indigenous health; 9/11/12 Australian Institute of Health and Welfare (2009) ‘Numbers of Indigenous GP’s, registered nurses and health students all rising’, Australian Institute of Health and Welfare Nursing and midwifery workforce National health workforce series no. 2. Cat. no. HWL 48. Canberra: AIHW. Duffield, et al, 2007, Staff satisfaction and retention, and the role of the Nursing Unit Manager, Collegian, Journal of the Royal College or Nursing Australia, 16;1;11-17. Health Workforce Australia, 2012, Health Workforce Insights, Issue 5, Hill, J, 2012 Six pak productions, Multicultural entertainment, The Courier-Mail, 2011 Torres Strait Island map, 2012, West, R, 2010, ‘Tjirtamai - ‘To Care for’: A nursing education model designed to increase the number of Aboriginal nurses in a rural and remote Queensland community’ Contemporary Nurse: a Journal for the Australian Nursing Profession, 37: 1, West, R, 2010, ‘Increased numbers of Australian Indigenous nurses would make a significant contribution to ‘closing the gap’ in Indigenous health: What is getting in the way?’ Contemporary Nurse: a Journal for the Australian Nursing Profession, 37; 1, pp Usher, K. (2010) ‘Indigenous higher degree research students making a difference to the Indigenous health agenda’, Contemporary Nurse: a Journal for the Australian nursing profession, Dec. IT Support: Alana Ryan To be finalised. (Don’t forget to thank Alana).

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