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Section 3: Concluding statement
SECTION 3:
CONCLUDING STATEMENT
Since the release of the GENKE I in 2002, there has been negligible improvement in the numbers of Aboriginal and Torres Strait Islander registered nurses and midwives and we are far off the necessary numbers completing tertiary programs to ensure parity is reached in the near future. The quality, rigour and consistency of course content in tertiary programs is of concern, as is the support available to Aboriginal and Torres Strait Islander nursing and midwifery students. The inclusion of a mandatory Aboriginal and Torres Strait Islander subject/unit by ANMAC has resulted in all nursing and midwifery education providers now including a discrete subject/unit in nursing and midwifery programs. What should be an important lever for quality Aboriginal and Torres Strait Islander health education has, however, in some cases, become a tokenistic process rather than a genuine driver of change. The GENKE II report presents three key strategic recommendations and eight supplementary recommendations for national-level strategic education reform to increase the numbers of Aboriginal and Torres Strait Islander nurses and midwives, in both absolute terms and as a proportion of the workforce as a whole. The delivery of the recommendations will be achieved through formalised authentic partnerships between CATSINaM and ANMAC, CATSINaM and the NMBA and CATSINaM the Australian Government. Recognising their essential roles, formal implementation partnerships and agreements will also include the CDNM, NENAC, NAATSIHWP and all government CNMOs to realise successful national-level strategic reform as envisaged by the GENKE II report. Through strong nursing and midwifery leadership, the professions have successfully navigated some of the most challenging times for these professions. For example, leadership has guided the transition from hospital to university-based education and conceptualised, developed and implemented national registration and accreditation. This same leadership is required to rise to the challenge of addressing inequities in the nursing and midwifery workforce and in employment for Aboriginal and Torres Strait Islander nurses and midwives, and for leadership that demonstrates that the health of Aboriginal and Torres Strait Islander peoples is a concern for all nurses and midwives. ...leadership is required to rise to the challenge of addressing inequities
in the nursing and midwifery workforce
APPENDIX 1:
THEMATIC CATEGORIES
GENKE II recommendations by thematic category
Forming a thematic framework for reform activity, the GENKE II report recommendations are grouped within the following categories to align with the Educating the Nurse of the Future implementation plan.
Monitoring, evaluation, accountability and learning
Baseline education requirements
Quality assurance of nursing and midwifery education
Assurance of clinical placements for students
Curriculum
Course design
Replacement, recruitment and retention
Funding of nursing and midwifery education
Under the auspices of the Australian Government Chief Nursing and Midwifery Officer, the National Nursing and Midwifery Education Advisory Network, in partnership with CATSINaM, NMBA, ANMAC, CDNM, NENAC, NAATSIHWP and all government CNMOs, share leadership and responsibility for monitoring the realisation of the GENKE II report recommendations.
Minimum education requirements for nursing and midwifery practice as accredited by ANMAC and regulated by NMBA.
Assuring the quality of Cultural Safety in Aboriginal and Torres Strait Islander peoples’ health and nursing and midwifery education.
Assuring clinical placements are Culturally Safe, supporting the clinical experiences of Aboriginal and Torres Strait Islander nursing and midwifery students.
Nursing and midwifery education programs reflect the Nursing and Midwifery Aboriginal and Torres Strait Islander Health Curriculum Framework.
All aspects of nursing education privilege Aboriginal and Torres Strait Islander Knowledges and reflect contemporary Cultural Safety philosophies and practices with program content and learning outcomes.
Education strategies to increase the participation of Aboriginal and Torres Strait Islander nurses and midwives.
Investment in new and existing programs to increase the participation of Aboriginal and Torres Strait Islander nurses and midwives.
APPENDIX 2:
GLOSSARY
Aboriginal and Torres Strait Islander Community Controlled Organisations encompasses organisations where ‘community control’ is a process that allows the local Aboriginal community to be involved in its affairs in accordance with whatever protocols or procedures are determined by the community.
Aboriginal and Torres Strait Islander Knowledges encompasses ‘ways of knowing, being and doing’ and ‘caring’ and worldviews, knowledges and realities as distinctive and vital to existence and survival (Martin & Mirraboopa 2003).
Aboriginal and Torres Strait Islander peoples refers to the 500 Aboriginal and Torres Strait Islander nations and peoples of Australia; purposely pluralised. Related terms such as ‘First Nations’ and ‘Indigenous’ are only used when referring to the names of organisations.
Co-accredit describes a commitment to activities and processes used in nursing and midwifery education accreditation that work in partnership with shared power with Aboriginal and Torres Strait Islander peoples who are directly or indirectly impacted by accreditation functions (NCOSS 2017).
Co-design describes a commitment to activities and processes used in the design of nursing and midwifery education accreditation and education regulation that work in partnership with shared power with Aboriginal and Torres Strait Islander peoples who are directly or indirectly impacted by accreditation and education regulation (NCOSS 2017).
Co-production describes processes of working in partnership with shared power to deliver on nursing and midwifery education accreditation and regulation as it relates to Aboriginal and Torres Strait Islander health (NCOSS 2017).
Decolonising approach is a clear transformational reform process to address oppressive practices and racism including attitudes, ignorance, bias, generalisations, assumptions, and uninformed opinions (Sherwood et al. 2021).
Decolonising nursing and midwifery education describes unsettling teaching approaches and curricula that consciously challenges problematic colonial thinking and actions that continue to pervade nursing and midwifery education and practice. Decolonising approaches challenge the biomedical-dominance of the knowing and practice of health, medical, nursing and midwifery care. Importantly, it recognises the competing claims to land and water territory within the international boundaries of Australia, between the multitude of sovereign Aboriginal and Torres Strait Islander peoples and the Australian nation-state.
Indigenous Cadetship Support is a program designed to support Aboriginal and Torres Strait Islander tertiary students to complete their undergraduate degrees and progress onto ongoing employment.
Indigenous Sovereignty or ‘First Nation peoples’ sovereignty is inherent in our bloodlines to Country, it is tens of thousands of years old, and it has never been ceded. It ‘invokes different sets of relations, belonging, and ownership that are grounded in a different epistemology [compared to the] patriarchal white sovereignty’ of the Australian colonial state (Moreton-Robinson 2015, p. 92). These differences unsettle the latter, justifying for them the violence they enact upon, including the erasure of, First Nations peoples (Watego 2021). Thus, First Nations peoples’ sovereignty is also enacted through holding our ground against ongoing colonialism (Watego 2021).
National Agreement on Closing the Gap is a formal agreement to enable Aboriginal and Torres Strait Islander peoples and governments to work together through shared decision making to overcome the inequality experienced by Aboriginal and Torres Strait Islander peoples (CtG 2019).
GLOSSARY (CONT’D)
Parity means gaining equality or equivalence and refers to achieving equality or equivalence in terms of participation and outcomes for Aboriginal and Torres Strait Islander nursing and midwifery workforce representation.
Partnership agreement is a formal bilateral agreement expressing agreed terms on how CATSINaM will work and share decisions with the Nursing and Midwifery Board of Australia, the Australian Nursing and Midwifery Council or the Australian Government, on the implementation and monitoring of the ‘getting em n keepin em n growin em’: Strategies for Aboriginal and Torres Strait Islander nursing and midwifery education reform (GENKE II) report recommendations. The partnership agreements are underpinned by the principle that shared decision making with Aboriginal and Torres Strait Islander community controlled representatives is essential to the delivery of the GENKE II report recommendations and to achieving national-level strategic reform for nursing and midwifery education as it relates to Aboriginal and Torres Strait Islander health (Closing the Gap 2019).
Racism includes prejudice, discrimination or hatred directed at someone because of their appearance, ethnicity, nationality, or culture. Racialisation is the act or process of applying racism or a racist perspective (AHRC 2018).
Replacement refers to nursing and midwifery workforce supply and demand, the number of nurses and midwives entering and leaving the profession over a determined time period.
Self-determination a right of free determination of political status; free pursuit of economic, social and cultural development; the right to autonomy or self-government in matters relating to internal and local affairs as well as ways and means for financing autonomous functions (United Nations 2007).
Subject/unit are often used interchangeably and refers to a single subject/unit of a Bachelor of Nursing, Diploma of Nursing or Bachelor of Midwifery.
Transition to practice program a formalised and coordinated program to support newly graduated nurses and midwives adapt into the workforce.
Tertiary preparation pathway describes a bridging program designed to provide skills development and knowledge to succeed in degree studies.
Truth-telling describes formal processes of telling the truth about past injustices experienced by Aboriginal and Torres Strait Islander peoples to promote awareness and understanding of ongoing impacts of past actions in the hope of reconciliation (Reconciliation Australia 2021).
REFERENCES
Australian Health Practitioner Regulation Agency (Ahpra) 2020, Aboriginal and Torres Strait Islander strategy statement of intent, viewed 12 July 2022, https://www.ahpra.gov.au/About-Ahpra/Aboriginal-and-Torres-Strait-Islander-HealthStrategy/Statement-of-intent.aspx
Australian Human Rights Commission (AHRC) 2018, What is racism? viewed 12 July 2022, https://humanrights.gov.au/ our-work/race-discrimination/what-racism
Australian Nursing and Midwifery Council (ANMAC) 2021, Australian Nursing and Midwifery Council Strategic Plan 2021–2024, viewed 12 July 2022, https://anmac.org.au/strategic-plan-2021-2024
Australian Government Department of Health (DoH) 2021, Corporate plan 2021–22, viewed 12 July 2022, https://www. health.gov.au/resources/publications/corporate-plan-2021-22
Australian Government Department of Health (DoH) 2022a, ‘Factsheet selector dashboard, nurses and midwives 2021, Australian-born Aboriginal and/or Torres Strait Islander’, Nursing and midwifery dashboards, viewed 12 July 2022, https:// hwd.health.gov.au/nrmw-dashboards/index.html
Australian Government Department of Health (DoH) 2022b, ‘Factsheet selector dashboard, registered nurses 2021, Australian-born Aboriginal and/or Torres Strait Islander’, Nursing and midwifery dashboards, viewed 12 July 2022, https:// hwd.health.gov.au/nrmw-dashboards/index.html
Australian Health Ministers’ Advisory Council’s National Aboriginal and Torres Strait Islander Health Standing Committee (AHMAC) 2016, Cultural respect framework for Aboriginal and Torres Strait Islander health: A national approach to building a culturally respectful health system, viewed 12 July 2022, https://nacchocommunique.files.wordpress.com/2016/12/ cultural_respect_framework_1december2016_1.pdf
Closing the Gap (CtG) 2019, National agreement on Closing the Gap, viewed 12 July 2022, https://www.closingthegap.gov. au/national-agreement
Commonwealth of Australia 2022, National Aboriginal and Torres Strait Islander health workforce strategic framework and implementation plan 2021–2031, viewed 12 July 2022, https://www.health.gov.au/resources/publications/nationalaboriginal-and-torres-strait-islander-health-workforce-strategic-framework-and-implementation-plan-2021-2031
Geia, et al. 2021, ‘A unified call to action from Australian nursing and midwifery leaders: Ensuring Black lives matter’, Contemporary Nurse, vol. 56, no. 4, viewed 12 July 2022, https://doi.org/10.1080/10376178.2020.1809107
Indigenous Nursing Education Working Group (INEWG) 2002, ‘gettin em n keepin em’, Report of the Indigenous Nursing Education Working Group, Report to the Commonwealth Department of Health and Ageing Office for Aboriginal and Torres Strait Islander Health, Commonwealth Department of Health and Ageing, viewed 12 July 2022, https://secureservercdn. net/198.71.233.110/dgc.5bd.myftpupload.com/wp-content/uploads/2021/01/gettinem-wfiwjthfuvhk.pdf
Martin, K, & Mirraboopa, B 2003, ‘Ways of knowing, being and doing: A theoretical framework and methods for Indigenous and Indigenist re-search’, Journal of Australian Studies, vol. 27, no. 76, pp.203-214.
Moreton-Robinson, A 2015, The white possessive: Property, power and Indigenous sovereignty, University of Minnesota Press, Minneapolis.
NSW Council of Social Services (NCOSS) 2017, Co-design principles, viewed 12 July 2022, https://www.ncoss.org.au/wpcontent/uploads/2017/06/Codesign-principles.pdf
REFERENCES (CONT’D)
Nursing and Midwifery Board of Australia (NMBA) 2018, NMBA and CATSINaM joint statement on culturally safe care, viewed 12 July 2022, https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Position-Statements/ joint-statement-on-culturally-safe-care.aspx
Phillips, GL 2015, Dancing with power: Aboriginal health, cultural safety and medical education, Monash University, viewed 12 July 2022, https://www.semanticscholar.org/paper/Dancing-with-power%3A-Aboriginal-health%2C-cultural-and-Phil lips/68df9e737a48d1b88e6855b451ed1d45c5da6367
Ramsden, I 2002, Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu, Victoria University of Wellington, viewed 12 July 2022, https://www.croakey.org/wp-content/uploads/2017/08/RAMSDEN-I-Cultural-Safety_Full.pdf
Reconciliation Australia 2021, Truth-telling, viewed 12 July 2022, https://www.reconciliation.org.au/reconciliation/truthtelling/
Sherwood, J, West, R, Geia, L, Drummond, A, Power, T, Stuart, L, & Dervin, L 2021, ‘“Taking our blindfolds off”: acknowledging the vision of First Nations peoples for nursing and midwifery’, Australian Journal of Advanced Nursing, vol. 38, no. 1, viewed 12 July 2022, https://doi.org/10.37464/2020.381.413
United Nations 2007, October 2, United nations declaration on the rights of Indigenous Peoples, UN General Assembly, viewed 12 July 2022, https://www.un.org/development/desa/indigenouspeoples/declaration-on-the-rights-ofindigenous-peoples.html
Usher, K, & Durkin, J 2021, Review of the ‘gettin em n keepin em’ report: Final report to the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) and the Council of Deans of Nursing and Midwifery (CDNM), CATSINaM, Brisbane.
Watego, C 2021, Another day in the colony, University of Queensland Press, Indooroopilly.
(GENKE II)
August 2022
1997 2022
CATSINaM R I G INAL AND TORRE S S T RAIT ISLANDER N U R O S A B E S CONGRES S O F A N D MIDWIVES
