Aboriginal and Torres Strait Islander Health Workers, Health Practitioners, and Nurses:

Understanding A Diverse Workforce

BY SYE HODGMAN, QNMU FIRST NATIONS RESEARCH AND POLICY OFFICER

As nurses and midwives, it is our professional obligation to understand the roles and scope of practice of the health professionals operating in the multidisciplinary environment. This is especially so in the case of those who fall under our supervision and delegation authority. This can be somewhat confusing, particularly to our colleagues who come from international health communities, due to the existence of multiple roles that are unique to Australia and Aboriginal and Torres Strait Islander health.

There are two categories of Aboriginal and Torres Strait Islander health professional that are regularly employed in Queensland: Aboriginal and Torres Strait Islander Health Workers and Aboriginal and Torres Strait Islander Health Practitioners. Whilst these roles sound similar, they are in fact different in their duties and responsibilities.

When it comes to providing care to Aboriginal and Torres Strait Islander communities, it can be difficult to know who to turn to and when, particularly if you don’t understand the roles of the other health professionals around you.

Aboriginal and Torres Strait Islander HEALTH WORKERS

Aboriginal and Torres Strait Islander Health Workers are an unregulated yet vital part of the health workforce, similar to the Assistant in Nursing (AIN) workforce.

They are qualified to a minimum Cert II level, up to a Diploma level (usually Cert III or IV in Queensland) in primary health. The core role of a Health Worker is to build connections between the Aboriginal and Torres Strait Islander community and the health care system.

This is a two- or three- way relationship building role, where to be successful, the Health Worker requires trust to lead this process from the community as well as other professionals in the health care team.

Duties that Health Workers typically participate in include: admission processes and assisting with completing paperwork discharge processes and follow-up planning follow-up care in community settings transport to and from appointments (often a great time to gain invaluable information and insight into patient’s health) evaluation of social determinants of health basic health assessment.

Duties that Health Workers should not be participating in include: administering or dispensing medications (however, under very specific circumstances, they may administer vaccines under the direct supervision of a Registered Nurse) providing clinical care to patients in an acute or critical care setting identifying or reporting a deteriorating patient in an acute setting.

Aboriginal and Torres Strait Islander

Health Practitioners

Aboriginal and Torres Strait Islander Health Practitioners are a regulated workforce, which means they are registered through a regulatory board via Ahpra.

They are subject to professional standards, checks and balances as per any other registered practitioner.

Health Practitioners are qualified to a minimum Cert IV to a Diploma Level Qualification in Primary Health Care Practice, including electives related to administration of medications.

The core of the Health Practitioner role is akin to that of the Health Worker in building connections between the community and the health care system.

Whilst Health Practitioners are regulated and therefore have increased scope of clinical practice over and above the duties of a Health Worker, the qualifications for this position are also focused on primary healthcare and so are not well-suited to incorporation into an acute clinical setting.

Duties that Health Practitioners typically participate in include: admission processes and assisting with completing paperwork discharge processes and follow-up planning follow-up care in community settings transport to and from appointments evaluation of social determinants of health basic health assessment providing basic health education to the community administering certain medications under the direct clinical supervision of a registered nurse or medical practitioner.

Duties that isolated and remote practice Health Practitioners may participate in include: suturing wounds managing critical incidents until relieved assisting with peritoneal and haemodialysis managing patient primary care per the queensland primary clinical care manual

Duties that Health Practitioners should not be participating in include: administering or dispensing medications without supervision providing clinical care to patients in an acute or critical care setting identifying or reporting a deteriorating patient in an acute setting.

For a useful definition of Aboriginal and Torres Strait Island Health Workers and Health Practitioners visit: https://bit.ly/ABTSIhphw

It is important to value the roles of all of our Aboriginal and Torres Strait Islander workforce in creating connections between Aboriginal and Torres Strait Islander communities and their healthcare journey.

Aboriginal and Torres Strait Islander NURSES AND MIDWIVES

Unfortunately, unlike Health Workers and Health Practitioners, Aboriginal and Torres Strait Islander nurses and midwives are not held in the same esteem by some as experts in Aboriginal and Torres Strait Islander Health.

However, they do hold the same level of cultural knowledge and connection to community as Health Workers and Health Practitioners.

There are over 1000 Aboriginal and Torres Strait Islander nurse and midwife members of the QNMU, which is almost double the known Queensland workforce of Health Workers and Health Practitioners combined.

Aboriginal and Torres Strait Islander nurses and midwives work on a 24/7 roster, as opposed to our Health Worker and Health Practitioner workforce, who usually work a 9-5 roster.

This makes Aboriginal and Torres Strait Islander nurses and midwives an invaluable and more readily available resource in providing high quality care for Aboriginal and Torres Strait Islander communities.

It is important to note that unlike Health Workers and Health Practitioners, most Aboriginal and Torres Strait Islander nurses and midwives are not employed in Aboriginal and Torres Strait Islander health roles, and therefore will likely have a full clinical load outside of offering cultural advice and mentoring.

This is an important distinction, as this is called “cultural load” and on top of a full clinical load and lack of cultural support mechanisms in the leadership structure; can lead to burnout.

Working together

When caring for any patient, it is vital that we stop to consider who in your multidisciplinary team has the skills, knowledge and ability to help your patient connect with their healthcare in a tangible way and to seek them out where appropriate.

With the above information in mind, it is vital to note the importance that each of the above roles plays in the provision of high quality and culturally safe care to Aboriginal and Torres Strait Islander patients and communities.

It is important to value the roles of all of our Aboriginal and Torres Strait Islander workforce in creating connections between Aboriginal and Torres Strait Islander communities and their healthcare journey.

C P D

1. How many people can you turn to for advice in connecting Aboriginal and Torres Strait Islander patients with their care?

2. When would you turn to them for advice?

3. When is it not appropriate to turn to them for this advice and why?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD