New South Wales Rural and Remote Aboriginal Nursing Strategy
Office of the Chief Nursing Officer
Prepared by: Raymond Lovett
Project Officer
February, 2002
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ACKNOWLEDGEMENTS
NSW RURAL AND REMOTE ABORIGINAL NURSING WORKING PARTY MEMBERS
Special thanks to the following members for their support and commitment to the Strategy:
Judith Meppem (OCNO) Chair
Barbara Oxford (FWAHS)
Bruce Forrest (GMAHS)
Carmen Parter (formerly of AHB)
Denise Ravenau (NEAHS)
Dulcie Flowers (AHMRC)
Heather Gibb (Charles Sturt University)
Julie Williams (OCNO)
Leica Mackaway (SWSAHS)
Lisa Mackey (AHB)
Marie Wilson (WSAHS)
Ray Lovett (OCNO)
Robyn Shields (CATSIN)
Sophie Erzay (AHMRC)
Tim Agius (AHB)
Trina Nelson (SWSAHS)
Vicki Bradford (CCAHS)
Vicki Wade (SWSAHS)
Wayne Merritt (CCAHS)
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TABLE OF CONTENTS
ACKNOWLEDGEMENTS...... 1
TABLE OF CONTENTS...... 2
ABBREVIATIONS...... 2
EXECUTIVE SUMMARY...... 3
BACKGROUND...... 5
IDENTIFIED ABORIGINAL NURSING ISSUES...... 5
SUMMARY OF INITIATIVES...... …7
Aboriginal Nurse Numbers in NSW...... …7
Careers Expo ‘Croc Festival’...... …7
Undergraduate Scholarships...... …8
Enrolled Nurse–Registered Nurse Education...... …8
Rural/Remote Recruitment and Promotion Drives...... …8
Aboriginal Nursing Career Material Distribution...... …9
Media and Advertising...... …9
TAFE/University and School Networks...... …9
Aboriginal Nursing Preparation Program...... 10
NSW Health Aboriginal Employment Strategy...... 10
Quarantined Registered Nurse Positions...... 11
Quarantined Trainee Enrolled Nurse Positions...... 11
ABORIGINAL NURSE STRATEGY WORKING PARTY...... 12
Timeframe...... 12
Membership...... 12
EVALUATION...... 12
GLOSSARY...... 13
Appendix...... 14
REFERENCE LIST...... 14
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ABBREVIATIONS
AEA - Aboriginal Education Assistant
AES - Aboriginal Employment Strategy
AEU - Aboriginal Education Unit
AHB - Aboriginal Health Branch
AHMRC - Aboriginal Health and Medical Research Council of NSW
AHS - Area Health Service
AHW - Aboriginal Health Worker
ASSPA - Aboriginal Student Support and Parents Association
CAN - Careers Advisers Network
CATSIN - Congress of Aboriginal and Torres Strait Islander Nurses
EN - Enrolled Nurse
NSW - New South Wales
OCNO - Office of the Chief Nursing Officer
RN - Registered Nurse
TAFE - Technical and Further Education
TEN - Trainee Enrolled Nurse
DOH - Department of Health
NSWH - New South Wales Health
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EXECUTIVE SUMMARY
The NSW Rural and Remote Aboriginal Nursing Strategy has been established as the result of a State Government commitment to increase the number of Aboriginal nurses in rural and remote NSW, and to improve their career development opportunities. The NSW Government has recognised the clear need for this Strategy, and has allocated recurrent funding for its implementation.
This Strategy incorporates the policy context of the National Aboriginal Health Strategy (1989), NSW Health: Better Health Good Health Care, the guiding principles of Ensuring Progress in Aboriginal Health; A Policy for the NSW Health System (1998), the Aboriginal Employment Strategy (1998) and the NSW Aboriginal Health Strategic Plan, (1999). These policies underline the importance of a viable and sustainable Aboriginal health workforce with sufficient institutional support and education.
This strategy also incorporates the broader State and Commonwealth nursing context. At a State level a wide range of strategies continue to be facilitated focusing on recruitment and retention of nurses. These include the NSW Nursing Scholarship Fund, strategies arising from the NSW Ministerial Standing Committee on the Nursing Workforce and a range of other initiatives. At the Commonwealth level it includes the development of a national strategic framework specifically related to recruitment and retention of Indigenous nurses. The NSW Strategy is consistent with the national strategic framework specifically related to recruitment and retention.
It is anticipated that, with the support of management and collaborative efforts between stakeholders and the community, the Strategy will have a positive impact on Aboriginal nurse numbers in NSW, as well as improving opportunities for existing Aboriginal nurses.
Although initiatives in relation to the recruitment of Aboriginal nursing staff have been identified in some Area Health Services (AHS), many are struggling to achieve the Aboriginal Employment Strategy of 2% employment for Aboriginal nurses across all classifications. This is due to a range of factors, which are discussed in the Identified Issues section of this document.
Currently some successful initiatives for recruitment of Aboriginal nurses exist in AHS including Wentworth AHS, New England AHS and Northern Rivers AHS, eg quarantining of Trainee Enrolled Nurse positions.
It is recognised that nursing education, employment, career development and promotion outcomes for Aboriginal people will not be achieved immediately. This Strategy will require commitment, time and funding in the short, medium and long term.
In developing effective nursing career and nursing education opportunities for Aboriginal people, the health system needs to:
è Provide clear leadership and direction;
è Provide appropriate infrastructure;
è Ensure ongoing coordination of specifically focused nursing recruitment, retention and career development initiatives; and
è Ensure effective implementation, monitoring and evaluation of Aboriginal nursing initiatives.
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This Strategy cannot be seen as a separate initiative. As noted above, it is a part of the broader Aboriginal Health and Nursing policy contexts, the shared objectives of which reflect improved health outcomes for Aboriginal people.
The Aboriginal Nursing Strategy is designed to increase the number of Aboriginal nurses in two ways:
è Increasing numbers of Aboriginal people undertaking nurse education.
è Increasing Aboriginal nurse employment and career development opportunities within the Public Health System.
The principles for the Aboriginal Nursing Strategy are consistent with broader Aboriginal Health policy principles. These principles include:
è A whole-of-life view of health;
è Practical exercise of the principles of self-determination;
è Partnership;
è Cultural understanding; and
è Recognition of trauma and loss.
The Strategy will adopt a staged approach over the next 12 months and beyond, including:
Stage 1 - Implementing a package of initiatives to increase the number of Aboriginal people undertaking nurse education in NSW. These include:
1. Ascertaining Aboriginal nurse numbers for all classifications across the state.
2. Active participation in Career Markets such as the ‘Croc Festival’.
3. Aboriginal nursing scholarships for undergraduates and complementary assessment procedures for applicants of those scholarships.
4. Support of enrolled nurses undertaking registered nurse education through allocation of scholarships.
5. Encouraging Aboriginal school leavers and community members into nursing by targeted rural and remote recruitment and promotion drives.
6. Review of Aboriginal nursing career material.
7. Promoting careers in nursing to the Aboriginal community using media advertising including the Internet.
8. Stronger networking with universities and NSW Technical and Further Education (TAFE) to actively recruit Aboriginal students into nursing, and
9. Development of a culturally sensitive university preparation program.
Stage 2 - Implementing a package of initiatives for increasing the number of Aboriginal nurse numbers in the Public Health System including:
10. Enhanced recruitment, retention, promotion and staff development opportunities for Aboriginal nurses through the Area Coordinators of the NSW Health Aboriginal Employment Strategy, the Area Managers, Aboriginal Health and AHS Nursing Career Advisers.
11. Quarantined registered nurse positions.
12. Quarantining Trainee Enrolled Nurse Positions (TEN).
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A Working Party has been established to facilitate the development and implementation of these stages. Stage 1 forms the foundation for the implementation of Stage 2. Monitoring and evaluation mechanisms will continue to be set throughout the progression of the Strategy.
BACKGROUND
In 1998 the National Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN) made recommendations regarding the recruitment and retention of Aboriginal nursing students. Some of the recommendations included designation of student places, bridging programs for potential Aboriginal nursing students, further education opportunities for Aboriginal health service employees and the development of partnerships with other related organisations for support of Aboriginal nursing students. The then NSW Minister for Health endorsed those recommendations. In March 1998, the NSW Chief Nursing Officer provided information on the recommendations of CATSIN to all related nursing forums in NSW. It was recognised that the recommendations needed to be progressed and that there would be a significant timeframe to achieve full implementation of those recommendations.
Recruitment and retention of nurses continues to be a priority for the NSW Government. Recommendations from documents such as the NSW Ministerial Standing Committee on the Nursing Workforce Action Plan, which has been endorsed by the Minister, will impact on the NSW Rural and Remote Aboriginal Nursing Strategy. This strategy contains specific programs aimed at implementing the core recommendations of National CATSIN arising from the 1998 and subsequent CATSIN meetings. Further nursing-related documents, including the Commonwealth strategic framework are being developed and may also impact on this Strategy in relation to the broader issues of nursing recruitment and retention.
The Aboriginal Nursing Strategy will also be influenced by the wider policy context of Aboriginal Health and in particular the NSW Aboriginal Health Strategic Plan. For example supportive strategy C4, Implement the Aboriginal Employment Strategy. More specifically this Strategy relates to: Key Priority 1 improving access to health services:
è 1.12 Develop opportunities to support nurse practitioner initiatives in identified areas of need; and
è 1.13 In collaboration with universities and colleges, identify potential opportunities to develop and implement strategies that improve recruitment and retention of specialist health service providers in rural NSW.
IDENTIFIED ABORIGINAL NURSING ISSUES
Many documents support the conclusion that to improve Aboriginal health a cultural understanding must exist within the health service, particularly among all people working within that service. Cultural understanding should shape the use and provision of health services. Understanding of Aboriginal culture must be applied in order to achieve improved Aboriginal health outcomes (Aboriginal Employment Strategy, 1999). To employ a greater number of Aboriginal nurses is an important part of the solution.
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There are varying explanations for why there may be small numbers of Aboriginal people in undergraduate nursing education and in the public nursing workforce arena.
A number of reports and other research point to issues such as financial matters, support mechanisms, the move from hospital training to universities, preparation for university studies, geographical isolation (in rural areas), family commitments and lack of access to information technology as some of the broad reasons for the under representation of Aboriginal people in the nursing field. To attract Aboriginal people to nursing, educators need to include culturally relevant education, and nursing departments and faculties need to be culturally sensitive (Armstrong, 2001).
In the past, the health and education systems may not have been sensitive to the needs of Aboriginal people. This impacts on Aboriginal peoples’ use of health and education systems today.
Given the multiple causes of the Aboriginal nursing shortage, a variety of initiatives need to be implemented in order to effect change. While a number of the initiatives currently exist, they are not utilised to maximum potential to address issues, which may include poor communication between service providers, poor public perception, inadequate coordination, funding issues, and poor baseline information. It is hoped that the NSW Rural and Remote Aboriginal Nursing Strategy will address these issues.
The main focus of the Strategy is to promote nursing as a career choice for Aboriginal people. It has been identified that Aboriginal people are under-represented within nursing education and participation in the nursing workforce. This Strategy aims to improve access to education, employment and career development opportunities for Aboriginal people in the nursing arena. This will be done through developing, implementing and evaluating initiatives that are consistent with the two common objectives of the strategy.
The principles for the NSW Rural and Remote Aboriginal Nursing Strategy are consistent with the principles within the Aboriginal Health policy context. The purpose of the principles is to guide the decision making process. Those principles include:
A whole-of-life view of health
Aboriginal people have a holistic and social view of health, encompassing the physical, emotional, cultural, and spiritual well-being of individuals and communities. A holistic approach to the delivery of services is essential to the improvement of Aboriginal health outcomes.
Practical exercise of the principles of self-determination
The practical exercise of self-determination is central to Aboriginal health. It underpins cultural, community and individual well-being. Aboriginal self-determination and responsibility lies at the heart of Aboriginal community control in the provision of community-based health services.
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Partnership
Partnership is about working collaboratively in an environment based on respect, trust and equality. It includes pursuing the achievement of joint positions on matters that are the agreed business of the NSW Aboriginal Health Partnership.
Working partnerships are essential to providing Aboriginal people with equitable access to culturally sensitive health services and to address the issues underlying the disadvantage of Aboriginal people and communities.
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SUMMARY OF INITIATIVES
It is recognised that there will be a two staged approach to the NSW Rural and Remote Aboriginal Nursing Strategy.
Stage 1
Aboriginal Nurse Numbers in NSW
Current information available on the number of Aboriginal nurses in the NSW public health system is an approximation. It is also unclear whether AHS report on the number of Aboriginal nurses in their employment. To make progress in the recruitment and retention of Aboriginal nurses, we need to know how many are in the NSW health system and in what positions they are employed.
• Procedures need to be introduced into the NSW public health system to identify the number of Aboriginal nurses employed in clinical and non-clinical positions.
Careers Expo ‘Croc Festival’
This is an Aboriginal version of the ‘Rock Eisteddfod’, held in Moree (New England/North-West region of NSW). The Festival consists of three components: Health Information, Careers Market and Performance (dance).