Aboriginal and Torres Strait Islander

Early Graduate Nurse Project

2012

Cover artwork: Lynette Briggs Celebrating the memorandum of understanding between Aboriginal health service and St Vincent’s Melbourne

Report authors: Ruth Crampton and Deanne Riddington- St Vincent’s Melbourne

Contents

Section One: Recommendations................................................................................................5

Summary...........................................................................................................................................6

Key recommendations:......................................................................................................................7

Process:.............................................................................................................................................8

Funding Requests:.............................................................................................................................9

Detailed Recommendations:...........................................................................................................10

Graduate Support Nurse Educator……………………………………………………………………………………………11

Cultural safety training................................................................................................................11

Supported Application process....................................................................................................12

Minimum cohort..........................................................................................................................14

Standard program........................................................................................................................15

Encourage career aspirations......................................................................................................16

CATSIN membership..................................................................................................................17

Increase awareness.....................................................................................................................18

Conclusion.......................................................................................................................................19

Section Two: BACKGROUND READING:.........................................................................................21

Introduction.....................................................................................................................................22

Closing the Gap............................................................................................................................22

CATSIN Congress of Aboriginal and Torres Strait Islander Nurses...............................................23

Gettin em n keeping em..............................................................................................................25

Nursing Cadetship........................................................................................................................26

Cultural safety..............................................................................................................................27

References.......................................................................................................................................29

Appendices:.....................................................................................................................................30

Appendix one: Consultation List..................................................................................................30

Appendix two: Cultural safety workshop.....................................................................................32

Appendix three: Networking Day................................................................................................33

Appendix four: St Vincent’s Early Graduate Nurse Program........................................................34

Appencix five: Interview questions for Aboriginal and Torres Strait Islander Early Graduate Nurse Project...............................................................................................................................35

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Section One: Recommendations

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Aboriginal and Torres Strait Islander

Early Graduate Nurse Project

Summary This project was embarked upon following funding from the Victorian Closing the Health Gap Aboriginal health workforce initiative and it contributes to the Australian commitment to boosting the Aboriginal and Torres Strait Islander workforce. St. Vincent’s facilitates a successful and robust graduate nurse program that continually seeks to evolve and improve. The aim of this project was to investigate the current early graduate nurse program and consider how this may be altered to meet the specific needs of Aboriginal and Torres Strait Islander graduate nurses in Victoria.

Underpinning this report is a belief in the importance of understanding history and culture and its role in shaping the health and wellbeing of Aboriginal and Torres Strait Islanders. To improve the health of Aboriginal and Torres Strait Islanders, all nurses need to have a comprehensive understanding of cultural safety and respect. It is also imperative to increase the numbers of nurses who identify as Aboriginal and Torres Strait Islanders.

It is also important to recognize the importance of a program which allows the early graduate nurse to focus their attention on consolidating and developing their clinical skills and the value of providing an environment which facilitates this. This document is one element of a multifaceted approach to foster and support Aboriginal and Torres Strait Islander nurses at an undergraduate, graduate and post graduate level.

We concluded that Aboriginal and Torres Strait Islander nurses should have the same access and opportunities to participate in any graduate nurse program. By bringing different groups together in a supportive environment all graduate nurses are able to flourish.

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Key recommendations:

o A Graduate Support Nurse Educator for Aboriginal Torres Strait Islander graduate nurses.

o Management, preceptors, senior ward staff, nurse educators and the Aboriginal and Torres Strait Islander graduate support nurse complete a specifically developed cultural safety workshop.

o Early identification of Aboriginal and Torres Strait Islander nurses at an undergraduate level and throughout the application process is essential. Support is offered to these applicants as required.

o Minimum cohort of 4 Aboriginal and Torres Strait Islander graduate nurses. This is to facilitate peer support which should occur throughout the year.

o Aboriginal and Torres Strait Islander nurses are enrolled in standard hospital graduate nurse program with the same rotations and general study days.

o Support the career aspirations of the Aboriginal and Torres Strait Islander graduate nurse. Supernumerary funding is sought to facilitate a two week elective rotation offered during the year to encourage their goals.

o Congress of Aboriginal and Torres Strait Islander Nurses membership and conference attendance costs are paid for the Aboriginal and Torres Strait Islander graduate nurse. The Aboriginal and Torres Strait Islander graduate nurse is also encouraged to avail themselves of the CATSIN mentorship program.

o Scholarship funding is also sought for any non-Aboriginal or Torres Strait Islander graduate nurse who would like to take the opportunity to spend one week in an Aboriginal and Torres Strait Islander community project.

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Process: This process was a consultative one and many experienced professionals and students were asked to consider what they would like to see in a graduate nursing program tailored to meet the needs of Aboriginal and Torres Strait Islander nurses. The support and generosity of those who contributed is greatly appreciated.

Most accessible information was focused at an undergraduate level, with many projects and funding already in place, achieving some significant results. There were examples of successful entry to practice models in other countries with indigenous populations but there was no evidence throughout our investigations of a specific targeted Aboriginal and Torres Strait Islander new graduate nurse program.

As it is breaking new ground this document is not intended to be static or regarded as an exhaustive account of all the issues that need to be considered within our or other health services. Overall our evaluation sought to obtain insight into the major issues that need to be considered when establishing a new graduate nurse program for Aboriginal and Torres Strait Islander nurses.

Fundamental to the process was the need for heartfelt and significant support from the highest levels of management to the most junior staff. This may require an attitudinal shift that can only begin to develop by undergoing cultural safety training. The process and goals of cultural safety training need to be acknowledged and addressed within the health service.

It is also necessary to be wary of discussing any group in generalisations. We need to acknowledge the myriad of differences in any cultural group. Every early graduate nurse experiences their graduate year in a unique and personal way. The health service has a responsibility to develop and support all graduate nurses to the best of their ability.

This program is aimed at being a comprehensive approach that works with the support systems already in place.

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Funding Requests: Funding requests focus on creating a safe and nurturing environment which the new graduate nurse can flourish and develop a foundation from which to build.

Funding aspects that would be considered imperative include the necessity for cultural safety training for those supervising the Aboriginal and Torres Strait Islander early graduate nurses and an educator whose focus is on their development.

Other aspects of the program such as the networking day, facilitating career goals and supporting the passions and career aspirations of the Aboriginal and Torres Strait Islander early graduate nurses requires minimal additional funding.

Further funding is sought to facilitate supernumerary experiences for both Aboriginal and Torres Strait Islander nurses and non-Aboriginal and Torres Strait Islander nurses, professional body membership and conferences is not essential but valuable to the overall goals of the program and would constitute best practice.

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Graduate Support Nurse Educator

Detailed Recommendations:

A Graduate Support Nurse Educator for Aboriginal and Torres Strait Islander graduate nurses.

The graduate support nurse educator needs to be specific and targeted for the Aboriginal and Torres Strait Islander cohort. This support nurse ideally needs to be of Aboriginal and Torres Strait Islander background and have clinical support as their focus embedded within a culturally supportive foundation. A model such as this requires strong leadership 1. This is essential for co-ordination of the program and ensuring policies and practices, such as those gleaned from the cultural safety model are in place and constantly applied.

One of the issues identified was the necessity for the Aboriginal or Torres Strait Islander early graduate nurse to be able to focus on being a nurse who is learning and consolidating their craft. They are not responsible for the care of all Aboriginal and Torres Strait Islander patients within the health service nor are they responsible for the cultural awareness training of the staff they work with. They need the space to concentrate on their clinical skills, which is the focus of the graduate support nurse educator.

The clinical support provided by the graduate support nurse will be at the same level as with any other graduate nurse however the supervision required to meet targets, maintain commitment and negotiate learning contracts will be able to be flexible to meet individual needs.

Health Services will have structures set in place for those early graduate nurses who are not coping with both the professional and personal demands of a new career, but the helping hands model developed by Odette Best at the University of Queensland may offer additional tools to manage the specific needs of Aboriginal and Torres Strait Islander graduate nurses2.

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Cultural safety training

It’s about respect, respect for the grad and the grad’s respect for the organisation.

Jenny DayNewcastle University

Management, preceptors, senior ward staff, nurse educators and the Aboriginal and Torres Strait Islander graduate support nurse complete a specifically developed cultural safety workshop.

In the future it would be ideal if new graduate Aboriginal and Torres Strait Islander nurses were preceptored and mentored by other experienced Aboriginal and Torres Strait Islander nurses. Other countries with an indigenous population such as Canada and New Zealand utilize this model. In NZ the Tuakana/Teina mentorship/mentee model is the standard support program for Maori new graduate nurses.

In Victoria however we have the lowest number of Aboriginal and Torres Strait Islander nurses in Australia at 0.4% and so there are few senior Aboriginal or Torres Strait Islander nurses available especially within the hospital system. The best alternative option is to have appropriately culturally trained staff available to precept. In addition to the preceptors who work with the early graduate nurse in the clinical area, educators and management also need to complete cultural safety training.

The focus of this cultural safety training is on more than an exploration of history and the impact of colonisation but needs to also encourage self-discovery. Nurses need to understand themselves, and their own cultural identities; as Jungerson explains cultural safety is “their attitudes values and beliefs and how those influence their working relationship with others in the context of family, social and work groups. This perspective also involves broader socio-political understandings, such as the impact of a culture of poverty on occupation, and an ability to critically analyse taken for granted assumptions about the nature of the social world people live and work in” 3.

Cultural safety training can be sourced from either an internal or external source; however there is a vast difference in the content delivered in many of the courses available and careful attention needs to be given to this during planning.

Options for cultural training can be found from the Department of Health Victoria cultural resource training guide available at http://docs.health.vic.gov.au/docs/doc/Cultural-resource-guide-October-2012 or by contacting sue.davey@health.vic.gov.au

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Supported Application process

The hardest thing is getting into a programBen GorrieAboriginal student nurse Cadet Co-ordinator STV

Early identification of Aboriginal and Torres Strait Islander nurses at an undergraduate level and throughout the application process is essential. Support is offered to these applicants as required.

The greatest success with recruitment will occur on occasions whereby the process can focus on personal interactions and relationships, so the student acknowledges a connection with the health service. Where possible this should be fostered within the university environment, with specific site visits, introductions and informal discussions about the opportunities the health service provides. If previous Aboriginal and Torres Strait Islander graduate nurses are available to attend university sessions and answer questions, this type of networking would be preferred.

Ideally the hospital has a cadetship program running whereby Aboriginal and Torres Strait Islander nurses working in the institution as cadets are familiar with the organisation and well supported throughout the application process. If the early graduate nurse is unfamiliar to the health service efforts should be made to familiarise them with the location and the education staff.

The application process needs to recognize those students who identify as being of Aboriginal or Torres Strait Islander descent, and once identified these students are given additional support. An additional question has been added to our application process.

A priority recruitment process or quarantined places are two approaches to process the Aboriginal and Torres Strait Islander applications once identified.

To quarantine places within the graduate program for Aboriginal and Torres Strait Islander nurses, entails setting aside 4 places and any Aboriginal or Torres Strait Islander nurse who applies for the program competes for one of these 4 places. The selection criteria can be modified for this process. Problems may arise if the pre-allocated places are not filled and a contingency needs to be considered.

Alternatively priority recruitment is another option which involves fast tracking the applicant through, in St. Vincent’s case to the interview stage of the application process, and judging the applicant against the larger group. We would recommend that all Aboriginal and Torres Strait Islander graduate nurses be interviewed on the same day, and interviewed by the same panel. This allows the Aboriginal and Torres

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Strait Islander nurse to gain some confidence

within the group and allow the panel to make some decisions regarding suitability and criteria.

The support should also include the graduate clinical support nurse, if one is available as the point of contact and who can assist the student through the application process, and be present on the day of interviews.

Further information on graduate nurse program application process can be found in the Nurse and midwife graduate handbook 2012 which can be downloaded at www.nursing.vic.gov.au

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Minimum cohort

It is recommended that the maximum possible time is allocated for clinical placement and time is found to include mentoring and discussion sessions with culturally sensitive nurses currently working in the industry who are willing to debrief and share their own experiences 4

Minimum cohort of 4 Aboriginal and Torres Strait Islander graduate nurses. This is to facilitate peer support which occurs throughout the year.

The benefits of peer support are acknowledged both within the academic literature and amongst those who work with Aboriginal and Torres Strait Islander students. Not being the only Aboriginal or Torres Strait Islander within a graduate nurse group and having likeminded people to debrief and share experiences with is fundamental to the success of this program. This peer support is also a key factor in reducing attrition.

Prior to the commencement of the official program a networking day is recommended to enable the establishment of relationships and team building both within the group and the support network. This day should be organised in association with the health service’s Aboriginal health team, and community. The day may involve meeting with Elders from the local community, Health services Aboriginal and Torres Strait Islander Health teams, Nurse Education Team and meeting with CATSIN to discuss their mentorship program and conference.

The group themselves can decide on the level of ongoing peer support they want to participate in but some form of monthly informal meetings are encouraged.

This peer support can facilitate many aspects of learning and emotional support. A welcoming and caring environment can reduce stress and isolation. In depth facilitated reflection upon clinical and cultural practice is regarded as important for ongoing development5. Reflection and storytelling from which others can relate to their own experiences is one such example.6

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Standard program

Encourage dreaming then ground them in the work required to get them there. Naomi Wolfe ACU

Aboriginal and Torres Strait Islander nurses are enrolled in standard hospital graduate nurse program with the same rotations and general study days.

It is important that all the early graduate nurses, Aboriginal and non-Aboriginal participate in the same graduate year with the same expectations and standards.

Additional support may be required for Aboriginal and Torres Strait Islander nurses; ideally the dreams and aspirations of any new graduate nurse are fostered and encouraged as any early graduate nurse program would hope to be able to do for all nurses.

To facilitate the necessity to have culturally trained managers and preceptors, the clinical rotations available may need to be restricted to those areas where the training has been undertaken. However the areas need to be acute, challenging and desirable, not gaps that are generally difficult to fill. We anticipate emergency, acute surgical and acute medical wards being the first areas to be offered. We will also endeavour to meet the needs of the Aboriginal and Torres Strait Islander nurse outside of these areas.

It is also important to note that these early graduate nurses are challenged and stressed, as any new graduate nurse would be during their graduate program. It is essential not to overload these nurses with additional stressors. Aboriginal and Torres Strait Islander nurses need to be able to focus on their own growth and clinical skills. Often the community and extended family place demands on the nurse. The health service can also unwittingly contribute to the level of stress by making demands on the nurse to assist with care of Aboriginal and Torres Strait Islander patients and taking responsibility for cultural education of staff. It is important to be cognizant of this – careful not to overload the nurse – and give them a chance to find their feet.

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Encourage career aspirations

You need to have conversations about the future and how you can help graduate nurses reach their goals.

Lynne Stuart USQ

Encourage the career aspirations of the Aboriginal and Torres Strait Islander graduate nurses. Supernumerary funding is sought to facilitate a two week elective rotation offered during the year to support their goals.

Part of the brief for this program was to facilitate and encourage the aspirations of Aboriginal and Torres Strait Islander early graduate nurses beyond the graduate year.

It is an incorrect assumption that all Aboriginal and Torres Strait Islander nurses wish to practice within a rural community – all manner of career goals and backgrounds need to be supported. It is an objective of this program to encourage and develop the passion whatever it might be for the Aboriginal and Torres Strait Islander nurse.

With this in mind Aboriginal and Torres Strait Islander early graduate nurse’s elective rotation choices should be given close consideration, in particular if those choices could directly benefit the Aboriginal or Torres Strait Islander community in the future.

We also recommend funding for two weeks additional supernumerary time is allocated for the nurse to gain clinical experience in another area. Experience in a community environment may be difficult to organise but clinical experiences in other areas of the hospital that the new graduate nurse considers to be of value to their future dreams would also be worth supporting.

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Case Study 1

The graduate nurse’s goal was to work with Royal Flying Doctor Service. The graduate requested an emergency rotation which was accommodated.

An acute medical placement was allocated for the final rotation to consolidate skills and knowledge. (Graduate nurses complete two- six month rotations)

Consider a facilitated Royal Flying Doctor Service 2 week placement.

Case Study 2

The graduate nurse’s goal was to attain advanced skills in renal nursing with longer term plans to return to the community to continue working in that speciality.

Rotation given was Dialysis as requested by the graduate nurse; also an acute medical placement was allocated as the initial rotation to consolidate knowledge and skills.

Consider the graduate nurse in the dialysis unit in her rural community for 2 weeks to establish relationships and knowledge that would be of benefit for the future.

CATSIN membership

CATSIN mentoring approach is beneficial because it provides the nurse with strength outside the system.

Jenny Day Newcastle University

CATSIN membership and conference attendance costs are paid for the graduate nurse. The graduate nurse is also encouraged to avail themselves of the CATSIN mentorship program.

CATSIN the Congress of Aboriginal and Torres Strait Islander Nurses is the professional nursing body for Aboriginal and Torres Strait Islander nurses in Australia. They offer a mentorship program which connects mentors and mentees together for ongoing career and cultural support. This organisation offers support that will go beyond the early graduate year, and support Aboriginal and Torres Strait Islander graduate nurses throughout their career. This makes it an ideal resource to utilize and to extend the goals of this program beyond nurses early years.

The CATSIN annual conference is also an excellent means to network and build relationships for a junior nurse. It is also an opportunity to advertise the Aboriginal and Torres Strait Islander early graduate nurse programs to the Aboriginal and Torres Strait Islander undergraduate nurses who attend.

One of the significant challenges faced by many Aboriginal and Torres Strait Islander new graduate nurses is the close ties to the community and the pressures placed on them by extended family. The benefit of a culturally appropriate mentorship program is a deep understanding of this among other pressures.

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Increase awareness

Aboriginal and Torres Strait Islanders cannot do it all themselves, it is necessary to improve awareness in the general population.

Naomi Wolfe Australian Catholic University

Scholarship funding is also sought for any graduate nurse who would like to take the opportunity to spend one week in an Aboriginal and Torres Strait Islander community project.

It is not possible or appropriate for the demands of Aboriginal and Torres Strait Islander healthcare to be met by Aboriginal and Torres Strait Islander nurses alone. The Australian community has a responsibility for the health and wellbeing of all Australians. To encourage non-Aboriginal nurses to consider a career with a focus on Indigenous health, the opportunity is given to send non-Aboriginal early graduate nurses – who express an interest – to an Aboriginal and Torres Strait Islander community settings, local or remote, to experience some of the issues facing the Aboriginal and Torres Strait Islander population. This opportunity needs to be facilitated by the health services Aboriginal and Torres Strait Islander health unit and supported by local community Elders.

Facilitating this opportunity for nurses to experience the health related problems faced by Aboriginal and Torres Strait Islander people first hand contributes to a greater understanding of the challenges facing these communities and reduces negative stereotypes and poor practice7. This benefits both the development of the nurse as an individual and contributes to ongoing efforts to improve Aboriginal and Torres Strait Islander health outcomes.

Scholarship funding should cover income, backfill and any travel/accommodation costs experienced but should not come from closing the gap funding rather some alternate mainstream scholarship opportunity.

How this opportunity is made available to the graduate nurse cohort may vary among health services but St. Vincent’s will ask for applications and anticipate up to 4 nurses will be successful and travel in groups of 2.

The graduate nurse needs to be well supported. If necessary the Graduate Support Nurse Educator may need to visit the community environment prior to graduate nurses attending the placement and attend with the graduate nurse in a supervisor role. We acknowledge it is important not to deplete or add any additional pressure to the community environment.

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Conclusion

Now I feel I need to give back to my Aboriginal community and by becoming a registered nurse I may be able to help a bit.Jason CoombesAboriginal Nursing Cadet STV

Ultimately graduation and employment of Aboriginal and Torres Strait Islander nurses is a vital part of reducing inequalities in the health of Aboriginal and Torres Strait Islander peoples. Aboriginal and Torres Strait Islander nurses bring a core set of unique skills, knowledge and understanding to any health service 8

The additional support we recommend includes an identifiable graduate clinical support nurse educator, who is ideally an Aboriginal or Torres Strait Islander nurse, an appropriately culturally trained preceptor in the nurse’s clinical area and ongoing mentorship as offered by CATSIN.

In addition to the 8 recommendations outlined in this report we would encourage support systems to be developed to nurture these nurses and to consider any individual initiative that may be required to facilitate the progress of the graduate nurse. An example of this may be priority access to childcare, flexible rostering or accommodation assistance if relocating.

It is interesting to note that many of the Aboriginal and Torres Strait Islander nurses that we spoke to during this project referred to the pressure of often being the only Aboriginal and Torres Strait Islander nurse in their environment. The fatigue and burnout experienced by these nurses as they tried to meet the needs of their workplace and their community was significant. It was clearly evident that additional support was required to foster these nurses to reach their full potential. This however needs to be done cognizant of the pressure to ‘fast track’ Aboriginal and Torres Strait Islander nurses because of their precious rarity to more senior positions without giving them opportunities to develop. It is clear that as an early graduate the nurse needs to be given room to grow and consolidate.

It is anticipated that the participants of this program and the clinical areas involved will engage in an evaluation process that will influence any further developments of this program in the future.

It is our aim that this project is able to deliver a grounded, professional and real program for Aboriginal and Torres Strait Islander early graduate nurses that engages them with their profession and facilitates the transition from university to health sector, while supporting their unique aspirations and dreams.

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Section Two: BACKGROUND READING:

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Aboriginal and Torres Strait Islander

Early Graduate Nurse Project

Introduction

Closing the Gap

To understand the necessity for the development of an Aboriginal and Torres Strait Island Graduate Nurse Program it is important to reflect on the implications for health and social justice that result in having just 0.4% Aboriginal Torres Strait Island nurses in Victoria. It has been often suggested that Indigenous health outcomes improve with an increase in the Aboriginal and Torres Straight Islanders health workforce at every level. This has certainly been true for other countries such as NZ and Canada. Many initiatives have been undertaken by the Federal and Victorian governments to improve Indigenous health, in particular and of note for this project there has been significant support for undergraduate training programs in the health sector. Numbers of undergraduate students are slowly increasing and the issue of continued support to maximise successful career outcomes for nurses, as a graduate nurse and beyond is the focus of this report.

All countries with a history of colonisation of the Indigenous populations have left that population disadvantaged, with a loss of identity among many other things. Australia has been slow to acknowledge the impact colonisation has had on the Aboriginal and Torres Strait Islander peoples, and has a poor record when compared to other such countries (NZ, Canada, USA) in all measurable outcomes such as health and education. For example life expectancy comparisons between Aboriginal and Torres strait Islander peoples in Australia, is reportedly anywhere between 15-20 years less than non-Indigenous populations. In 2010 then Prime Minister Kevin Rudd committed to ‘closing the gap’ on Indigenous disadvantage, such as life expectancy – committing to six ambitious targets:

Closing the life expectancy gap within a generation; Halving the gap in mortality rates for Aboriginal and Torres Strait

Islander children under five within a decade; Ensuring all Aboriginal and Torres Strait Islander four year olds

in remote communities have access to early childhood education within five years (by 2013);

Halving the gap for Aboriginal and Torres Strait Islander students in reading, writing and numeracy within a decade (by 2018);

At least halving the gap in Aboriginal and Torres Strait Islander Year 12 attainment or equivalent attainment rates by 2020; and

Halving the gap in employment outcomes by 2018.

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CATSIN Congress of Aboriginal and Torres Strait Islander Nurses

One element in closing the gap is to increase the numbers of Aboriginal and Torres Strait Islander nurses within the workforce. Several initiatives have been made in this regard. There have been programs established at a university level to recruit students into nursing and other health professions.

The formation of CATSIN was deemed the first step in Aboriginal and Torres Strait Islander nurses and midwives claiming ownership for setting the agenda, and addressing the needs of the Aboriginal and Torres Strait Islander nurses and midwives, and student nurses.

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CATSIN objectives include: Advising on a range of issues related to Aboriginal and Torres

Strait Islander health. Promoting a culturally appropriate interviewing and selection

process, familiarity with customary practices and implications for face-to-face interviews.

Acknowledgement of the expertise, knowledge and leadership role that Aboriginal and Torres Strait Islander nurses and midwives contribute to health care.

Providing for this cultural expertise and knowledge to be incorporated into nursing and midwifery practice, leadership, education and research.

Contributing to the development, implementation and promotion of Aboriginal and Torres Strait Islander nurse and midwife education and employment strategies.

Advising Commonwealth, State/Territory health ministers and their relevant departments on strategic developments, policy development and implementation, regarding Aboriginal and Torres Strait Islander health and nursing and midwifery workforce issues.

Advising the nursing and midwifery profession on specific issues, trends, expectations and considerations.

Lobbying all key stakeholders to progress CATSIN’s objectives to maximise its contribution.

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Gettin em n keeping em

Getting em and keepin em9 was a 2002 report which explored how Aboriginal and Torres Strait Islander health can be enhanced using culturally appropriate recruitment, retention and support strategies to increase the involvement of Aboriginal and Torres Strait Islander peoples in education programs and health care delivery. Overseas experience has shown that strategies to provide non-Indigenous health professionals with appropriate education about indigenous issues and health care also contributes positively to the health status of Indigenous peoples. This report made 32 recommendations including

• Increase the recruitment, retention and graduation of Aboriginal and Torres Strait Islander students of nursing;

• Promote the integration of Aboriginal and Torres Strait Islander health issues into core nursing curricula;

• Improve nurses’ health service delivery to Aboriginal and Torres Strait Islander Australians; and

• Monitor outcomes and revise strategies accordingly.

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Nursing Cadetship The Victorian Aboriginal Nursing and Midwifery Cadetship Program Pilot is for Aboriginal students who are undertaking study in an undergraduate nursing/midwifery degree.The overall aim of the program is to:

• Increase the number of Aboriginal people working in the profession of nursing across the Victorian Public Health Sector.

LHN staff

The program offers Cadets:• The opportunity to work in their local public hospital whilst

completing nursing/midwifery studies.• An income whilst studying.• Support and mentoring by professionals (both Aboriginal and

non-Aboriginal) who are already working within the health setting.

• The opportunity to personally experience employment in a health facility and develop both cultural and nursing/midwifery contacts.

• Opportunity for employment post cadetship

Work PlacementThe cadets work placement is for a period of up to 12 weeks in either nursing or midwifery. The work placement allows the cadet to consolidate their theoretical knowledge and to practice their clinical skills.

Work placements are completed during the long semester break or throughout the academic year as long as it does not interfere with the cadet’s study. The work placement must not replace the university clinical placements and must not interfere with the completion of their course clinical placements.

It is an expectation in most circumstances that the work placement will be undertaken during the long summer semester break so that it does not interfere with their study during the semester.

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Cultural safety

Cultural safety is a concept that is fundamental to understanding the process and goals of this project.

Within a cultural safety education programme nurses identify social and personal attitudes and have an opportunity to examine their own beliefs values and assumptions about other people. The focus of cultural safety teaching is to educate nurses and midwives:

To examine their own realities and the attitudes they bring to each new person they encounter in their practice;

To be open minded and flexible in their attitudes toward people who are different from themselves, to whom they offer or deliver service;

Not to blame the victims of historical and social processes from their current plight;

To produce a workforce of well educated, self-aware registered nurses who are culturally safe to practice. 12

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Cultural awareness is a beginning step towards understanding there is a difference

Cultural sensitivity alerts to the legitimacy of difference and begins a process of self-exploration

Cultural safety is an outcome of nursing education that enables safe care to be defined by those who receive it.

It is more than just learning about history and customs, fundamental to the concept is the focus on the self and a well-developed sense of self-awareness and how individuals impact on the dynamic of a relationship, but also how social and political forces impact on our sense of who we are and our relationships.

The idea of cultural safety has been further extended to include an emphasis on the relationship between nurses and patients who differ from them by:

Age or generation Gender Sexual orientation Socioeconomic status Ethnic origin Religious or spiritual beliefs Disability12

However in saying this; the primary focus internationally remains on the health outcomes of indigenous populations. The goal is not to recognise people’s difference and treat them the same, which previously would have been considered as equality, now however thinking has evolved to acknowledge that it is necessary to recognise people’s differences and treat them differently as an individual with specific needs. 12

Further information on cultural safety can be found on the Victorian Department of Health website http://docs.health.vic.gov.au/docs/culturalresourceguide

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References 1. Haggerty C, McEldowney R, Wilson D, Kathryn H. We need to grow our own: An evaluation of nurse entry to practice programmes. Whitireia Nursing Journal. 2010(17):16-20.

2. Stuart L, Nielsen A-M, Horner V. Support strategies that graduate Indigenous nurses - A dreaming journey. Journal of Australian Indigenous Issues. 2010;13(3):95-99.

3. Jungersen K. Cultural safety: Kawa whakaruruhau - A occupational therapy perspective. New Zealand Journal of Occupational Therapy. 2002;49(1):4-9.

4. Hinton A, Chirgwin S. Nursing education: reducing reality shock for graduate Indigenous nurses - it's all about time. Australian Journal of Advanced Nursing. 2010;28(1):60-66.

5. Baker M. Nga Wawata o nga Neehi Maori me Nga Tapuhi Maori. Responses from Maori nurses and midwives nationally. In: Health Mo, ed2009.

6. Smith D, Tedford Gold S, McAlister S, Sullivan-Bentz M. Aboriginal recruitment and retention in nursing education: A review of the literature. International Journal of Nursing Education Scholarship. 2011;8(1):1-22.

7. Usher K, Goold S. Meeting the health needs of Indigenous people: How is nursing education meeting the challange? Contemporary Nurse. 2006;22:288-295.

8. West R, Usher K, Foster K. 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. 2010;36(1-2):121-130.

9. Goold S, Turale K, Miller M, Usher K. Gettin em n keepin em. Canberra: Indigenous nursing education working group;2002.

10. Gregory D, Pijl-Zieber E, Barsky J, Daniels M. Aboriginal nursing education in Canada: An update. Canadian Nurse. 2008:24-28.

11. Simon V. Characterising Maori nursing practice. Contemporary Nurse. 2006;22:203-213.

12. Papps E, Ramsden I. Cultural Safety in Nursing: the New Zealand experience. International Journal for Quality in Health Care. 1996;8(5):491-497.

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Appendices:

1. Consultation list2. Cultural Safety Workshop3. Outline Networking day4. STV graduate nurse program5. Interview questions for Aboriginal and Torres Strait Islander Early Graduate Nurse Project

Appendix one: Consultation List

Name Title consultationRobyn Coulthard Acting Chief Executive Officer

CATSINInterview and ongoing consultation

Jill Gallagher Chief Executive OfficerVictorian Aboriginal Community Controlled Health Organisation

Meeting

Carol Williams ManagerEducation and TrainingVictorian Aboriginal Community Controlled Health Organisation

Meeting

Karen Adams Research and Health informationVictorian Aboriginal Community Controlled Health Organisation

Interview

Naomi Wolfe Academic Coordinator Jim-baa-yerAustralian Catholic UniversityMelbourne

Interview

Gregory Phillips Head of SchoolSchool for Indigenous Health Monash University

Interview

Jenny Day Lecturer & Indigenous Student Liaison OfficerNewcastle University

Interview

Nat Heath Indigenous Student Support and Development Newcastle University

Interview

Lynne Stuart Lecturer Indigenous academic support University Southern

Interview

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Queensland

Professor Wendy Brabham

Director Institute of Koorie Education Deakin University Melbourne

Meeting

Orana Harris Maori Entry to Practice support nurseBay of Plenty District health BoardNew Zealand

Phone Interview

Ngaira Harker-Wilcox

DirectorSchool of Nursing and Health StudiesWaiariki InstituteNew Zealand

Phone Interview

Alyssha Fooks Co-ordinator cadetshipRoyal Women’s HospitalMelbourne

Meeting

Lisa McDonald Director MissionSTV Melbourne

Meeting

Ben Gorrie Co-ordinator Cadetship STVMelbourne

Interview & Consultation

Jason Coombs Aboriginal Nursing Cadet STVMelbourne

Consultation

Ashima Gupta Project Officer Aboriginal HealthSTVMelbourne

Consultation

Michelle Winters Aboriginal Liaison Training OfficerSTVMelbourne

Consultation

Jade Murphy Graduate Nurse Co-ordinator STVMelbourne

Consultation

Cathrine Klomp Regulation Policy & Programs Nursing and Midwifery Policy Department of HealthVictoria

Consultation

Steering Committee Members:

Lisa McDonald Director of Mission and executive sponsorDeanne Riddington Manager Nurse Education UnitMichelle Winters Aboriginal Liaison Training OfficerAshima Gupta Project Officer- Aboriginal HealthJade Murphy Graduate Nurse Co-ordinator

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Ben Gorrie Co-ordinator CadetshipRuth Crampton Nurse Educator

Appendix two: Cultural safety workshop

Two full day workshops recommended for each group with some time in-between each day to allow for reflection.

Generally a maximum of 20 people to attend, with an ideal number being 12-16 attendees so the workshop may need to be run on more than one occasion to target the necessary people.

It is imperative that all the senior management, educators and nurse preceptors in contact with the Aboriginal and Torres Strait Islander early graduate nurse attend this training.

The training needs to focus on not only the pre and post colonisation history of the Aboriginal and Torres Strait Islander people but also have as a significant focus on self-discovery for the participants where they have the opportunity to examine their own realities and attitudes.

Other objectives can include Aboriginal and Torres Strait Islander learning styles and strategies to manage and supervise Aboriginal and Torres Strait islander staff.

Further information on cultural safety can be found on the Victorian Department of Health website http://docs.health.vic.gov.au/docs/culturalresourceguide or by contacting sue.davey@health.vic.gov.au

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Appendix three: Networking Day

Aims of networking dayThis day is planned to occur in the week prior to the general graduate nurse intake. It is intended to be casual and welcoming to the group and facilitate the development of relationships within the peer group. The welcome group will be kept intentionally small and low key with the graduate co-ordinator and the graduate support nurse and a representative from the Aboriginal health liaison team. The day will be catered, with morning tea and lunch provided. STV is fortunate to have an established walking tour program which introduces participants to local significant sites and both the graduate nurses and their preceptors will be invited on this tour following lunch. In the future the opportunity may present where a current participant of this program could meet the new group and be available during question and answer time. This is a format that currently works well in our established graduate nurse program.

Objectives for the day include:

For the participants to become familiar with the hospital environment. To encourage relationships to develop both within the team and with the support staff. To introduce the participants to the local Aboriginal and Torres Strait Islander community. Outline the specifics of the Aboriginal and Torres Strait Islander graduate nurse program. To introduce the group to CATSIN the professional body for Aboriginal and Torres Strait Islander

nurses.

Outline of networking day9-1030: Introductions & Welcome

Meeting key people and support staff

Outline of Aboriginal and Torres Strait islander graduate nurse program

Question and answer time

1030-11: Morning tea

11-1130: CATSIN

Introduction and discussion re conference and mentorship

1130-1230: Hospital Tour

1230-1330: LUNCH

1330-1530: Walking tour

An Aboriginal cultural awareness program that takes participants on a walking tour of Fitzroy sites of significance.

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Appendix four: St Vincent’s Early Graduate Nurse Program

STV early graduate nurse program follows the guidelines and objectives outlined by the Victorian Government .

The following principles underpin EGP's:

1. Best practice EGPs are delivered in organisations that value learning, professional development, evidence based practice and research.

2. Best practice EGPs thrive in an organisational culture that values nurses, their contribution to client care and service delivery and the role of the early graduate in the health team.

3. Best practice EGPs are provided in a safe and supportive work environment that complies with principles of the Occupational Health and Safety Act 2004.

4. Best practice EGPs are planned learning and professional development experiences that address both early graduate and workplace needs.

5. Best practice EGPs are based on the understanding that early graduates have been prepared through their tertiary qualifications for beginner level practice. As such, early graduates require access to more experienced nurses and midwives as preceptors for supervision, direction and instruction

6. Best practice EGPs adopt a holistic approach that considers professional, social and whole of life issues.

7. Best practice EGPs are integrally linked to the organisations quality, safety and risk management frameworks.

In addition the St Vincent’s graduate program consists of two 6 month rotations in over 24 clinical areas. The first week of the program is supernumerary and consists of orientation and study days as well as several shifts in the clinical area. The early graduate nurses participate in 4 additional study days throughout the year and are given pre-reading and practice development pathways tailored to each clinical rotation. There are also regular nursing forums, in-service education sessions and competency programs.

Further information on graduate nurse programs can be found in the Nurse and midwife graduate handbook 2012 which can be found in as a PDF on the internet www.nursing.vic.gov.au

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Appendix five: Interview questions for Aboriginal and Torres Strait Islander Early Graduate Nurse ProjectThe interviews completed for this project where unstructured and conversational in style. This philosophical approach was adopted deliberately as we were aware of the limited knowledge on such a program and found no other benchmarking opportunities. When entering the interviews the aim was to allow the interviewee to lead the conversation, without the limitations of a formal question list.

As information and knowledge was shared and the project progressed a clearer direction was established with the drafting of some early recommendations, which were shared with those consulted for feedback.

Questions asked generally included but not limited to the following:

Can you tell us about your current role, the challenges you face and the lessons you have learnt?

When developing a New Graduate Program for Aboriginal and Torres Strait Islanders what do you think might be challenging for the nurses?

What level of support do you think they might require?

Do you have any support structures in place for your students/staff that you think might be of benefit to these nurses in their first year of nursing?

Ideally new Graduate Nurses of an Aboriginal or Torres Strait Islander background would be mentored by an Aboriginal or Torres Strait Islander senior nurse. If there are none of these mentors available what do you think might be an alternative model?

What other ways do you think we could support Aboriginal and Torres Strait Islander Nurses career ambitions?

Once Aboriginal and Torres Strait Islander nurses have been through this development program what things do you think might influence them to stay within the hospital?

In what ways do you think a hospital such as St. Vincent’s can develop relationships with the community?

Can you think of a hospital that has an entry to practice program for new nurses that offers a model we would benefit from observing?

If you were given funding to develop this type of program what areas would you focus on?

These are the draft recommendations we are developing do you have any comments?

Is there anyone else you think we should talk to?

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