University nursing courses are not only increasing intakes of indigenous students, they are also learning how to keep them. By Mardi Chapman.
Changes in recruitment and retention strategies are ensuring university nursing courses are not only getting more indigenous recruits, they are also “keepin em”.
The genuine progress comes 10 years after the 2002 gettin em n keepin em report laid out extensive recommendations to bolster the number of indigenous nurses.
University recruitment efforts have delivered an increase in nursing enrolments and extra support to encourage student retention is in place. Some universities are boasting indigenous students in undergraduate, postgraduate and doctoral nursing programs. Workforce data shows improvements in indigenous participation at all levels of the profession.
The gettin em n keepin em report has a comparatively low profile and pre-dated the broader Close the Gap campaign but they share similar themes and a clear objective of attaining significant improvement in the health of indigenous Australians.
However it specifically recognises more indigenous nurses in mainstream and community-controlled health services will play an important role in a more accessible and appropriate health workforce.
Australian Institute of Health and Welfare labour force data from 2009 shows 1,605 out of 320,982 or 0.6 per cent of employed nurses identify themselves as indigenous – a disproportionate rate compared with indigenous Australians in the population.
Commonwealth Chief Nurse and Midwifery Officer Dr Rosemary Bryant reported to the Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN) annual conference last year that registered nurses increased from 694 in 1996 to 1111 in 2006.
Dr Sally Goold, executive director of CATSIN and chair of the Indigenous Nursing Education Working Group who authored the 2002 report, is optimistic any gains in workforce numbers will be ongoing.
“Progress is slow but we have come a very long way. There are increasing numbers of students recruited into nursing; student retention is not as good but certainly improving; and more financial support such as scholarships and cadetships has become available,” she told Nursing Review.
CATSIN was established in 1997 to increase recruitment and retention of indigenous nurses and its activities include a mentoring program for students and new graduates in nursing and midwifery.
However Goold would be delighted if CATSIN was no longer necessary: “One day we won’t need a separate organisation. Our people will be treated well in schools, at university and on the job. It won’t be in my lifetime but I can dream.”
PhD candidate Roianne West was an Aboriginal health worker with the Royal Flying Doctor Service, but wanted to do more towards improving the health of her people.
“My role models were my mother who had worked tirelessly in indigenous health as a health worker for 40-plus years and my grandmother who had worked right across indigenous affairs for as many years. I have been raised with a strong sense of obligation to give back to the community and to make a difference,” West says.
However West admits she wouldn’t be where she is now – close to submitting her thesis, a suite of journal articles written, and a position as nursing director for indigenous heath at Townsville Health Services District – without the opportunity to enrol in an innovative degree program in her home town of Mount Isa, in Queensland’s far north-west.
The community-based learning program run by Deakin University’s School of Nursing and Institute of Koorie Education also gave her brother and a twin sister the opportunity to upgrade from enrolled to registered nurses. Her sister had previously withdrawn from degree programs that required her to move away from her community.
West has also completed a Masters degree in mental health and worked as a clinical nurse consultant and with the Federal Government’s Office of Aboriginal and Torres Strait Islander Health.
Professor Kim Usher, director of research education at James Cook University (JCU), supervises three indigenous PhD candidates, including West.
She is justifiably proud of JCU’s record in attracting and graduating indigenous students. Its success rate is partly due to a deliberate strategy of targeting the remote communities of Mount Isa and Thursday Island. Most of the undergraduate degree program is delivered in the communities with two, week-long blocks on campus each semester.
Usher says they also offer a pre-entry program to better prepare indigenous students for university.
“Not all Aboriginal or Torres Strait Island students are less educationally prepared – some come from isolated communities on the Cape while others come from boarding school. People will need different strategies to help them succeed.”
Usher, who co-authored the gettin em report, says financial support for students via scholarships and cadetships has been a successful strategy. “These initiatives made a big difference to students’ viability,” she says.
The University of Southern Queensland received a 2011 Australian Learning and Teaching Council (ALTC) Citation for its Helping Hands model of support for indigenous nursing students.
Nursing and midwifery head Professor Cath Rogers-Clark says the model, which has attracted national and international attention, was “not rocket science but just hits the right note”.
“The Helping Hands model is quite directive, highly supportive and structured. Dedicated indigenous nurse academics help recruit students, work with them individually to set goals and check up on them in a supportive way.”
She says indigenous academics Lynne Stuart and Vicki-Ellen Horner have a strong personal motivation to help students and do so by acting as role models as well as by providing support.
Importantly, their commitment to graduating indigenous nurses is shared by the broader teaching community.
“Indigenous academics are sometimes appointed to schools of nursing but if they themselves are not supported then it is difficult to do much,” says Rogers-Clark.
Rogers-Clark says many indigenous students have cadetships with Queensland Health so they continue to be well supported when they graduate.
Tim Fawcett coordinates a nurse cadetship program at the Lyell McEwin Hospital in Adelaide. The program has been nominated for a SA Health Nursing and Midwifery Excellence Award.
Cadets receive fortnightly study payments, are paid for clinical placements, and offered casual employment as assistants-in-nursing for more hands-on experience during their training.
He says the program, which only started a few years ago, has graduated five students and all have had an offer of ongoing employment at the hospital.
Another 18 cadets are in training to become enrolled or registered nurses, and for the first time this year, a direct entry Bachelor of Midwifery student.
“We have drawn in cadets from Aboriginal health workers and two of the cadets have already moved from an enrolled to registered nurse pathway,” says Fawcett.
“We’ve made an investment in this program and we consider it to be sustainable. Feedback is good, outcomes are good and it keeps growing.”
West says gettin em n keepin em started the conversations about more indigenous nurses and every professional group, peak body and government agency now speaks the same language.
However rigidity in the system and a shortage of champions on the ground stymie more consistent gains across the country.
Even with increasing enrolments, only about 30 per cent of indigenous nursing students complete their undergraduate degree compared with 65 per cent of other students.
West says a multitude of factors are known to contribute to non-completions including social isolation, culture shock, experiences of racism, poor health, kinship responsibilities, poor English language skills and poor adjustment to university teaching styles.
She says one community averaged a funeral each week during the delivery of a three-month pre-entry nursing program in remote Queensland - significantly impacting on attendance. That program also identified a real need to address personal issues such as self esteem, confidence and motivation.
She believes success breeds success and as more indigenous nurses move into leadership positions, there will be more innovation around recruitment and retention.
Usher says indigenous nurses have the potential to make a big difference to their patients through their understanding of indigenous culture and shared experience of access and equity issues.
She also believes they can help non-indigenous nurses to deal better with the disadvantage and diversity they will meet in their professional lives.
“Indigenous nurses will rise fast and be sought after as leaders in their field,” says Usher.Do you have an idea for a story?
Email [email protected]