Recruiting and retaining First Nations health workers

First Nations people need culturally and physically safe healthcare, and the best way to ensure this, is to maintain a presence of First Nations health workers in all roles, locations and professions across Australia. The Lowitja Institute conducted a study looking at the development and careers of Aboriginal and Torres Strait Islander people in the health workforce. Carissa Lee Godwin, Editor, APO’s First Peoples & Public Policy Collection, explores this Lowitja Institute’s report investigating the current representation and support of First Nations people in the healthcare workforce, and how employment recruitment and retention can be improved further.

Career pathways for the Aboriginal and Torres Strait Islander health workforce

The Lowitja Institute conducted research into First Nations health workers across Australia as part of its Career Pathways Project (CPP). The CPP was initiated by the Aboriginal Community Controlled Health Organisation (ACCHO), to highlight the unique skill sets and values First Nations health workers can bring to health services, and to see how these health workers can be supported to develop and advance their careers. The Career Pathways for the Aboriginal Torres Strait Islander workforce series produced a number of reports, including:

• The National Survey Report
• The National Career Trajectory Interviews Report
• Northern Territory (NT) workplace case studies report
• NSW workplace case studies report.

This article will include information from all of these reports.

Key findings

The Lowitja Institute provided urban, regional and remote perspectives from within Aboriginal Community-Controlled Health Organisations and government services. This was achieved via the first national survey of First Nations health staff across Australia, with accompanying Northern Territory (NT) and New South Wales (NSW) case studies and interviews. Key findings include:

1. First Nations people in the health workforce bring unique cultural skills, knowledge and values to the delivery of services. Through personal experiences of living and working in community, First Nations people bring essential communication skills and ways of conducting business that allow for the cultural needs of First Nations patients.
2. The CPP National Survey Report found respondents claimed that a main factor impeding First Nations health workers were ‘limited opportunities being offered’ (mostly respondents over 40 years of age), ‘not feeling supported by their manager’ and ‘a lack of cultural sensitivity among colleagues.’ These issues call attention to the importance of supportive management for career development that also addresses the needs of all ages and career stages of the health workforce.
3. Career decisions of First Nations people are often influenced by cultural factors, and the health and wellbeing of their family and/or community, the findings in the CPP trajectory interviews show. Therefore, it is important to note that motivations behind career decisions for First Nations people can often be quite different to the motivations behind the decisions of non-Aboriginal health workers.

Key policy recommendations

The NT and NSW Case Studies have similar findings, but each area needs tailored responses that acknowledge the needs of that particular community. A blanket solution across these communities will not be an effective approach.

1. The NT Case Studies Report recommends that contributing to the alleviation of poverty needs to be a priority. This could be done through employment opportunities that allow for viable career paths and progression, with wage parity and equitable opportunities. In addition to these, the housing and infrastructure needs of Aboriginal and Torres Strait Islander staff should be made a priority to alleviate overcrowding and safety.
2. The NSW Case Studies Report recommends that health services create formal partnerships between TAFE (technical and further education), universities and high schools to establish career pathways for First Nations people. These partnerships across institutions would function to create opportunities for collaborative training, such as work experience and student placements in health services.
3. Career development and pathways for First Nations health staff across all professions, roles and locations should be a priority for government, the community-controlled sector, professional associations, other peak bodies and policy makers. This is also critical to facilitate improved access and better experiences with health services for wider First Nations communities.

The National Career Trajectory Interviews Report iterates the importance of honouring the unique needs of each First Nations community. However, a common thread through all of the CPP reports is the need for First Nations people to be employed across all levels and areas of organisations, including executive and senior management positions. In addition to this, there needs to be a commitment to career development for First Nations people and creating career pathways supported by a cultural safety framework.

Far-reaching benefits

The reports in this series provide a great insight into the lives of First Nations workers and the additional barriers they must overcome or balance in order to gain and keep employment in health services. Health service employers need to ensure there is adequate support available for these workers and their communities, and to also ensure that relevant cultural and community practices are embedded in their workplace.

The National Career Trajectory Interviews Report states that self-determination is an important factor to ensure the success of First Nations people. The report recommends that this should be done through: “privileging the Aboriginal and Torres Strait Islander cultural and community knowledge in the workplace that promotes cultural integrity of both workers and the organisation and supported through more widespread use of cultural supervision.”

The report goes on to state there should be an embedding of respective cultural practices into service delivery and design within health workplaces. Linking an understanding of cultural and social aspects of health will be of great benefit not only to First Nations health workers, but also First Nations patients. 

About the First Peoples & Public Policy Collection

As part of its mission to improve Indigenous policy in Australia and Aotearoa-New Zealand, ANZSOG is working to increase knowledge of Indigenous culture and history. Part of this is our support of the Analysis & Policy Observatory’s (APO) First Peoples & Public Policy Collection, launched at our Reimagining Public Administration conference in February 2019.

APO is an open access evidence platform that makes public policy research accessible and usable. It has more than 40,000 resources, including specialist collections, grey literature reports, articles and data.

The First Peoples & Public Policy Collection is curated from a broad choice of key Indigenous policy topics, and provides a valuable resource on Indigenous affairs, with a focus on diverse Indigenous voices.

Resources

• Search APO’s First Peoples & Public Policy Collection
• Sign up to ANZSOG’s Indigenous news mailing list
• Find our more about ANZSOG's Indigenous engagement

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• February 2020 - Garma 2019 report: Including First Nations in future policies
• April 2020 - Closing the gap: A new partnership
• June 2020 - After the bushfires: The absence of First Nations' voices
• July 2020 - Making retirement accessible for First Nations people
• August 2020 - Self Determination needed for effective First Nations Peoples’ response to family violence