| Abstract | Background
Following the release of the Social Justice report in 2005, the federal government of Australia, along with other states and territories, signed an agreement (commonly known as the ‘Closing the Gap’ policy) as an overarching document to support strategies designed to reduce the health inequity between Aboriginal and Torres Strait Islander and non-Indigenous Australians. Although the Closing the Gap policy has been in place since 2008, progress has been limited. The policy agreement noted that investment was required to increase the Aboriginal and Torres Strait Islander health workforce, including nursing, as a way to reduce this health inequity. Aims of this study
The aim of this study was to illuminate the rationale for, and implications of, the Australian Government’s affirmative-action strategy, Closing the Gap, which aimed to increase the proportion of Aboriginal and Torres Strait Islander people in the health workforce. Specifically, the implications for the profession of nursing are examined. Method
To understand the way government policy affects Aboriginal and Torres Strait Islander people’s decisions to enter and remain in nursing, the research adopted a critical discourse analysis methodology, as informed by Fairclough. This methodology used a four-phase approach that included linguistic and sociolinguistic analysis, consideration of historical events that influenced policy development and evidence of dialectical argumentation. Two primary texts were examined: the ‘National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes’ and the ‘National Indigenous Reform Agreement (Closing the Gap)’. In addition, secondary- and tertiary-level texts, including subsequent government annual reports, were reviewed to provide correlations (triangulation) to the overt and covert discourses found within the primary texts. These discourses revealed that there is an imbalance of power when the knowledge of one group is not shared with the other. Results
The textual analysis showed that the Closing the Gap policy carries an overt message that the balance of power favours the government over the Aboriginal and Torres Strait Islander people for whom the policy was developed. This has a significant influence on the level of representation of Aboriginal and Torres Strait Islander people in the nursing workforce. Other significant factors that also have an impact include; cultural considerations, obligations to family and community; the embedding of cultural competence and humility within the health and education sectors; and the lack of access to education, limiting employment choices in areas such as nursing. In addition, pathways into nursing are affected by government policy, which prioritises (through funding initiatives) a pathway for Aboriginal and Torres Strait Islander people into an unregulated and unskilled health workforce, rather than professions such as nursing. Conclusion
This study identifies barriers that are not likely to support the implementation of the Closing the Gap policy, that may influence Aboriginal and Torres Strait Islander people from choosing nursing as a career option. Recommendations that would support an increase in Aboriginal and Torres Strait Islander people in nursing are cultural competency programs for academic and health staff and the embedding of cultural content including Indigenous pedagogies into health curricula; increased representation of Aboriginal and Torres Strait Islander people on ANMAC course accreditation reviews for nursing and midwifery; ongoing support, both financial and cultural, to Aboriginal and Torres Strait Islander students, regardless of study modalities; the promotion of successful role models in nursing, to attract Aboriginal and Torres Strait Islander people into the nursing profession particularly in leadership roles within clinical settings and academia; the expansion of Indigenous only nursing cohorts within the tertiary education sector; reverse articulation pathways where a student can graduate with a lower award, i.e. Diploma (as an enrolled nurse) and thereby sustain nursing workforce at various levels within the industry; the modification of funding models provided to universities that support student progression through significant milestones in a study program and the mapping to nursing qualifications and skills, giving recognition and credit for prior learning from other health professions. |
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