Fact sheet: Guidance for nurses and midwives working with Aboriginal and Torres Strait Islander Health Practitioners

Aboriginal and Torres Strait Islander Health Practitioners are a regulated profession and are an integral part of the multi-disciplinary team. They provide culturally safe clinical and primary healthcare services to Aboriginal and Torres Strait Islander Peoples. Aboriginal and Torres Strait Islander Health Practitioners are a critical ‘first-port of call’ for their communities and therefore play a key healthcare role of Aboriginal and Torres Strait Islander Peoples.

The wellbeing of Aboriginal and Torres Strait Islander communities is underpinned by structured knowledge and social systems developed over many millennia. An Aboriginal and Torres Strait Islander Health Practitioner’s practice encompasses Aboriginal and Torres Strait Islander knowledge systems that are complemented and underpinned by their accredited healthcare education, knowledge, skills and competence. They build trust and bring an understanding which strengthens health outcomes for Aboriginal and Torres Strait Islander Peoples² and which is central to providing culturally safe healthcare services. Aboriginal and Torres Strait Islander Health Practitioners are eligible to provide Medicare rebated services. This enables people with chronic diseases to receive a rebate for treatments.

Aboriginal and Torres Strait Islander Health Practitioners can work autonomously or as part of a multi-disciplinary team, providing a broad range of expertise. Each practitioner’s scope of practice is different and is determined by the Aboriginal and Torres Strait Islander Health Practitioner’s diverse individual knowledge, skills, professional attributes and level of independent practice. This is based on a range of elements such as qualifications, experience, practice setting and in response to the needs of local Aboriginal and Torres Strait Islander Peoples³. The scope of an Aboriginal and Torres Strait Islander Health Practitioner’s scope of practice may also reflect the needs and demands of that health service.

An Aboriginal and Torres Strait Islander Health Practitioner’s practice may include but is not limited to:

• primary health
• clinical care such as pre-examination, assessments, observational screening
• implementing clinical treatments and provide care according to care plans and/or treatment protocols
• vaccinations (in line with state and territory legislation)
• administering and supplying medications (in line with state and territory legislation)
• acute and chronic disease management
• trauma and emergency care management
• procedural care (wound management)
• assessment and screening of the physical, social and emotional wellbeing of Aboriginal and Torres Strait Islander Peoples
• planning and delivering health programs
• advocating for clients.

The following table reflects the similarites between the three professions.

Importantly, Aboriginal and Torres Strait Islander Health Workers are not a regulated health profession and are different from Aboriginal and Torres Strait Islander Health Practitioners. Aboriginal Liaison Officers fulfill a different role altogether. Further information about these roles can be found at on the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP) website.

²https://www.atsihealthpracticeboard.gov.au/News/2019-08-20-Brochures.aspx

³https://naatsihwp.org.au/sites/default/files/naatsihwp-scope_of_practice_2022_v2-web_0.pdf - accessed May 2023.

⁴The qualification entry level is determined by the individual regulatory board and varies across professions.

Aboriginal and Torres Strait Islander Health Practitioners work in primary, secondary and tertiary health care settings and across both generalist and specialty fields.

Most Aboriginal and Torres Strait Islander Health Practitioners work in a wide variety of public, private, non-government and/or Aboriginal Community Controlled Health Organisations (ACCHOs). Many Aboriginal and Torres Strait Islander communities are dependent on primary healthcare services, particularly those provided by Aboriginal and Torres Strait Islander Health Practitioners.

Aboriginal and Torres Strait Islander Health Practitioners work closely with Aboriginal and Torres Strait Islander communities. In addition to providing clinical healthcare, they also contribute to their community in identifying and responding to health needs providing education, awareness, advice, support, training and education. They can also provide support and advice on culturally safe health practice to other members of the health care team, including nurses and midwives.

All health practitioners in Australia need a working knowledge of factors that contribute to and influence the health and wellbeing of Aboriginal and Torres Strait Islander Peoples. These factors include cultural history, spirituality, relationship and connectedness to Country (land, deserts, rivers and seas) and other cultural and social determinants of health in Aboriginal and Torres Strait Islander communities⁵.

Aboriginal and Torres Strait Islander Health Practitioners help build trust and bring an understanding that is central to providing culturally safe care, which we know will strengthen health outcomes for Aboriginal and Torres Strait Islander Peoples. Aboriginal and Torres Strait Islander Health Practitioners, can support and advise nurses and midwives on the specific needs of Aboriginal and Torres Strait Islander Peoples and their health, which enhances both care and Cultural Safety. This includes that:

• Aboriginal and Torres Strait Islander Peoples have access to health services that are free from racism so that they can enjoy a healthy life, equal to that of other Australians, enriched by a strong living culture, dignity and justice and
• ensuring that Aboriginal and Torres Strait Islander Peoples are actively leading the design, delivery and control of health services.

The principles of culturally safe care are embedded in the respective registered nurse, enrolled nurse, nurse practitioner and midwife standards for practice and codes of conduct.

⁵https://naatsihwp.org.au/sites/default/files/naatsihwp-scope_of_practice_2022_v2-web_0.pdf

It is in the best interest of the people receiving care that Aboriginal and Torres Strait Islander Health Practitioners, nurses and midwives collaborate as equal partners, ensuring the most appropriate health professional is providing the right care, at the right time and in the right health setting. The professions may need to refer to, or seek support from each other, to ensure the right care is provided by the right person, at the right time and in the right setting depending on the circumstances.

There are many instances where this collaboration exists. Qualities of successful models of collaborative relationships are represented in the diagram below.

Interprofessional respect results in true collaborate professional relationships and improved quality care for Aboriginal and Torres Strait Islander Peoples and an increased access to care; it is an enabling environment not a ‘gate-keeper’ relationship: The willingness of practitioners to collaborate can positively affect unintended systemic restrictions.

The NMBA’s Decision-making framework for nursing and midwifery provides guidance on making practice decisions in a collaborative way, through professional consensus, consultation and negotiation with the care receiver, relevant family members and other members of the healthcare team.

For additional information, please refer to the resource list found in the downloadable version of this document.