Healthier Ma¯ori staff levels sought

Ma¯ori nurse Debbie* has worked in public hospitals for nine years but experiences of institutional and casual racism often make her think about quitting her job.

‘‘What I’ve seen is judgment. Like when a gangster presents to ED having been stabbed or shot, the first thing that happens is security is notified, so naturally the whole feel and mood changes, everyone goes on high alert.’’

She sees the same attitude towards any ‘‘big brown man’’, including her own father.

District health boards (DHBs) have failed to attract and retain Ma¯ori staff at the same rate as non-Ma¯ori since their creation nearly 20 years ago.

New targets quietly approved by DHBs in 2019 aim to turn this situation around.

These include recording employee ethnicity, employing a Ma¯ori workforce that reflects Ma¯ori population proportionally for their region by 2030, and Ma¯ori staff turnover being no greater than DHB turnover for all staff.

There are also targets around cultural competency training being delivered for all DHB staff in their interactions with Ma¯ori patients and wha¯nau.

Debbie became a registered nurse to care for her wha¯nau but she feels her Ma¯ori identity has been an obstacle to career progression.

‘‘For me, the only reason why I do what I do is because I know I can sympathise with that wha¯nau.

‘‘Having experience as a patient, seeing how my father, my mother, grandmother, aunty and uncle have been through the system and have been treated, if I see something I will try and intervene, so they don’t have that experience.’’

She said while some colleagues were committed to partnership principles of Te Tiriti/Treaty of Waitangi, others were half-hearted – and then there were those who objected to the concept of cultural competence altogether.

‘‘You’ve got people who are racist who have resisted all through their training, and they get out into practice, and they still continue to resist – and now they are looking after wha¯nau.’’

DHBs are expected to report annually and quarterly to the national workforce strategy group on their progress on the targets, but do not have to make the data publicly available.

Since the targets were endorsed in late 2019, little has changed.

Across the national DHB workforce, 7.9 per cent of employees were Ma¯ori, compared to 15.8 per cent of the population, as of June 2020, the latest data available, provided to Stuff by the Ministry of Health.

The deficit of Ma¯ori staff ranged from 2.5 per cent at Waitemata¯ DHB, to 17 per cent at Taira¯whiti DHB.

At four DHBs – Lakes, Waikato, Taranaki and South Canterbury – the gap has widened since the targets were introduced. The other 16 DHBs have seen minor improvements.

Auckland DHB chief executive and lead of the national workforce strategy group Ailsa Claire said increasing the Ma¯ori workforce was a priority for DHBs, ‘‘reflecting our obligations under the Treaty of Waitangi and our focus on equity’’.

‘‘You’ve got people who are racist who have resisted all through their training . . .’’ Ma¯ori nurse Debbie*

But she said progress would be gradual. ‘‘This is because recruitment of more Ma¯ori staff into health careers, and structural changes in the health system, take time.’’

New Zealand Nursing Organisation Kaiwhakahaere Kerri Nuku said DHBs need to do more to recruit Ma¯ori nurses, but also to retain them by creating a more culturally supportive environment. She highlighted a 2018 survey which found Ma¯ori members reported experiences of racism on a daily basis.

‘‘What a lot of Ma¯ori nurses were saying was when we go and work at the DHB you walk in the front door, you leave your Ma¯ori-ness behind and you pick it up on the way out. And sometimes you’re that tired you don’t even bother.’’

A target to have all staff and board members complete cultural competency training by 2022 would only work if DHBs took it seriously, Nuku believes.

‘‘We need to see a service responding to the realities of having Ma¯ori within the workforce and there’s very little of that. That’s why Ma¯ori don’t stay.

‘‘There’s only so much they can tolerate in terms of sticking inside a DHB.’’

She said cultural competency training was treated as a ‘‘tick box’’ exercise without any real expectations or accountability.