Cultural safety training should be compulsory.

ALL OVERSEAS nurses should have cultural safety training before they are allowed to practise here, according to English-trained nurse and NZNO professional nursing adviser (PNA) Faith Roberts.

Roberts came to New Zealand in 1988 and began as charge nurse in the intensive care/ coronary care unit (ICU/CCU) at Rotorua Hospital in early 1989. She says her experience in that role, in a number of other nursing positions and now as a PNA has convinced her of the need for all overseas nurses to undergo cultural safety education.

"There were many Maori patients in ICU/ CCU and I didn't know what I was doing in terms of cultural safety. I've definitely learnt a lot but there is still so much I don't know. Sometimes I wouldn't realise when I'd make a mistake, I wouldn't pick up the signals if patients or their families were not happy about the care. Now, if I make a mistake, I can rectify it more quickly."

Roberts was very grateful to the Maori health care team at Lakeland Health and the opportunities she had to learn about cultural safety. "But it wasn't something that happened straight away and it wasn't insisted on."

She believes all nurses from overseas should have to do formal Treaty of Waitangi workshops and cultural safety assessments before they are allowed to practise. "I have interviewed nurses from overseas who have minimal understanding of cultural safety. It is so important for overseas nurses to realise that what they accept as absolute norms, eg sitting on tables, issues around death, are not the norm for many people in New Zealand."

One of Roberts' guiding principles as a student nurse was to treat everyone as she wanted to be treated. "But many people do not want to be treated the way I want to be treated. There are very different ways people want to be treated and that is a key issue in cultural safety."

She is grateful for some "very privileged partnerships" she has had with patients and their families, which have benefitted all involved. The cultural safety training she has done facilitated that "but I don't want to give the impression that I have 'got it'".

Roberts was relatively young and with little ICU experience when she was appointed charge nurse and there was some resentment and questioning of her suitablity for the role. "That was a bit of a shock because in England it was perfectly normal for a nurse with two-and-a-half years' clinical experience to become a sister. But I had a very supportive principal nurse and the other charge nurses were also very supportive."

But despite that less than auspicious start, Roberts loved working in New Zealand--the informality; the pragmatism, the "get on and do it" attitude, the more relaxed approach.

Despite having English as her first language, Roberts got caught out by some peculiarly New Zealand expressions. "Once a Kiwi friend rang to say she was coming round to 'skite'. I didn't know whether to boil the jug or provide tissues. And there were differences in the names of drugs and other nursing terminology."

From her perspective as a PNA, Roberts believes it is important New Zealand-educated nurses are grounded in this country's heritage and ways. "It's sad but there is still a strong belief here that if ideas come from they UK or the States they must be better. Cultural safety is incredibly important for nursing internationally and yet New Zealand nurses rush to adopt American models, eg magnet hospitals."

She believes New Zealand nurses don't know how good they are. "You've had registration for more than a century. You had polytechnic education very early. You have cultural safety. Sadly many nurses don't understand the importance of that. I think New Zealand nurses are leaders internationally."