The attributes needed to nurse effectively.

   Whaanau Ora--Maori Ora
   kia whai kaha,
   Whai mana painga
   Ki ngaa kawenga
   Oranga iwi ki
   Tua a rangi.

   Whanau inspired,
   enabled, resourced
   and in control
   of their own health.

   Tena koutou katoa.

Before being appointed the inaugural nurse Leader in Maori health at the Counties Manukau District Health Board (CMDHB) earlier this year, I worked as a district nurse in South Auckland. Caring for clients and their whanau, who were predominantly of Maori and Pacific Island origin, with complex whanau dynamics, could be quite challenging at times. As identified in the He Korowai Oranga: Maori Health Strategy 2002, "inequalities between the health status of Maori and other New Zealanders are well documented. Across New Zealand, health inequalities are greater for those in more deprived socioeconomic groups. Whanau are not only over-represented in the more deprived groups, but also appear to experience further inequalities over and above those experienced in the same socioeconomic groups." (1)

Fortunately, as a Maori, I was aware of these issues and, from the start, practised whanaungatanga with clients. This is about the interconnectedness of things as shown through whakapapa. When planning and delivering nursing care, I worked from the principle of tino rangatiratanga. This principle supports Maori to Lead and make decisions for themselves. When health professionals and clients are able to share resources, real outcomes can be achieved. By empowering the client and the whanau with knowledge about a condition, the disease process and treatment options, the support of the whanau can strengthen the wairua of the client to make an informed choice. Through this process of whanaungatanga, the client, whanau and health professional are able to work together effectively.

I also acknowledge the significance of the primary health care principle of intersectoral collaboration and relate this to the concept of kotahitanga. This denotes the unity of all things, eg forming collectives to deal with issues of marginalisation. Kotahitanga is related to the integrity of a health organisation, internally and externally.

The concept of nurse leader in relation to Maori health is not a new idea but an encouraging sign that the development of a bicultural partnership is an essential way to reduce health inequalities.

Key strategies for nurse leader role

The key strategies for the role of nurse Leader, Maori Health CMDHB, involve the following:

* Strategic development: this is achieved through establishing national, regional and local relationships required to facilitate and advocate for nursing objectives for workforce development, education/training and professional development.

* To provide clinical and professional leadership by promoting culturally safe practice (tikanga best practice) in the nursing workforce and to assist with initiatives developed to have a positive impact on Maori health and to reducing health inequalities for Maori.

* To assist with continuous quality improvement through the implementation and management of initiatives to address differential access to health care services for Maori, and to work closely with key stakeholders to identify opportunities for continuous quality improvement in the delivery of services to Maori.

* Finally, to maintain my professional development and clinical competency by updating my knowledge base on current and relevant research, including trends and best practice within nursing.

Within my own journey as a registered nurse, there are several attributes I have identified, that have enabled me to function effectively in my nursing career. I would like to share them.

The art of reflection: It is important to take time to look back at significant situations/issues, whether good or bad, to acknowledge what went well and to have the courage to make positive changes in those situations where things did not go well.

Being innovative and adaptable: Nurses should not be afraid of change. I know at times it is hard to teach an old dog new tricks, but it is important to consult, negotiate and adapt. Do not be afraid to look for support if necessary through this change.

Dealing with adversity: The third attribute Lakes a little Longer to develop. Success is not about how popular you are, or how bright you are, but about how you manage to cope with the low times. Should you fall or feel rejected or not heard, remain positive and Learn to be resilient. Learn to get back up on your feet and to continue the journey. Remember to reflect and remain positive through these tough times.

Caring for others: We must never lose the passion and desire to care for others. To maintain this attribute, we need to nurture ourselves as well as our patients. Caring and sensitivity start at home, with our own whanau. It is important we are aware of how we speak, care and develop fulfilling and therapeutic relationships that will permeate our work, community and society.

   He aha te mea nui,
   Tenei ao maku e ki atu,
   He tangata, he tangata, he tangata.

   What is the most important thing
   in this world? I will tell you.
   It is people, it is people, it is people.

Reference

1) Ministry of Health (2002) He Korowai Oranga: Maori Health Strategy. Wellington: author.

Report by Te Runanga member Devi Ann Hall

Devi Ann Hall, RN, PGDip, was appointed nurse Leader, Maori HeaLth, at Counties Manukau District HeaLth Board (CMDHB) in February. Of Ngati Porou and Ngapuhi descent, she has lived in South Auckland all her Life and completed her nurse training at Middlemore Hospital. She has 31 years of nursing experience and has spent the Last 15 years or so working in primary health.

She participates in a variety of community health forums, is a member of Te Runanga's Tamaki Makaurau branch, is on the Manukau Institute of Technology's (MIT) Nursing and HeaLth Studies Advisory Board, the joint MIT and CMDHB Te Komiti Kawawhakaruruhau and several allied health committee groups.