Valuing, protecting and remunerating Māori staff

Māori staff within health organisations often work a double day – they fulfil the role they are remunerated to do and then their employer often expects them to carry out cultural activities. For example, they are expected to perform customary rituals (e.g. to clear a room after a death). They may be expected to attend meetings with Māori patients and whānau, they educate staff on cultural matters and facilitate cultural processes including leading karakia. These informal but necessary cultural roles are expected but are usually unpaid. This can lead to stress and burnout among Māori staff. At the very least, Māori staff often voluntarily meet the cultural safety gap by extending their working role to ensure that the kaumātua and whānau are well taken care of.

Joy (health professional) visits patients on the wards to see if they need anything. Joy's previous community nursing experience is a definite advantage as she knows what is needed to enable patients to return home and also what they need while in hospital:

...I’ve got access to the patients who are inpatients in the hospital so if I see they’re in the ward then I go and visit them there as well, yeah. Um yeah, making sure they’re okay. Making sure they don’t need anything else… you would hope that the nurses do that in the wards, you know, like social workers, if they need that kind of support, home help. It’s quite good because when you work in the community you know what’s needed in the home as well as what’s needed in the hospital. Yeah.

Kuia K. spoke about a family member (nurse) who went the extra mile, often without additional remuneration, to provide end of life care, highlighting that organisations need to care for their Māori staff appropriately. It also signals the need for health managers to be aware that the needs of some Māori patients and whānau are often being met by health professionals who go the extra mile to take care of them. This can impact personally on staff members:

But some of them [the ill and dying] won’t have any whānau, you know, so she’d go up on Saturday and take them out, or she’d go back on Sunday. And when they really need somebody towards the end, they’ll ask for her. So, she found herself working almost 6 days a week. And she had to pull herself back after a while. After a long while, she had to realise. Her husband pointed out, ‘Hey, are you getting paid for going back on? Are you getting double pay or something?’ ‘No.’ ‘Well what you going back [for]?’ [She replied] ‘Well they need me; they don’t have any whānau’ she said.

Respecting Māori health professionals' knowledge of Māori communities

Issues can arise for Māori workers when their professional ethics are questioned because they go the extra mile to support Māori whānau who use health services. Supporting Māori health and social care professionals to carry out their roles will undoubtedly help to reduce inequities for whānau within their community.

Whaea T. (health professional) expressed that in the past, a health service had questioned her about her professional boundaries, as she often works with, and provides support to, people in her extended whānau:

… I’ve been questioned by [name of health provider] and the auditors about my boundaries being Māori and being around [name of iwi]. I affiliate to the whole hapū, iwi you know. And lot of the whānau’s that are coming through I’m connected to them… [I’ve been asked] ‘How do I deal with you know, if I see a whānau… what do I say? How do [you] feel about you know, working alongside them? And your role?’ And I said, ‘no problem’.

Wondering… what they mean by all that? I said, ‘you mean by my boundaries because I might be doing too much you know for that family…?’ And I said ‘I don’t have any problems. I know my boundaries. I know when to pull away’. But for whānau I’m there for them and if I can offer you know some- oh alleviate you know… some of the stress and that I just do it automatically… Yeah. Yeah, I think it’s about boundaries. And I said, ‘I know when to take my hat [off] and when to put it back on’.

Māori health professionals go the extra mile to ensure that cultural customs are upheld within the health service. For example, karakia is important to Joy (health professional) in her busy working role and she tries to integrate it into her current work at the DHB:

…. I tell you that’s what I missed when I left [name of Māori service] and went to the DHB because at [name] every morning we had karakia, we had waiata. So, I missed all that…and of course you try and integrate it into the DHB services but there’s only so much you can do... But I still do my karakia and that, you know, maintain all of that. And when we have pōwhiri[s] I enjoy a waiata down there.

Whānau can feel afraid, confused and stressed when they do not understand how palliative care and treatments work or what is happening to their family member. Māori health professionals can be very supportive of whānau and their guidance can also help non-Māori staff to perform their roles. Kui (health care assistant) spoke about how she cared for a whānau who were upset at the hospice where she worked:

… And that, the family that I was talking about that caused all the havoc… they were pushing away the nurse saying, ‘Oh she doesn’t know what she’s doing’... So, I said, ‘What are you people up to? What are you actually up to?’ Trying to be very serious and professional, I said, ‘How do you [sic] push the nurses away?’ I said, ‘These nurses are the best nurses you’re ever going to get. You go to the hospital you’re not going to get this care because they’ve got too many patients. Our nurses here can focus, and keep focused, and look after her really well. So, stop trying to make out, you know, that “oh, no, no I think she’s hurting her.’ No. Our nurses would never ever do that.’ And in the end, they apologised. I said, ‘Don’t you dare say that about these nurses and doctors. These are the best you’re ever going to get.’

Recommendation

For health and palliative care organisations, we recommend:

  • Support Māori staff who may feel isolated working in a busy urban hospital by establishing a time and space for them to meet each other.
  • Support any additional cultural activities carried out by Māori staff by recognising the value of their cultural contributions and work.

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