Cultural Safety

Cultural Safety is a big issue in New Zealand. It is a foundation of healthcare and important for protecting consumers rights. This is a real brief rundown of Cultural Safety in NZ nursing setting.

Cultural safety in New Zealand nursing

By Andrew Gowan © All rights reserved

1)            The concept of cultural safety in nursing in NZ began in the 1980’s with a commitment to biculturalism, and the Treaty of Waitangi. It developed out of a concern for the health disparities among Maori. There was an effort to promote cultural awareness and the need for more Māori nurses to be trained. As a concept, cultural safety was ratified at a hui in 1988, and since then has been refined. The Nursing Council in 1991 supported the inclusion of cultural safety in the nursing state examinations, and the guidelines were officially adopted in 1992.  These moves led to some level of controversy with  a large public and media outcry.  Cultural safety became negatively associated with political correctness and social engineering such that a governmental enquiry was established to examine the concerns. The Nursing Council initiated an investigation of education providers in 1995, and following this review, recommendations were made with respect to the controversial elements, and educational standards were set for the implementation of cultural safety in nursing. (Papps & Ramsden, 1996)

2)            The Health Practitioners Competency Assurance Act (2003) ensures the safety and competency of health practitioners in NZ. The NCNZ sets standards of competency for NZ nurses, and all registered nurses must demonstrate that they are able to maintain these competencies. One competency of registered nurses is to be culturally safe. Competency 1.5 states that nurses are to “practice nursing in a manner that the health consumer determines as being culturally safe” (Nursing Council of New Zealand, 2012, p.13). Nursing, by its very nature exists within a cultural context of its own which will impact on the level and quality of care.  Cultural safety recognises that all people are individual, each with their own values and beliefs. The nurse brings to any nurse- client interaction his/her own culture and prejudices, whether overt or covert, as well as a power relationship. The nurse must be able to self-reflect on his/her own culture, and the impact this has on client care, and not impose any judgement, or disempowering on those in care. The nurse is to support and advocate for the protection of the cultural factors that the client (healthcare consumer) holds as important, respecting those factors at all times, ensuring the wellbeing of the client. Safety is the key idea and whether the client feels safe is determined not by the nurse, but by the client (Richardson et al, 2009; Nursing Council of New Zealand, 2012, p.13).

3)            Cultural safety recognises that all people are individual and the nurse must endeavour to practice in a manner that is mindful of those factors that make the individual unique. Cultural safety takes account of the cultural aspects of the health consumer such as age, gender, sexual orientation, religious beliefs, values, and /or disabilities. Underlying this is the recognition of the nursing culture and inherent prejudices of each nurse, and ensuring this does not impact the quality of care. The wellbeing of the client is of paramount importance. The safety aspect includes respecting the physical, mental, social, spiritual and cultural factors of the client/healthcare consumer.

4)            Irihapeti Ramsden was an advocate and political figurehead who helped develop cultural safety in NZ. She was a nurse who became the spokesperson for cultural safety responding to the tirade of controversy and media frenzy surrounding the whole issue. She provided a level headed, knowledgeable rebuttal to the accusations, paving the way for cultural safety to be standardised and recognised in NZ nursing. She taught and facilitated educational approaches to improve understanding of cultural safety, particularly at the political level (Nursing Council of New Zealand, 2011; Irihapeti Ramsden link ).

5)            In nursing practice a common issue that has some members of the community divided is childhood vaccinations. Some health consumers will have religious reasons for refusing vaccinations, others have reservations or will refuse based on their beliefs. This is a cultural safety issue. While biomedicine has evidence of the benefits and safety of vaccinations, and nursing follows current immunisation practice, there remains other perspectives and scientific evidence of negative outcomes of vaccinations. The consumer who is given the tools necessary to make an informed choice and who decides not to proceed with an immunisation schedule should be supported on the basis of his or her beliefs. From a cultural safety perspective, the client’s wellbeing and preservation of their right to hold a belief must be maintained, regardless of the status quo. The nurse must not impose upon or disempower the client, but respect their right to make an informed choice.


Irihapeti Ramsden link to document:

Nursing Council of New Zealand. (2012). Competencies for registered nurses: Regulating nursing practice to protect public safety. Wellington: Nursing Council of New Zealand. Retrieved from

Nursing Council of New Zealand. (2011). Guidelines for cultural safety, the Treaty of Waitangi and Maori health in nursing education and practice. Wellington: Nursing Council of New Zealand. Retrieved from

Papps, E., & Ramsden, I. (1996). Cultural safety in nursing: The New Zealand experience. International Journal for Quality in Healthcare, 8(5), 491-497.

Richardson, S., Williams, T., Finlay, A., & Farrell, M. (2009). Senior nurses’ perceptions of cultural safety in an acute clinical practice area. Nursing Praxis In New Zealand, 25(3), 27-36.