Intersectionality in Practice: What New Nurses, Administrators, and Practice Managers Teach Us About Equity and Care
Cape Reinga where the Tasman Sea and the Pacific Ocean converge. Photo credit: Rāwā Karetai-Wood-Bodley
Speaking With Our New Nurses
Over the past few weeks, I’ve had the privilege of speaking with newly qualified nurses, registered nurses, as well as administrators and practice managers, who are either working in or transitioning to general practice, across Health New Zealand | Te Whatu Ora.
For me, these moments are deeply grounding. Standing alongside people at the beginning of their careers in healthcare is humbling. Nurses, Administrators, and Practice managers are the heartbeat of our health system. They hold trust in their hands every day, trust that is given at moments of vulnerability, pain, and hope.
What struck me most was not just their excitement, but their values. These cohorts are more focused on equity, sustainability, and inclusion than I dared expect. It makes me hopeful for the future of healthcare.
And it reminds me that intersectionality is not an abstract idea. It is what determines whether a patient feels seen, safe, and cared for.
“Inclusion isn’t a ‘nice to have.’ It’s clinical excellence. It’s whether someone feels safe enough to tell you the truth.”
Tension: A Waka Built for One Paddler
In my talks, I used the image of a waka to illustrate the concept of equity.
Imagine a waka built for one kind of paddler. Those who don’t fit that design will struggle. They may try to keep up, but they will tire, fall behind, or be excluded entirely.
For too long, our health system has been a waka designed for only one kind of patient, often Pākehā, middle-class, English-speaking, non-disabled. Everyone else has been expected to adapt.
The result is predictable: Māori and Pacific whānau die younger. Disabled people face barriers to even getting in the door. Rainbow and takatāpui communities experience stigma that drives poorer mental health. Migrants and older people are sometimes left without culturally safe, affordable care.
The question is not whether these groups exist. They always have. The question is whether the waka was ever designed with them in mind.
Intersectionality in Healthcare
Intersectionality, a concept introduced by Kimberlé Crenshaw, teaches us that no one lives a single identity at a time. Health outcomes are shaped by how identities and experiences overlap, just like the Tasman Sea and the Pacific Ocean converge at Cape Reinga.
For example:
A disabled Māori elder faces barriers that are not the same as those faced by a Pākehā disabled elder.
A Pacific Rainbow youth experiences stigma differently from a straight Pacific youth.
A rural refugee whānau with language barriers will experience inequities differently from urban Pākehā whānau.
These are not edge cases. They are the very people most likely to fall through the cracks when healthcare is designed in silos.
“Intersectionality isn’t a theory to leave in textbooks. It is the daily reality of patients walking through clinic doors.”
What Nurses, Administrators, and Practice Managers Can Do From Day One
Nurses, Administrators, and Practice Managers are uniquely placed to bring intersectionality into action. Why? Because they are often the first face patients meet, and the one who sees them most often.
Here’s how intersectionality translates into daily practice:
Respect identity. Learn names. Use pronouns. Honour whakapapa. Small acts build trust quickly.
Ask, don’t assume. If someone needs adjustments, an interpreter, accessible equipment, or cultural support, ask them what works best.
Whakawhanaungatanga. Relationships matter. When you know the story behind the symptoms, you deliver care that is holistic, not transactional.
Challenge bias gently. When you see exclusion in your workplace, name it. You don’t need to be perfect. You need to be willing.
Become an ally. Use your position to open doors, create space for conversations about continuous improvement, service design, and systemic change.
These are not extras. They are the difference between care that heals and care that harms.
The Challenge of Bias
Bias is not always loud or obvious. Often, it is invisible, shaped by what we’ve been taught to see as “normal.”
For example:
Assuming an elderly Māori kuia has whānau support without asking.
Believing a migrant whānau “doesn’t comply” with treatment, when the real barrier is cost.
Assuming a Rainbow patient is straight and partnered in the “usual” way.
Talking to a parent, but not the disabled young person sitting right in front of you.
Expecting the child of a patient to interpret New Zealand Sign Language (NZSL) into spoken words.
None of these is malicious. But all of them can undermine trust.
That is why intersectional practice matters. It slows us down long enough to ask, "Who is in front of me, really?"
Hope for the Future
As I left each of these talks, I felt a sense of hope.
I had worried, given today’s global climate, that new healthcare workers might shy away from equity and inclusion, that they might see them as “political” rather than essential. Instead, I found curiosity, compassion, and courage to do the right thing.
Intersectionality in action is about more than frameworks. It’s about people. It’s about Hiwa growing up in a world where his whakapapa, his disability whānau, and his Rainbow whānau are celebrated, not erased. It’s about every nurse, administrator, and practice manager choosing to design care that fits the person, not the other way around.
“Every shift, every patient, every interaction is an opportunity to centre equity and aroha.”
That is what new nurses reminded me: the future of healthcare is not just about clinical skill. It’s about compassion, humility, and equity in action.
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🖤 Ko te pae tawhiti whāia kia tata. Ko te pae tata whakamaua kia tīna. | Seek out the distant horizons so they may become close. Hold fast to the close horizons so they may be secured.