The concept of kawa whakaruruhau (cultural safety) arose out of a nursing education leadership hui held in Christchurch in 1989 in response to recruitment and retention issues of Maori nurses. The cultural safety guidelines were initially written by Irihapeti Ramsden in 1991, and further developed by a Nursing Council committee (1996), led by Irihapeti Ramsden, in response to the recommendations arising from the Cultural Safety Review Committee (1995). Guidelines to Cultural Safety, the Treaty of Waitangi and Maori Health in Nursing Education and Practice.

Initially the educational focus was on teaching cultural safety to health professionals in relation to Maori, but the principles of cultural safety have been recognised as relevant to all cultures and their application has been broadened accordingly.