THE GOAL OF THIS CULTURAL COMPETENCY CON- TINUING EDUCATION PROGRAM is to enhance nurses’ abilities to work effectively with colleagues from other cultures. After studying the information presented here, you will be able to:


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3 Explain characteristics of the increasingly diverse workplace


Describe how cultural differences in work patterns and communication styles infl uence the nursing environment


Identify person- and organization-centered strategies for working effectively within a diverse environment


By Kirtley Ceballos, MSN, RNC, PCNS-BC


The nurses on a hospital unit are in an uproar. They object to the management style of their supervisor, a Latino man. “He doesn’t listen to our opinions,” they complain. “He issues directives without checking with us.” The supervisor is surprised when he hears this complaint. “I’m in charge, and my job is to direct the staff ,” he says. “My decisions are made to get the work done and keep things running smoothly.” When he discusses this problem with the nursing director, she suggests that the problem has arisen because of cultural diff erences in working styles.


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ituations in which miscommunication and diff erences in work styles create problems will become increasingly more common in the future. Communication and work styles are


learned within a cultural context. Every nurse, regardless of specialty, whether working in a large medical facility or in a local clinic, will be working with colleagues and support staff from diff erent cultural backgrounds. Learning about cultural diff erences in work patterns and communication styles, and specifi c strategies for working eff ectively within a diverse environment will benefi t every nurse.


What is culture and cultural diversity? Culture is the totality of socially transmitted behavioral patterns, beliefs, values and customs that guide the worldview and decision making of a specifi c population.1


The concept of culture tran-


scends ethnic identity. For example, Latinos from Mexico may have a common language — Spanish — with those who come from Ecuador or Cuba, Peru or Puerto Rico, but each country has its own cultural identity. Even a common language has many subtle and not so subtle diff erences among groups that may cause communication gaps. Diversity refers simply to diff erences in race, ethnicity, culture and language, as well as age, sex and sexual ori- entation. These factors infl uence the way a person interprets the world and such aspects of life as work ethic and communication. Interestingly, diversity, when applied specifi cally to the workforce, usually refers to the presence of workers who are not white men. The U.S. healthcare system is unique in that nearly 75% of the workforce is composed of women, with women making up more than 91% of the RN population.2


The nursing shortage has


encouraged active recruitment of trained nursing professionals from abroad as well as recruitment of American-born minorities. Why is the growing diversity of the nursing workforce im-


portant? As more nursing colleagues enter the workforce from diff erent cultures and varied language backgrounds, communi- cation is bound to become more diffi cult. Unless nurses learn to overcome these language barriers, mistakes could occur, putting both nurses and patients at serious risk.


An added complexity of this situation is that our values and goals


are defi ned and molded by the culture to which we belong. You can’t assume that coworkers from various cultures mean the same thing when they say they have a strong work ethic or loyalty to an institution or supervisor. Cultural norms infl uence the meaning of work based on group interest versus individual interest in the diverse workforce.3


can and do cause misunderstandings.4


Diff erences among nurses of diverse cultures The Joint Commission ac-


knowledges the signifi cance of this problem by requiring accredited hospitals to orient each staff member, student and volunteer to cultural diversity and sensitivity issues.5 Madeleine Leininger, nurse educator, anthropolo-


gist and founder of Transcultural Nursing, recog- nizes the importance of the shared similarities and the distinct diff erences among people from diff erent ethnic backgrounds. She says, “Similar- ities help to contribute to feelings of familiarity, while the diff erences stimulate new discoveries and approaches.”6


It’s the responsibility of nurses


and managers to be particularly aware of diff er- ences in the work setting that may aff ect the way staff works together. We need to learn to use staff diversity so it becomes a


positive force and a distinct asset in working together on behalf of the increasing number of patients who come from other cultures. Once nurses better understand each other, they can make more informed choices about their responses and actions, learn to communicate more eff ectively with one another, and provide better care to their patients.4,6 An understanding and appreciation of diverse communication and work styles can lead to constructive strategies for working together.


The changing ethnicity of the workplace The diversity in the U.S. population is increasing. In a population of more than 312 million, almost 51% are women. In the 2009- 2013 American Community Survey 5-Year Estimates report, the U.S. Census Bureau estimated that 74% of the population is white; 12.5% is black; 16.6% is Hispanic (of any race); 4.9% is Asian; and 0.2% Native Hawaiian or Pacifi c Islander. About 0.8% of the population is American Indian, Eskimo, or Aleut (some people are counted in more than one category). Future projections indicate that people of color will comprise just under half of the U.S. population by 2020.7 The U.S. Census Bureau reports that the Hispanic population


increased by more than 1 million from 2011 to 2012, accounting for almost half of the national population growth during that timeframe. It is predicted that Hispanics will comprise 31% of the U.S. population


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