We live in a multicultural and multigenerational world that enriches many nurse teams but also adds complexity for nurse leaders. How do you respect and leverage differences yet create a cohesive team rallied around core goals and values? Is there a “right” leadership style? Does it take more than one approach? Will you alienate others in the process?
These may seem like complex questions, but likely you already have what you need to strengthen your team’s diversity and effectiveness.
Successful diverse teams shine in three areas: staff acceptance, patient acceptance and cultural perceptions of health care. You’ll stand out in each with a little inside knowledge, supplemented with a lot of commitment to leadership and education.
It is important to understand cultural differences in social norms and interpersonal communications when counseling employees from diverse cultures. For example, in some countries it is considered respectful to avoid eye contact with authority figures and elders. In these cultures, avoiding eye contact shows humility, and direct eye contact may seem rude or even hostile.
In contrast, in the U.S., avoiding eye contact can often be considered a sign that someone is not being truthful. Direct eye contact is a meaningful and important sign of confidence, respect and social communication. I have therefore coached some nurse employees to make eye contact with patients and managers.
Most of us spend our days inside a comfortable circle of friends and family who look and act very much like we do. It’s familiar and easy. It’s human nature. But this means we often don’t develop a true understanding of cultural and generational differences. Your goal as a nurse leader is to make diversity familiar and, ultimately, the norm among your staff.
Your team will take cues from you, so a critical step is to communicate your expectations clearly up front. Let your team know that you and your organization are fully committed to succeeding with a diverse team, and they’ll be setting an example for the rest of the hospital. Once your expectation is set, the work and fun begin.
I work with international nurses who have amazing stories about how and why they came to the U.S. and what their new lives mean to them. Everyone loves a story and, as Americans, we root for an underdog — those people who work and struggle to make their lives and families better. I encourage nurses of different cultures to tell their stories and for their nurse leaders to provide the right setting for this communication. Empathy breaks down barriers quickly.
But first educate yourself. You can do that by surrounding yourself with “cultural informants,” as I once heard them called — people from diverse backgrounds who can keep you informed of what is important to that group. With good cultural informants you’ll stay ahead of emerging issues and can anticipate the effect on your team. Develop cultural informants both on your team and off, inside your care facility and out. By explaining your goals, you will likely generate more participation than you need. Many people are happy to enrich the lives of others with similar challenges and backgrounds.
Patient acceptance can be a bit trickier than staff acceptance, but it is equally as important and often overlooked. I counsel many nurses from minority backgrounds after they’ve experienced negative comments or behavior from patients at their care facility. It prompts too many nurses to leave their jobs if it goes unnoticed or unaddressed.
Your team members can influence patient acceptance by modeling it when in front of patients. Younger and minority nurses are particularly vulnerable, so ensure all team members always treat one another with respect. It may also help if you explain how their behavior can affect patients.
Culturally diverse nurses will need sufficient education about U.S. norms in general and U.S. patient expectations specifically. Ensure that you have access to comprehensive training that prepares nurses from other countries for U.S. perceptions, body language, beliefs, customs, holiday observances, humor, religious beliefs and so forth.
When adequately prepared, culturally diverse nurses are strong contributors. They add years of experience as well as richness to the team and culturally relevant care for many patients. Imagine the bump you’ll get in patient satisfaction when a native speaker stops by to take a temp and explains things in the patient’s first language — just one less thing the patient must struggle with that day.
What is quality of care? It seems like a simple question, but the answer really depends on the culture or age of the person you ask.
A nurse might have difficulty informing a patient about their elevated blood pressure because the nurse doesn’t want to add to the patient's stress. The nurse might avoid speaking loudly to an elderly, hearing-impaired patient because the nurse may believe it is rude to raise your voice. Instead, the nurse “courteously” leans over and whispers the information into the patient’s ear — inadvertently violating a U.S. cultural and health care norm.
The same nurse may not identify an elderly patient with a walking device for physical therapy because the patient “looks good for his age.” It is more common for families in the nurse's culture to take elderly relatives into their homes and care for them than to stress independence or living alone.
With training, cultural norms can be changed. It’s not that nurses abandon their cultural norms. They alter them for their situation while also helping teammates understand the health care expectations and norms of patients from other cultures.
So, instead of speaking louder to be heard by elderly, hearing-impaired patients of certain cultures, you may choose to explore alternatives for your team members.
When issues arise
There will be misunderstandings, miscommunications and maybe even some malicious actions from time to time. Expect this, and you will be ready. Address it immediately. This is not the time to second-guess or make allowances — for anyone.
A nurse of color once told the nurse's supervisor that a patient had made derogatory racial remarks while in the same room. The comments were not directed at the nurse but generally referenced people of the nurse's race. The supervisor thanked the nurse for bringing up the situation and then visited the patient, making it clear that that language wasn’t acceptable in the hospital. The nurse leader also counseled the nurse, advising that the patient would be talked with, and reported back after doing so.
If there was another nurse present in the patient’s room during this incident, I’d have suggested the leader counsel that nurse as well. It must be clear to everyone that issues will be resolved quickly.
A changing landscape
Today, 87 percent of RNs in care facilities are white, but that will change in the next five to 10 years as minority students, who now comprise 30 percent of the nurse-student population, graduate and enter the field.
Moreover, international nurses will be filling positions vacated by retiring nurses. The growing base of minority nurses mirrors the demographic shift in the U.S., where 37 percent of the population now belongs to an ethnic or racial minority. By 2049, they will be the majority.
The demographics of the primary health care consumer, people over age 65, will shift more slowly than those of the nursing staff. Nevertheless, this shift will ensure that diversity stays toward the top of the key issues list for most health care systems.
Shari Dingle Costantini, R.N., MBA, is CEO and founder of Avant Healthcare Professionals in Casselberry, Fla.
The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.