JUDY SECCOMBE looks at nursing attitude to those who are ‘different’ and challenges kiwi nurses to be more welcoming to new colleagues from different ethnicities, cultures, or countries.
More than a decade ago for my master’s degree, I studied the attitudes of nursing students towards people with disabilities.
The literature review for this study showed very clearly that nurses’ interactions are affected when working with people who are ‘different’ in any way. The studies I looked at covered nurses’ attitudes to people with intellectual impairments, mental health issues, brain injuries, and physical impairments.
I undertook this research because of my concern at hearing reports, and frequently observing, negative nursing approaches to caring for people who are different. Society’s perceptions about ‘different’ people were also often reflected in the attitudes of first year nursing students. Clinical placements for nursing students at the time included places like the former Kimberley Hospital, IHC (now IDEA) residences and workplaces, special needs classes in primary and secondary schools, and rehabilitation units in various settings.
These experiences allowed students to learn how to interact and communicate with people of varying abilities; they learnt to value the person and to work alongside and within that person’s abilities. Most of all, they learnt not to judge, not to discriminate, and that all people respond positively to caring, patience, and kindness.
Sadly, these valuable clinical placements are no longer accessible due to the lack of registered nurse (RN) supervision for student nurses. This means that today’s RNs often encounter people who are different for the first time in an acute healthcare environment. In many cases, these nurses find they are ill-prepared to understand, communicate and safely manage an acutely ill person with a significant existing impairment.
I was thinking about this recently as I reflected on the transition of nurses of different ethnicities and cultures into our nursing workforce.
Research shows that communities in many countries are becoming increasingly diverse in terms of their cultural and ethnic mix. This trend is reflected in the changing face of our nursing workforce which, according to the Nursing Council of New Zealand 2011 workforce statistics, is 68 per cent New Zealand European/Pākehā,
7 per cent Māori, and 4 per cent Pacific, with the remaining 21 per cent drawn from a wide range of ethnicities. New Zealand relies heavily on overseas nurses to replace and grow our nursing workforce. Women and men from a wide variety of countries and cultures are also evident in our student nurse population and the internationally qualified RNs who seek New Zealand registration through competency assessment programmes (CAP).
Every year in New Zealand, a proportion of nurses are audited by the Nursing Council to demonstrate that we can meet all the competency indicators including cultural safety, accountability, effective communication, and inter-professional collaboration. We are also bound by the Code of Conduct and Code of Ethics that guide us on upholding our professionalism in practice.
So how is it that nurses from another culture continue to be treated differently when they enter our healthcare workplaces? I would suggest that this arises from the same intolerance shown to people different through disability.
During my many years in clinical practice and as a nurse educator, I have listened to students and RNs, and observed for myself, the discrimination often evident from my nursing colleagues towards nurses of another ethnicity endeavouring to practise in the New Zealand healthcare system. This is not only culturally unsafe but is a total disregard of our professional and inter-professional responsibilities. Rather than facilitating a new nurse’s integration into the team, this negative behaviour creates fear, loss of confidence, mistakes, and increased difficulty communicating in English. This is well documented in the literature.
Every nurse has a responsibility to support and encourage other nurses as they transition into working as an RN in New Zealand and becoming a colleague and team member. Some nurses take a little more time, direction, and effort than others but every individual deserves a chance to grow into their new role. We have excellent international RNs who are valued members of their healthcare team but many can readily describe the struggle it was to reach that point.
Established RNs also have a significant impact on the experiences of nursing students and new graduates transitioning into the workforce. That impact can range from being empowering and liberating to disempowering and disillusioning; and at times can result in an RN leaving the workforce.
Each and every one of us can think back to our first days as an RN and how frightening that was. We can also name those colleagues who, through their patience and support, made a difference in our developing confidence as a nurse. The Nursing Council Code of Conduct has a new principle on working respectfully with colleagues which I believe also encompasses respecting their cultural needs.
Think about this! Think about your attitude to people who are different and how your professionalism is demonstrated in your practice. Cultural safety in nursing practice encompasses our interactions with clients, colleagues and students; people who are the same and people who are different. We can learn so much from others – parents, children, older adults, people with impairments, and people from other cultures – and we will be personally and professionally richer from that experience. New Zealand needs a multicultural workforce to provide healthcare for our multicultural community and we all have a part to play in achieving this.
Judy Seccombe RN MN (Dist) is a programme leader at UCOL’s nursing school in Palmerston North.