Cultural Competence

I recently became a manager of a unit where I have never worked. I set up interviews with the staff so I could start getting to know them and hear their thoughts about what worked well in the unit and what did not. One of the things that became clear to me is that there are issues with respect for cultural diversity. Several of the staff identify that at times they feel uncomfortable in the workplace. There aren’t any displays of outward hostility, but they feel there is racism happening. I want to work on addressing this issue. Is there information that might help me understand the expectations of RNs in relation to cultural competence? 

• RNs are expected to practice using a holistic client/family centred approach ensuring culturally safe client care. (1)
• RNs incorporate knowledge that reflects a deep understanding and respect for different ways of knowing that exhibits cultural competence/cultural humility. (2)
• RNs have a responsibility to conduct themselves according to the ethical responsibilities outlined in the current CNA Code of Ethics (2017) and practice standards. These ethical responsibilities outline how they interact with persons receiving care as well as families, communities, groups, populations and other members of the health care team. (3)
• RNs collaborate with health care providers and others to maximize health benefits to persons receiving care and with health care needs, recognizing and respecting the knowledge, skills and perspectives of all. (4)
• RNs refrain from judging, labelling, stigmatizing and humiliating behaviours towards clients receiving care or towards other health care professionals, students and each other. (5)
• RNs adapt practice in response to the spiritual beliefs and cultural practices of clients. (6)
• RNs take action to support culturally-safe practice environments. (7)

What are some actions I can take with my team to create a unit culture that embraces and celebrates diversity?

There are several things you might decide to do:

• Engage the staff to provide ideas that will be helpful in creating a unit that is culturally competent.
• Invite internationally educated nurses (IENs) to share their stories of differences between nursing in Canada versus nursing in other countries and challenges they have faced.
• Create an opportunity to share their culture with the team. For example, a cultural celebration with displays and food to increase people’s understanding.
• Offer a general cultural diversity education session about being aware of own behaviours and how they can impact someone else.
• Invite a speaker from an organization focused on supporting immigrants to integrate into the community to attend a staff meeting to discuss how to best support IENs.
• Create a small lending library of materials people can borrow and read.
• Remind staff of organizational mission/vision/value statements that include cultural competence. Consider incorporating cultural competence into your unit’s value statements.
• Explore learning modules that offer cultural awareness.
• Connect with community organizations such as the Anti-Racism Network.
• Invite staff who may be interested in developing a learning module as part of their continuing competence program (CCP) to approach you to develop a plan for sharing or presenting this information. As a RN manager, you may want to add this activity to your own CCP learning plan.

What responsibility do RNs have with regards to the recommendations found in the Truth and Reconciliation Commission of Canada, Calls to Action?

"In order to redress the legacy of residential schools and advance the process of Canadian reconciliation,” recommendations 18 through 24 contain the health-related calls to action (8). Every RN is held to a standard or practice in which culturally safe care is provided. Through CCP, RNs can begin to explore the recommendations individually and in groups to assist our health care system in moving forward with the recommendations and promoting Canadian reconciliation.

CRNS Resources

Code of Ethics for registered nurses (2017)

Registered Nurse Practice Standards (2019)

Toolkit for Managers of RNs resource Truth and Reconciliation

External Resources

RNAO Nursing Best Practice Guidelines.  Embracing Cultural Diversity in Health Care: Developing Cultural Competence (2007)

Canadian Nurses Association (CNA): Racism in Health Care

Truth and Reconciliation Commission of Canada: Calls to Action

National Centre for Truth and Reconciliation

Anti-Racism Network