One of the key areas of difficulty for internationally-qualified nurses is their different relationships with medical staff.
Cultural differences between New Zealand-educated and internationally-educated nurses can amplify existing workplace pressures, according to new research from Massey University. The study, which involved in-depth interviews and an online national survey with nurses about cultural and values-based differences, found that communication breakdowns were common, reducing the efficacy of clinical teams.
Associate Professor Margaret Brunton, from Massey’s School of Communication, Journalism and Marketing, says the number of internationally-qualified nurses in New Zealand has increased over time.
“Nursing is now an internationalised workforce and the New Zealand health sector is reliant on migrant nurses to deliver care,” she says. “Around one-quarter of registered nurses in New Zealand have qualified overseas and both New Zealand and internationally qualified nurses need to adapt to the changes this brings.”
Dr Brunton says one of the key areas of difficulty for internationally-qualified nurses is their different relationships with medical and nursing staff.
“Many come from countries with very hierarchical relationships between doctors and nurses so there is a clear demarcation between medicine and nursing. While New Zealand nurses recognised the clinical expertise of their foreign counterparts, they wanted their colleagues to be able to speak up and advocate for patient wellbeing, rather than being merely task-focused.”
Massey researchers Dr Catherine Cook from the School of Nursing and Associate Professor Margaret Brunton from the School of Communication, Journalism and Marketing.
Migrant nurses feel under constant scrutiny
However, migrant nurses reported unrelenting scrutiny of their practice. “One migrant nurse described his workplace as being ‘like having a dinner with your in-laws — everything that you do will be judged’,” Dr Brunton says. “He felt he had to be cautious about everything he said.”
Co-researcher Dr Catherine Cook, from Massey University’s School of Nursing, says New Zealand nurses don’t always understand how the role of registered nurses can differ overseas.
“In some countries families provide 24-hour, hands-on patient care,” she says. “Migrant nurses are also working in an unfamiliar environment so, for both groups, there is a high emotional cost that comes with trying to keep workplace emotions under control.”
The research also found that internationally-qualified nurses experienced racism from patients and their families, and this led to an uneven allocation of work if patients refused to be treated by migrant staff. Internationally-qualified nurses also reported feeling unsafe at work.
Difficult for nurses to see cultural differences positively
Dr Brunton says it’s not surprising, in the high-pressure and under-resourced environment that nurses work in, that cultural differences can lead to negative feelings.
“We are often told that exposure to different cultures leads to acceptance, but that requires the time and space to explore differences. That’s not possible for most nurses so the differences more commonly cause frustration, which impedes effective patient care.”
She says nurses only have informal ways of addressing cultural tensions and a supportive institutional environment is critical to enhancing teamwork, wellbeing and patient safety.
“Typically, cultural competence education focuses on nurse-patient relationships, whereas our study draws attention to the point that patient wellbeing is reliant on culturally-diverse teams communicating well.
“Throughout our interviews it was clear that nurses struggled with a pressured work environment, further complicated by increasing diversity in both patients and staff. This made it difficult for them to see cultural differences in a positive way.”
Participants in the study wanted clinical leaders and managers to champion enhanced communication in culturally-diverse teams, Dr Brunton says, because maintaining the status-quo was costly to both staff and patients.