The challenges of working in a multicultural team – a debate paper
Healthcare provision encompasses various professions, institutions, none – professionals and the client (patient). Emphatically, the provision of care must balance the weighing scale so that everyone in the facility is considered important. For instance, the European Council Convention for the Protection of Human Rights and Dignity (1999) highlight upholding patients’ dignity irrespective of what situation the client faces. Some patients have the right to exercise their right to “do not resuscitate order” (Käypähoito 2020) which is a typical example of respect. Multicultural complexity of patients also raise inhibition to the limit of care provision, for instance, based on religious, cultural, sexual orientation among others (e.g., McClimen et al., 2014). Different multicultural backgrounds of the healthcare professionals (HCP) demand due diligence and respect to fully comply with working ethics and regulations among these professionals. Thus, HCP are required to be aware of cultural backgrounds of the clients, right of the patient, diverse nature of others, among others as enshrined in Finnish law 785/1992 that covers patients’ rights and status (Finlex.fi, 2020). Aside, ethical issues are considered on the part of the interventions of the nurse while adhering to the patient’s autonomy (Gallacher, 2015). This gives us a clear indication of how diverse our patients/clients and the professional team has become in recent times.
The continuous challenges of nurses to work in a multicultural team is due to the migration of nurses from one country to the other. There is a global shortage of nurses (Li, Nie, & Li, 2014). A recent literature review on migrant healthcare provision show instances whereby migrant staff lacked adequate knowledge about the host country’s patient culture and diversity among others (Kaun et al., 2020). In Finland for instance, Hanna Aschan (former Manager of Nursing at Helsinki University Central Hospital) said: “Cultural differences are visible at the workplace. Employees may have different views about, say, punctuality, hygiene, temperament, and how to approach certain topics of conversation. Religious views and traditions may also impose restrictions or procedural differences. For people who come from outside the Western cultural sphere, the Finnish way of life may pose challenges” (Korpela, 2008). Moreover, a National Institute of Occupational Health (THL, 2013) report on medical doctors and nurses having foreign backgrounds working in Finnish healthcare found that nurses with African background hold the opinion that their ethnic descent poses a barrier to prospects of getting employed in Finland. Nonetheless, working within a multicultural team provide team members the possibility to learn and appreciate people from different cultural backgrounds and to be in precepts of diversity at work regulations.
Culture shock in addition to cultural conflict is attributing factors that make migrants suffer depression (Bhugra & Ayonrinde, 2004). Accordingly, it is glaring the challenges and gains when we talk about working in a multicultural team (Li et al., 2014). Due to migration, working environments have become culturally diverse and this is evident in nurses that work in multicultural teams in the Nordic countries (Sellevold et al., 2018). In that respect, this, assignment discusses challenges nurses face working in a multicultural team.
Multicultural teamwork predicaments
Working in a multicultural team has its challenges as having been outlined in the preceding section. Now this section discusses in detail what some of these challenges are. Foreign nurses face the challenge of cultural awareness, that is, how different cultural systems operate. Deal and Kennedy (1982) have defined culture as simply how we do things around here. Thus, what is acceptable as a norm in one’s culture may not necessarily be acceptable in a different cultural background. Based on a qualitative descriptive investigation to capture the perception of difficulties and rewards of nurses at residential aged care found that foreign-born nurses and nursing assistants need cultural awareness, support for the English language among other things and conclude that these issues need the attention of management and policymakers in the sector as they are a requirement for their retention (Gao et al., 2015). Other studies corroborate this finding. For instance, culturally and linguistically diverse is some of the challenges facing HCP maternity care delivery. Thus, language and cultural factors present a significant challenge to maternity care delivery due to lack of interpreters and this causes inequities and inhibits maternity care access (Hughson et al., 2018). It can be imagined how nurses will severely struggle to cope with these pregnant women to properly ascertain their pregnancy progress and provide the needed interventions.
Cross-cultural communication problems compound the already difficult and the complexity of working in multicultural teams. Based on a qualitative research through narrative interviews, a study investigated healthcare provision by minorities (i.e., people from foreign backgrounds), trained nurses, nursing assistants, and difficulties they faced working in a multicultural team in Norway reported that, HCP from foreign countries struggle to cope with the Norwegian language that became a hindrance to progression academically (Egede-Nissen et al., 2019).
(Pitkajarvi, Haavisto, Kekki, and Pitkala (2012) reported similar findings in their study in Finland , that is, a major barrier for nursing students to get placement as a result of weak competence in the Finnish or Swedish language, One can only imagine how these students will struggle to cope if they have to work as qualified nurses in these cross-cultural healthcare setting.
Communication problems are also witnessed among inter-professional and this further compound the already difficult and complex nature of working in multicultural teams. Inter-professionals have their jargon – technical words used and understandable within the confines of the profession in that specific context (Falvo, 2011). Professionals outside this sphere are aliens to the languages used and might create tensions and difficulty in comprehending what is being discussed (Yasouka, 2015). Critically, a nurse might misinterpret jargon and could be catastrophic to the entire care delivery especially patient death or accident. Sellevold Gerd, Egede-Nissen, Jakobsen, and Sørlie (2019) substantiates this point. Thus, the study into relational ethics within multicultural healthcare providers to achieve quality healthcare for dementia patients evidenced that the biggest barrier foreign workers faced in the host country was the language barrier (Sellevold et al., 2019). Worth highlighted here, there is a provision by the European Society of Clinical Pharmacy (ESCP) and country-specific efforts to achieve harmony of professional scientific vocabularies used for healthcare delivery (Carollo, Reintord, and Launay – Vacher, 2012). Unfortunately, these vocabularies are not comprehensive, and hence, others not familiar might still struggle to come to terms with them (Carollo et al., 2012).
Despite global sentiments about discrimination against race, gender, religion, faith, sex among others, it persists in our daily lives. Recent log of events such as George Floyd’s death in the USA and others still counting to the archives reminds us of the stigmatization, stereotype, and prejudices, minorities face in their daily lives. Such an act of discrimination is enrooted within the healthcare system. Thus, discrimination account for challenges in working in a multicultural team. Negative attitudes towards nursing students with foreign and cultural backgrounds in clinical settings breed social and professional seclusion (Pitkajarvi et al., 2012). In other instances, migrant staff face discriminatory practices, poor peer relations, and even they are made to do the most difficult part of the work compared to their counterparts who are natives (Goel and Goel and Penman, 2015). An earlier qualitative study into migrant care workers in Dublin, Ireland reiterates this, that is, migrant care staffs experience substantial racial abuse in the hands of natives who are colleagues in the healthcare facility (Timonen and Doyle, 2010). Not surprisingly, a recent literature review about care workers for dementia patients also share the same sentiment. The review found that discrimination against migrant care staff is among the key factors that contribute to the ineffective retention of these workers (Adebayo et al., 2020).
Addressing challenges in working in a multicultural team
It is well documented that working in a multicultural team presents several challenges to which some have been explored above. However, efforts have been put in place either globally, nationally, local laws, and regulations to protect and enhance a free working environment. Multicultural teamwork promotes learning that is relevant to quality education (Finnish Ministry of Education, 2005). In that sense, migrant workers are enshrined into working practices and environment that enhance or facilitate learning. Some migrant care workers participate fully in what the department put across, read through patient notes, and approach other colleagues for more insight that is built into getting in-depth knowledge about the patient, working environment to appreciate the multi-diverse background of everyone in the facility (Egede-Nissen et al., 2019).
Staff members in the host healthcare facility ensure migrant care workers are well integrated into the new system despite the huge burden it comes with, however, such an intervention protocol is in the right direction to survive and growth multiculturalism teamwork (Kaun et al., 2020; Walsh & O'Shea, 2010).
Aside, some healthcare providers have support services through which migrant staff can access for their sustenance, development, and integration into the new working environment, provision of professional development opportunities, the establishment of mutual respect within the entire healthcare professionals community and clients to address challenges posed by multicultural teamwork (Adebayo et al., 2020).
Training facilities have been used to address challenges in working in a multicultural team. One such training is through cultural awareness courses that migrant staff must go through to become acquainted with the new cultural working environment (Goel & Penman, 2015; Goel and Penman, 2015). These programs are important because it has prospects to eliminate and reduce the cultural awareness gap among HCP (Alzayer et al., 2020).
This debate paper discusses challenges within multicultural teamwork. Irrespective of client backgrounds and other staff members, various laws and regulations require each HCP to work within the confines of a specific ethos. Nonetheless, working in a multicultural team exposes cracks in such a working atmosphere. Migrants or HCP from foreign countries struggle to integrate into host healthcare services to provide a good working environment. Some migrant nurses face the challenge of the host country’s language requirement to fit in with the working people. Such a daunting task sometimes may even prevent staff development. Cultural backgrounds pose another challenge. What is acceptable in one environment is not necessarily the case in another working set-up. In that respect, it becomes a challenge to fit in with that new healthcare provider in a different cultural context. Cross-cultural communication is another identified agent posing challenge to multicultural teamwork. Racism has been reported as a contributing factor to predicament affecting smooth multi-cultural team working and even is detrimental to staff retention (Adebayo et al., 2020). Inter-professional communication using jargon that are only understandable within the professions cause a significant setback in multi-cultural team working. Thus, HCP has their terminologies spoken only among the healthcare profession. It means those outside this sphere of the profession might struggle to comprehend what is being said (Falvo, 2011).
At this point, it can be concluded that working in a multicultural team adds great benefits and richness of diversity to a team in any organization for that matter. Migrants have been evident to suffer in comparison with a native citizen. Nonetheless, several interventions have been advanced to address these challenges. For instance, the cultural awareness/competence program that migrant care workers need to undergo to be well informed is an important step in the right direction to mitigate some of the challenges discussed (Goel & Penman, 2015). Fighting this course is necessary because there is a shortage of nurses globally. Advanced countries such as Finland depend on migrant staffs to supplement and mitigate the shortfall. Therefore, these high-quality labour force need the necessary support to thrive for the betterment of the patient, colleagues, and healthcare service provider. Also, for their health and safety and the host country to be able to retain them.
BSc student nurse
Anita Wikberg, Supervisor, RN, RM, PhD, Senior lecturer
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For further reading:
- Finlex (2020) Available from: https://www.finlex.fi/fi/laki/alkup/2020/