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Cultural variation in nursing: opportunities and challenges

In recent years a number of countries, including the United Kingdom (UK) and Ireland, have recruited a large number of overseas nurses to address the shortage of qualified nurses in their own health services. The issues which have received much attention were mainly related to the ethics of ‘poaching’ nurses from other countries (see e.g. Singh et al., 2003) and the ways to address the global nursing shortage (Buchan 2006). There is also a growing literature on the experience of migrant nurses and how they integrate (or not) into the health systems and social and cultural fabric of their host countries. The study reported by Teresa Cummins in this issue of Journal of Advanced Nursing (pp. 1611–1616) adds to this literature by focusing on migrant nurses’ perceptions and attitudes of integration into the perioperative setting in Ireland (Cummins 2009). As expected, communication issues such as understanding the host culture, tradition and accents was a challenge for these nurses. While the majority rated themselves as ‘assertive’ towards nursing and medical colleagues, they had difficulties in delegating to ancillary staff. In response to patients’ concerns, these nurses felt ‘the need to reassure patients of their competence and skills in caring for them’ (p. 1613). On the positive side they reported that orientation and induction programmes and support from preceptors were beneficial to them.

As Cummins recognized, the use of a quantitative approach limited further probing into why these nurses found it difficult to be assertive and to delegate, especially to ancillary staff. Cummins concluded by stressing the ‘need for more cultural education to promote awareness and understanding’ (p. 1615) for both migrants and hosts.

The recent recruitment drive of migrant nurses in the UK and Ireland has tailed off. It would be easy to confine these issues to history and to forget these nurses. Those who recruited them have a duty to continue to provide support to enable them to fully contribute to, and benefit from, the society they currently live in. The lessons of studies, such as the one discussed here, are important for countries such as Saudi Arabia and the United Arab Emirates, which historically have relied heavily on migrant nurses. Demographic, economic and political changes in Europe have resulted in increased movement of people across borders. This means that both health service users and healthcare professionals are increasingly likely to reflect cultural diversity. For nursing to adapt to this change, it is important that training for cultural competence be built into nursing curriculae.

Some of the problems faced by migrant nurses are the same as those of other migrant workers. Nurses have the opportunity to make a valuable contribution to this field of research. Cummins should be congratulated for rising to this challenge.

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