Are You a Culturally Competent Nurse?

January 15, 2021 •

“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman…”

This quote is taken from a speech given by Dr. Martin Luther King, Jr. in 1966 that urged legal action against hospitals that were out of compliance with the Civil Rights Act. He said, “We put the blame right on [the American Medical Association’s] doorstep.”

As of the writing of this article in 2021, it has been only 55 years since this speech. Reform didn’t happen overnight. Even with protective laws and policies now in place, many people outside of minority groups are unaware that discrimination is still rampant based on country of origin, skin color, gender expression, sexual preference, mental status, method of communication, personality, and much more.

But nurses have a unique opportunity to improve equity in healthcare. When they do, equity in society will progress as a result.

This practice is called “cultural competence.”

What Is Cultural Competence?

Terry Cross and others published the 1989 article “Towards a Culturally Competent System of Care,” funded by the National Institute of Mental Health and available courtesy of Seattle Pacific University. The article provides crucial definitions of several terms:

1.    Cultural Competence

Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations.”

In this definition, nurses fall under the definition of professionals working effectively cross-culturally.

2.    Culture

“The word ‘culture’ is used because it implies the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious, or social group.”

This definition was given decades ago. Since then, more types of identifiable groups have emerged and cultures we encounter daily have continued to diversify, which means nurses must constantly learn to navigate new cultures.

3.    Competence

“The word ‘competence’ is used because it implies having the capacity to function effectively.”

Note that a competent person has the ability to function effectively; they may or may not choose to use this ability. This is why nurses should be aware of their own biases, a topic to be discussed later in this article.

Why Practice Cultural Competence?

Obey Laws and Policies

For a list of some federal and state requirements for cultural competence, see “A Guide to Incorporating Cultural Competency into Health Professionals’ Education and Training.” (Beamon et al. pp. 4-10).

In order to follow these federal and state guidelines, healthcare organizations develop their own internal policies and training programs.

This same article nods to the American Nurses Association (ANA), who in 1991 made a statement about cultural diversity. In its summary of the statement, the article states:

“Nurses are encouraged to do a cultural evaluation of each patient because interactions will occur between the nurse, the patient, and the environment. As patient advocates, nurses need to understand how each cultural group understands life processes, defines health and illness, maintains wellness, identifies causes of illness, and accepts the role of healers.” (p.13).

Protect Yourself from Lawsuits

18-year-old Willie Ramirez was at a friend’s house when he felt a stabbing, needle-like pain in his head. He made it to his car and drove to his girlfriend’s house where he managed to park before losing consciousness.

When he awoke from a coma two days later, he learned doctors had interpreted his girlfriend’s limited English to mean he had overdosed on drugs. They had treated him for drug abuse, and only two days later performed a neurological exam.

It was found that Willie had experienced a left intracerebellar hematoma with brain-stem compression and an acute subdural hematoma. Even after emergency surgery, Willie was irreversibly quadriplegic. The hospital settled for approximately $71 million.

Stories like these highlight not only the importance of cultural competence, but also the need for RNs and NPs to invest in nurse insurance and nurse practitioner insurance in order to protect their personal assets in the unfortunate event of a work-related lawsuit.

Follow the Nursing Code

As a nurse, you signed up to follow the Code of Ethics for Nurses. The second sentence of the document says this:

“The need for and right to health care is universal, transcending all individual differences.” (1.1).

And then:

“Optimal nursing care enables the patient to live with as much physical, emotional, social, and religious or spiritual well-being as possible and reflects the patient’s own values.” (1.3).

But aside from any code, you became a nurse because you wanted to care for people. Your conscience requires you to do this to the best of your ability, especially when cultural barriers involve extra effort.

How to Become Culturally Competent

Learn About Yourself

Become aware of your own prejudices. We all have opinions about other lifestyles, and that’s normal to some extent—but regardless of their feelings, nurses must learn how to provide the best care for each culture.

We are often unaware of our own biases. Learn what they are by taking this test by Project Implicit developed by psychologists at Harvard, the University of Virginia, and the University of Washington.

Pursue Training

The U.S. Department of Health & Human Services: Office of Minority Health offers a free e-learning program for nurses for up to nine continuing education credits. From the main page: “This e-learning program is designed to help you deliver culturally and linguistically competent care.”

Zuwang Shen wrote a literature review about cultural competence models used in nursing between 1982 and 2014. This is a good tool for the nurse wishing to learn the history and theory behind cultural care methods that have shaped nursing today.

The “Purnell” approach refers to Larry Purnell’s book Transcultural Health Care: A Culturally Competent Approach (2013). His book is widely used by medical professionals to provide individualized healthcare for 33 minority groups.

Ask the Patient

The adage “Treat others how you want to be treated” does not apply to cultural competence.

For example, a nurse may feel that distracting and chatting with a patient are the best measures of pain relief based on their own personal experiences. But the nurse’s patient may come from a culture where it is noble to bear pain silently.

It would be better to say simply, “Treat others how they want to be treated.”

And the best way to find out how they want to be treated is to ask them. For example, “I can chat while I do this. Would that help distract you?”

While asking may feel awkward—and the nurse may worry about causing offense—people often appreciate others taking care to ask their preference instead of making assumptions.

Stay Protected

As a nurse, you work within the bounds of your profession, your organization, and the law—but you also know that mistakes can happen, or patients can perceive that mistakes have happened, possibly due to a lack of cultural competence.

Invest in nurse insurance to protect yourself in case of lawsuits that might happen in your career—whether on the clock, when you’re navigating cultural competency—or off the clock, when you’re being a good Samaritan.

The best insurance policy will:

  1. Specialize in RN insurance and NP insurance
  2. Protect your personal finances if a lawsuit is filed against you
  3. Pay claims on your behalf
  4. Help you find legal representation if needed
  5. Base premiums on your type of work or specialty, increasing affordability
  6. Be experienced in managing Medical Professional Liability Policies

Get a quick personalized quote today from our application. With your specialized nurse or nurse practitioner’s insurance secured, you can focus on caring for patients without worrying about liability.