I am an American.

[UnionRN2]

In the last staff meeting, NM states Dr. A has complained because the female nurses make eye contact with him. We were instructed to respect his (and other doctors) culture and NOT make eye contact or appear assertive. When asked to clarify assertive we were told assertive was "asking or suggesting something for the patients".

Excuse me! I am American and I am living in America! How come these doctors don't have to respect my culture? How come they don't have to respect me (I am a woman)?

Of course I will continue to make eye contact and I will continue to request things my patients need and I will continue to suggest things that the patient needs. I will continue to advocate for my patients. If the doc doesn't like it... tough crap. I live in America and have the rights afforded American women. I am not giving them up to stroke the ego of a bigot.

[kty1]

This really has nothing to do with you being an American. Lots of Americans have the same culture this man does (who very likely may also be an American).

Call a spade a spade: the title should probably read "I'm a caucasian, European-American."

If you go back to the OP, you will see he is not from America. The posts relate to OP's concerns. Again, when one comes to America to practice there are papers to sign, read etc.; all about the norms, proceedures, policy etc, about America; thus, this dr was well informed about practices here.

Please go back and read OP to better understand what the concerns are here.

[kty1]

I agree that it's good to learn as much as one can about another culture before becoming a part of it. But all the reading and studying in the world won't prevent some degree of culture shock, or occasional blunders caused by unrealistic expectations. One example of a blunder is assuming that American nurses have the same perception of, and reaction to, direct eye contact, as the nurses in one's own country. That's one of those assumptions that people make, that they don't even realize they have, until they learn the hard way that not everyone the world over shares it.

You seem to be assuming that this doctor is well aware of such fine points of American professional etiquette, but chooses instead to force American nurses to do things his way. It's far more likely that he was simply misinterpreting the action, and needed to have someone explain to him that it's not considered intrusive in the U.S. for a nurse to look him in the eye and occasionally challenge his decisions.

You obviously have a right to your opinions, but going back on all your posts it seems that you are defending this dr.as if you know him on a personal level. Have you ever worked outside the US? Believe me, there are tons of paper work and docs. to sign, classes to help you understand what is expected and accepted of any nurse or dr. working in another country/culture; and if this dr. as you state "needed to have someone explain professional etiquette" then he should have talked with another dr./peer to help him better understand what is/is not appropriate actions. By going to the OP's supervisor is not looking for "better understanding" as anyone would know what action this would lead to.

[NocturneRN]

You obviously have a right to your opinions, but going back on all your posts it seems that you are defending this dr.as if you know him on a personal level. Have you ever worked outside the US? Believe me, there are tons of paper work and docs. to sign, classes to help you understand what is expected and accepted of any nurse or dr. working in another country/culture; and if this dr. as you state "needed to have someone explain professional etiquette" then he should have talked with another dr./peer to help him better understand what is/is not appropriate actions. By going to the OP's supervisor is not looking for "better understanding" as anyone would know what action this would lead to.

z----As a matter of fact, I HAVE lived and worked outside the U.S. (though not in health care), and I know from experience just how tricky it can be to negotiate another culture, even with the help of classes or books or International Etiquette websites. Even in western European nations, where people look and dress pretty much like Americans, eat similar food and enjoy American TV shows and music, there can be quite a difference in perceptions----differences that neither side mentions, because they're both (erroneously) assuming that the other one's perception is just like theirs.

That's why I "defend" this doctor----I've been there and done that, and it's not nearly as easy as it looks.

In any case, if we're looking at this issue from a problem solving perspective (as opposed to deciding which side to blame), doesn't it make more sense to start conservatively (assuming that it's a matter of misinterpreting nonverbal cues), and address that possibility first? If it IS just a matter of Dr. A misinterpreting Nurse B's behavior, the problem might be remedied through education---explaining to Dr. A that (1) American nurses are taught to challenge the physician, when the patient's well-being or comfort is at stake, and (2) it isn't necessarily a sign of insolence or intrusiveness when Americans look each other in the eye. But it's also important for Nurse B to see where Dr. A is coming from: that not only does he need to understand this intellectually, but he needs to unlearn the behavior of taking offense when nurses look him in the eye or challenge his medical decisions.

When I lived in France, there were quite a few behaviors I had to unlearn, cultural differences that I learned about only through trial and error over many months. A couple of examples: I had to learn not to get angry when people butted in front of me when waiting in line. This is something one just doesn't do in Anglo-Saxon cultures, but it's quite acceptable in France, as it's assumed that line jumpers have a good reason for needing to go first.

Another example: learning to turn a blind eye to things I wasn't expected to see. For example: in French neighborhoods, it's quite appropriate for neighbors to greet each other from the front yard, the front door or the sidewalk; but the back yard is considered private space. Therefore, it's common practice for neighbors to ignore each other there, even if they're standing just 10 feet apart, no matter what goofy activity is taking place in the adjoining yard. It's also proper, when using the local cafe's unisex rest room, to turn a blind eye (and ear) to the guy tinkling into the urinal five feet behind you, while you're standing at the sink washing your hands or applying makeup. Even if he (and all involved body parts) are plainly visible in the rest room mirror, you're expected to be completely unaware of his presence. Trust me----it takes time and practice to cultivate that bland, oblivious expression! In fact, I'm still working at it, although a background in nursing is helpful here.

Of course, if the education thing has already been tried, and the nurse is making an effort but the doctor isn't, then would be the time to get medical administration involved. As we all know, some doctors are arrogant jerks, no matter how well they understand cultural expectations. It's possible that this guy is one, too. But, before arriving at that conclusion, I'd want to exhaust other possibilities.

[NocturneRN]

The reason behind this "don't look me in the eye" thing is that there are quite a few cultures who regard women as not only submissive to men, but not valued as human beings. And how dare a mere -woman- look this great man in the eye - much less, tell him what his patient might need! The nerve! Makes me want to vomit.

There are also cultures in which it's considered truculent, or hostile, to keep one's eyes trained on another person's face.

You can't just assume that this guy expects nurses to behave submissively. It could also be that his culture sees it as a sign of respect to make only brief (or no) eye contact.

[bagladyrn, RN]

There are also cultures in which it's considered truculent, or hostile, to keep one's eyes trained on another person's face.

You can't just assume that this guy expects nurses to behave submissively. It could also be that his culture sees it as a sign of respect to make only brief (or no) eye contact.

I think one CAN assume that this doctor expects nurses to behave submissively in light of the OP's relating that he went to her supervisor who then instructed the nurses to comply with the doctor's expectations.

[CrunchRN, ADN, RN]

My bottom line is that if i was in HIS country and that was the norm then I would comply.

Since he is in my country and that is NOT the cultural norm here no freaking way will I comply.:smokin::smokin:

[CuriousMe]

My bottom line is that if i was in HIS country and that was the norm then I would comply.

Since he is in my country and that is NOT the cultural norm here no freaking way will I comply.:smokin::smokin:

I think NocturneRN's point is though, that you'd need to know that it was the norm before you could comply.

[CrunchRN, ADN, RN]

No I don't. Because I know the norm here in the USA and that is where I am and I will act as per our cultural norms.

If I did go to his country to work then of course I would need to learn their norms.

[CuriousMe]

No I don't. Because I know the norm here in the USA and that is where I am and I will act as per our cultural norms.

If I did go to his country to work then of course I would need to learn their norms.

Right, if you went to his country....once you got there you'd try and learn their norms. You won't know them as you walk off the plane. As someone who has lived around the world, it can take a really long time to learn another set of cultural norms.

I think that NocturneRN is just stating (and I agree with them) that it's far better to assume ignorance than maliciousness. This physician needs to be spoken to and educated of course. If they continue this behavior, then they needs to be stood up to by a nurse and informed again.

[CrunchRN, ADN, RN]

I never assumed maliciousness, but it was totally inappropriate of the management to ask the nurse to comply with his home countries cultural norms here in the US.

It is nothing to with anger or dislike or fear of another culture or anything like that. Everyone wants to make this so complicated when it is so simple. I have no animosity towards this individual at all.

However, to ask me to change my cultural norms in my country to suit someone else's from another country is plainly ridiculous.

[Cul2]

"but it was totally inappropriate of the management to ask the nurse to comply with his home countries cultural norms here in the US."

From my perspective, that's the key to this discussion. Of course, we don't know the specifics behind the doctor's request. We can assume, but as many have suggested, it's better to find out the reason. If it's ignorance, then educate. If it's maliciousness, educate in a more forceful way. But don't force foreign cultural norms on a team working in our culture working with patients in such an inportant setting.

As any text on the psychology of communication directed to this culture will clearly point out eye contact is generally essential for most situations, especially working situations like medicine. There are exceptions, of course. The expression -- The eyes are the window to the soul -- didn't spring out of nowhere.

[CrunchRN, ADN, RN]

I don't believe the OP ever came back which really makes me wonder about this......

I work at a University with a medical school and graduate schools. We have many international students and professors from the countries that have this kind of culture. I have never had any request to modify my behavior and have had wonderful working relationships. And many were MD's in their country. I treat them as I would anyone else of any other culture. If anything they just kind of act a little shy when they 1st get here, but then they get over it.