Patient-Nurse Culture Matching

[perfexion, ASN, RN]

I'd like feedback from current nurses only, please no students. Do you think that the cultural make up of the nurse population at your hospital should match that of the patients? In other words, if you work with a predominantly Hispanic population, should the majority of the nurses in that hospital be Hispanic? Do you think having the majority of nurses from a different cultural background than the patients poses a problem with cultural competence? Personally I do. I work at a hospital now with a large Bangladeshi population but very few, if any, Bangladeshi nurses. The nurses are very ignorant of that culture, particularly their views on pain, despite numerous annual in-services on cultural competence. There is just no getting through to the nurses. They just think those patients can't handle pain, and they are treated as drug seekers, but it's a cultural thing. Do you think having more Bangladeshi nurses would solve that particular problem?

[Sour Lemon]

I'd like feedback from current nurses only, please no students. Do you think that the cultural make up of the nurse population at your hospital should match that of the patients? In other words, if you work with a predominantly Hispanic population, should the majority of the nurses in that hospital be Hispanic? Do you think having the majority of nurses from a different cultural background than the patients poses a problem with cultural competence? Personally I do. I work at a hospital now with a large Bangladeshi population but very few, if any, Bangladeshi nurses. The nurses are very ignorant of that culture, particularly their views on pain, despite numerous annual in-services on cultural competence. There is just no getting through to the nurses. They just think those patients can't handle pain, and they are treated as drug seekers, but it's a cultural thing. Do you think having more Bangladeshi nurses would solve that particular problem?

I think people should be treated as individuals and not as "cultures". And no, I don't think the nursing population needs to match the patient population in an ethnic manner. It is helpful to have nurses who speak a variety of languages, though.

[RNperdiem, RN]

As long as translators are available, nurses can be of any cultural background. Give the nurses credit to learn about different cultures and patients to adapt.

My immigrant parents had to teach one of their friends how healthcare worked here. The friend was treating nurses like they were servants back in the home country ready to cater to his every need. My parents set him straight on the American way of doing things.

What happens when there aren't enough Bangladeshi nurses and every patient wants one? What about the doctors?

[Horseshoe, BSN, RN]

I'd like feedback from current nurses only, please no students. Do you think that the cultural make up of the nurse population at your hospital should match that of the patients? In other words, if you work with a predominantly Hispanic population, should the majority of the nurses in that hospital be Hispanic? Do you think having the majority of nurses from a different cultural background than the patients poses a problem with cultural competence? Personally I do. I work at a hospital now with a large Bangladeshi population but very few, if any, Bangladeshi nurses. The nurses are very ignorant of that culture, particularly their views on pain, despite numerous annual in-services on cultural competence. There is just no getting through to the nurses. They just think those patients can't handle pain, and they are treated as drug seekers, but it's a cultural thing. Do you think having more Bangladeshi nurses would solve that particular problem?

I see several difficulties with this proposal. I'll just talk about one of them. Race is a protected class. I think a hospital making hiring decisions based on race or even ethnicity is going to be walking a fine line and exposes itself to legal liability.

What would be said if a hospital which services a large population of whites of European ancestry decided that it needed to be "culturally sensitive" to those patients and decided to only hire white nurses of European ancestry? Can you imagine the outcry?

[FolksBtrippin, BSN, RN]

I think it might help in this case if more nurses were Bangladeshi. But it might not be the problem.

I also don't think you have to have nurses that are culturally similar to the patient population.

And if you've done cultural competence education and it hasn't helped, maybe the problem isn't cultural competence.

If staffing and acuity is an issue, nurses never get the chance to prioritize pain management. Constantly seeing people in pain causes compassion fatigue. Then nurses tend to blame the patient.

I have firsthand seen hospitals create problems by understaffing units, then apply some corny intervention like cultural competence training. I've seen it so many times that I always suspect it.

Look deeper for the cause.

[perfexion, ASN, RN]

Staffing isn't to blame for everything. But I agree that it's a compassion problem. Some patients are screaming in pain when you empty their Foley. I don't know the specifics of how pain is regarded in that culture, but I know that for the most part, it seems that a lot of them have low pain thresholds. I can see how that would get old to nurses who constantly work with that population. I don't think fixing staff ratios would solve that. You'd just have more nurses on the floor rolling their eyes behind the patients backs and ignoring their cries for medication.

[caliotter3]

Based upon my experience observing how a nurse of the same background as a resident (who happened to be a lawyer in his native land), talked to him, I would have to say it would not necessarily fix the perceived problem. You can't guarantee that individuals are going to act in an expected way in any given situation.

[LibraSunCNM, BSN, MSN, CNM]

As someone who used to take care of a lot of Bangladeshi women, I can tell you that given the extremely paternalistic nature of their culture, the fact that most women are not encouraged to continue their education after high school or have a career outside the home, and that Bangladeshi men generally would not be encouraged to enter a stereotypically "feminine" field like nursing, there really aren't a ton of Bangladeshi nurses to be found somewhere to solve your problem.

If your staff has had numerous inservices about sensitivity toward Bangladeshi culture and still shows no sensitivity towards those patients, then you have a workplace culture problem that will likely not be solved other than with an influx of differently-minded new staff.

[Emergent, RN]

If patients of any race or culture have histrionics from the emptying of a Foley, please don't blame the nurse. The patient is emotionally unbalanced. We, as nurses, don't have a duty to cater to hysteria. We should remain calmly detached and professional, and try to gently educate.

[perfexion, ASN, RN]

Nobody is blaming the nurse for anything. But I think if there is a cultural explanation for certain behavior, maybe having a nurse of that same culture would help. Think about what you just said: you'd assume the patient was emotionally unbalanced. What if they weren't? What if they were just taught to exaggerate pain response for whatever reason. You are just like the nurses im talking about. You think the patient's cultural nuances makes them crazy. That's exactly the lack of cultural competence that im referring to.

[TriciaJ, RN]

I think it might help in this case if more nurses were Bangladeshi. But it might not be the problem.

I also don't think you have to have nurses that are culturally similar to the patient population.

And if you've done cultural competence education and it hasn't helped, maybe the problem isn't cultural competence.

If staffing and acuity is an issue, nurses never get the chance to prioritize pain management. Constantly seeing people in pain causes compassion fatigue. Then nurses tend to blame the patient.

I have firsthand seen hospitals create problems by understaffing units, then apply some corny intervention like cultural competence training. I've seen it so many times that I always suspect it.

Look deeper for the cause.

Can't love this one enough.

[Horseshoe, BSN, RN]

Nobody is blaming the nurse for anything. But I think if there is a cultural explanation for certain behavior, maybe having a nurse of that same culture would help. Think about what you just said: you'd assume the patient was emotionally unbalanced. What if they weren't? What if they were just taught to exaggerate pain response for whatever reason. You are just like the nurses im talking about. You think the patient's cultural nuances makes them crazy. That's exactly the lack of cultural competence that im referring to.

Well, if they are "taught to exaggerate pain," I can see how that would make it difficult for the nurse to accurately assess them and take the appropriate action.