Intra-professional cultural competence: Exploring a strategy to support Australia’s culturally and linguistically diverse nursing workforce

Abstract

Objective: The objective of this study is to provide a possible strategy to enhance professional integration through education relating to a new concept: Intra-Professional Cultural Competence (IPCC). This concept primarily focuses on the interactions between nurses within the workplace.

Background: Australia's nursing workforce is starting to reflect the nation's diverse population. In 2022, 43% of the nursing workforce were born overseas, with 22% being internationally qualified nurses and 21% locally qualified, but overseas-born. As a result, up to 43% of the workforce may be culturally and linguistically diverse. Locally qualified, overseas-born nurses may be first-generation migrants or international students who have remained working in Australia after graduation. The latter group has been steadily rising. These three groups of nurses (overseas-born first-generation immigrants, international nursing graduates and internationally qualified nurses) may face similar challenges integrating into the workforce. Among the most frequently mentioned challenges for international students and internationally qualified nurses are language barriers, differences in communication patterns, and situations related to racism, discrimination, bullying, and harassment.

Study design and methods: This article is structured as a discussion paper, grounded in research, and backed by relevant literature.

Results: This paper defines IPCC as: “A set of congruent behaviours and attitudes that enable professionals to work respectfully and effectively in cross-cultural situations”.  IPCC involves four main domains: a) mutual collaboration, b) the prevention of racism, discrimination, bullying, and harassment among nurses, c) respect of values, attitudes, and beliefs of colleagues that may differ across cultures, and d) appropriate responses to cross-cultural interactions with colleagues.

Discussion: The descriptor "cultural competence" was deliberately chosen over alternatives like “cultural safety” or “cultural humility”, recognising that these concepts mainly focus on the power dynamics between healthcare providers and patients, which may not always apply to interactions between healthcare professionals. "Competence" suggests having the skills, knowledge, and abilities necessary for effective role fulfilment that could be developed through training and skill acquisition. Consequently, IPCC refers to the essential skills, knowledge, and abilities required to engage respectfully and effectively in cross-cultural interactions with other nurses.

Conclusion: The relevance of this paper lies in identifying the growing proportions of both overseas-born, locally qualified nurses and internationally qualified nurses. Mutual collaboration and communication are essential to prevent incidents related to racism, discrimination, bullying, and harassment, while also fostering team cohesion, well-being, job satisfaction, and retention. Clear communication is crucial for maintaining quality care, ensuring patient safety, and preventing fatalities. This is particularly important in multicultural teams, such as those commonly found in Australia, where a growing number of nurses may not speak English as their first language.

Implications for research, policy, and practice: With 43% of nurses being born overseas, the persistence of racism, discrimination, bullying, and harassment within clinical settings highlights the gap between existing regulations and their enforcement. Intra-professional cultural competence could positively influence communication, teamwork, and mutual respect within nursing, potentially reducing racism, discrimination, bullying, and harassment, improving nurse retention, and overall quality of care. Strengthening IPCC frameworks at institutional, national, and clinical levels and incorporating them into orientation programs and continuous professional education could serve as an effective strategy to address these issues.