[Articles]

JONA: The Journal of Nursing Administration

Issue: Volume 28(11), November 1998, pp 30-38
Copyright: 1998 Wolters Kluwer Health | Lippincott Williams & Wilkins
Publication Type: [Articles]
ISSN: 0002-0443
Accession: 00005110-199811000-00008
Transcultural Perspectives in Nursing Administration
Andrews, Margaret M. PhD, RN, CTN
Author Information
Margaret M. Andrews, PhD, RN, CTN, Chairperson and Professor, Department of Nursing, e-mail:[email protected], Nazareth College, Rochester, New York.
Abstract

Population demographics are reshaping the healthcare work force with respect to race, ethnicity, gender,
national origin, sexual orientation, age, handicap, disability, and related factors as national sensitivity to various
forms of diversity grows. Given the demographic trends, it is inevitable that nurse administrators will need skill in
transcultural administration as they manage diversity and identify the cultural origins of conflict in the multicultural
workplace. Culture influences the manner in which administrators, staff and patients perceive, identify, define and
solve problems. In this article, the complex and interrelated factors that influence workplace diversity are examined.


According to the U.S. Department of Health and Human Services, 9%, or 207,000, of the 2.24 million registered
nurses (RNs) in the United States come from racial or ethnic minority backgrounds.1 Although fewer than 4% of
licensed nurses in the United States are foreign-educated, this represents 73,423 nurses. These figures do not reflect
the variation that exists within panethnic population categories, nor differences related to religion, age, gender,
sexual orientation, size, disability, handicap, or other forms of diversity.

A significant number of the Healthy People 20002 goals involve specific objectives for improving the health
status of racial and ethnic minorities, particularly those with low incomes. As the year 2000 approaches, culturally
diverse cohorts of children, women of childbearing age, and the elderly are expected to grow, exacerbating the need
for culturally and gender-sensitive providers of healthcare. Since 1972, there has been an explosion in the numbers of
people migrating to the United States, both with and without legal documentation. Overall, 8%, or 19.8 million
people, in the United States are foreign-born residents from other North American nations (41%), Asia (25%), Europe
(29%), South America (5%), Africa (2%), the former Soviet Union (2%), and Oceania (1%).3

By the year 2000, immigrants, women, and minorities will account for 85% of the net growth in the labor force.
Women will account for more than 46% of the total work force, and 61% of all American women will be employed.
African Americans will comprise 12% of the labor force, Hispanics 10%, Asians and Pacific Islanders 3%, and Native
Americans 1%. More than 25% of the work force will be comprised of people from Third World countries. People 35 to
54 years of age will make up 51% of the work force, whereas those aged 16 to 24 years will decline to approximately
8%.1-7

Transcultural nursing administration refers to the "process of assessing, planning, and making decisions and
policies that will facilitate the provision of educational and clinical services that take into account the cultural caring
values, beliefs, symbols, references, and lifeways of people of diverse and similar cultures for beneficial or satisfying
outcomes."4(p30) Transcultural perspectives in nursing administration are essential for survival, growth, satisfaction,
and achievement of goals in the multicultural workplace. With increasing frequency, nurse administrators are
realizing the importance of transculturally based administrative practices that positively influence cost benefits and
quality outcomes. With the increasing diversity among members of the healthcare work force, nurses are challenged
to develop and practice a new kind of administration that incorporates transcultural concepts.

Cultural Perspectives on the Meaning of Work

In contemporary society, the concept of work must be considered in its historical and cultural context. Cultural
views about those who care for the sick are complex and nursing may be perceived as a divine calling for those with
supernatural powers (some African and Hispanic groups), a religious vocation (some ethnic Catholic groups, such as
the Irish), or an undignified occupation for lower class workers (some Arab groups, such as Kuwaitis and Saudi
Arabians).

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There are two prevailing paradigms concerning the orientation to work, individualism or collectivism. With
individualism, importance is placed on individual inputs, rights, and rewards. Individualists emphasize values such as
autonomy, competitiveness, achievement, and self-sufficiency. Most English-speaking and European countries have
individualist cultures.

Collectivism entails the need to maintain group harmony above the partisan interests of subgroups and
individuals. In collectivist cultures, values such as interpersonal harmony and group solidarity prevail. Staff whose
ethnic heritage is Asian or South American are likely to be influenced by collectivism. Amish and Mennonite groups
also are considered collectivist cultures. One of the most notable distinctions between people from individualist and
collectivist cultures is the meaning of work.

Individualists work to earn a living. People are expected to work and need not enjoy it. Leisure or recreational
activities frequently are pursued to alleviate the monotony of work, and they tend to dichotomize work and leisure.
Individualist concepts of work reflect an orientation toward achievement and the future. They want to do better,
accomplish more, and take responsibility for their actions, which results in the development of personality traits such
as assertiveness and competitiveness.

In many collectivist cultures, conversely, people expect to find satisfaction in job-related relationships, have less
clearly delineated boundaries between work and leisure, and focus on the present. Qualities such as commitment to
relationships, gentleness, cooperativeness, and indirectness are valued. Although some individuals exhibit a
combination of the two, most staff will display either an individualistic or collectivistic orientation in the workplace.
Nurse administrators need to recognize the fundamental value system embraced by their staff to understand why
they behave as they do at work.

Corporate Cultures and Organizational Climate

Healthcare organizations are minisocieties that have their own distinctive patterns of culture and subculture.
One organization may have a high degree of cohesiveness with staff working together, like members of a single family
toward achievement of common goals. Another may be highly fragmented, divided into groups that have different
aspirations as to what their organization should be. Corporate culture refers to a process of reality construction that
allows staff to see and understand particular events, actions, objects, communications, or situations in distinctive
ways. Shared values, beliefs, meaning, and understanding are components of the corporate culture. One of the
easiest ways to appreciate the nature of corporate culture is to observe the day-to-day functioning of the
organization. Note the patterns of interaction among individuals, the language that is used, the images and themes
explored in conversation, and the various rituals of daily routine. Although the corporate or organizational culture
consists of what its members share, often unconsciously, concerning beliefs, values, assumptions, rituals, the
organizational climate usually measures perceptions or feelings about the organization or work environment.5

Nurse administrators should be committed to multiculturalism at all levels of the organization and periodically
should review mission statements and policies as they relate to diversity. They should actively encourage the
recruitment of diverse staff and administrators and be alert for overt and covert evidence of prejudice and
discrimination in their organizations. A policy of zero tolerance should be established concerning negative behaviors
that are based on race, ethnicity, religion, gender, sexual orientation, national origin, class, or handicap/disability.
Ethnic violence should be grounds for immediate dismissal and reported to the proper authorities.

Cultural Values

Because they form the core of a culture, values frequently lie at the root of cross-cultural differences in the
multicultural work place. Time orientation, family obligations, communication patterns (including etiquette,
space/distance, touch), interpersonal relationships (including long-standing historic rivalries), gender/sexual
orientation, education, moral/religious beliefs, hygiene, clothing, and beliefs about the meaning of work are shaped
by cultural values.6-9

What is the importance of learning about the values of people from diverse cultural groups? Values exert a
powerful influence on how each person behaves, reacts, and feels. In the multicultural workplace, values affect
people's lives in four major ways. Values underlie perceived needs, what is defined as a problem, how conflict is
resolved, and expectations of behavior. When cultural values of individual staff members conflict with the
organizational values or those held by coworkers, challenges, misunderstandings, and difficulties in the workplace
become inevitable. Nurse administrators must examine the underlying values orientation to identify the root cause of
the conflict and to foster cross-cultural understanding among staff and patients from diverse backgrounds.

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Cultural Perspectives on Conflict

The term conflict is derived from Latin roots (confligere, to strike against) and refers to actions that range from
intellectual disagreement to physical violence. Frequently, the action that precipitates the conflict is based on
different cultural perceptions of the situation. As indicated in Figure 1, the nursing administrator must consider
influences on organizations, such as political, economic, legal, technological, and religious factors (especially for
organizations owned and operated by religious groups) and influences on individuals, such as educational
background, socioeconomic status, family obligations, political orientation, cultural factors, moral and religious
beliefs, and personal traits (e.g., age, gender, size, state of physical and emotional health, and others). Both the
organization and the individuals within it are influenced by the corporate culture, organizational climate, and
cultural meaning of work. The organization's cultural meaning of work usually can be identified through its mission
statement, personnel policies, job descriptions, and related documents.
Figure 1. Origins of conflict in the multicultural healthcare setting. * = factors apply especially to organizations
owned and operated by religious groups.
Nurse administrators from individualist cultures are likely to view conflict as a healthy, natural, and inevitable
component of all relationships. People from many collectivist cultures, however, have learned to internalize conflict
and value harmonious relationships above winning arguments. To many people of Native American and Asian descent,
conflict is considered unhealthy, undesirable, and nonconstructive. In the Arab world, mediation is critical in
resolving disputes, and confrontation seldom works. Mediation allows for saving face and is rooted in the realization
that all conflicts do not have simple solutions. The assertive, confrontational, direct style of communicating is
characteristic of people from individualistic cultures, whereas the cooperative, conciliatory style is a more
collectivist or Eastern mode of managing conflict. When attempting to influence others during a disagreement, for
example, nurses from Chinese American, Japanese American, or other collectivist cultures may employ covert
conflict prevention strategies to minimize interpersonal conflicts. Nurses from individualistic cultures are more likely
to rely on the overt confrontation of ideas and argumentation by reason. When participants in a conflict are from the
same culture, they are more likely to perceive the situation in the same way and organize their perceptions in similar
ways.

Some of the more frequently encountered cultural origins of conflict in the multicultural workplace may be
traced to differences in one or more of the following: cross-cultural communication (including touch, space,
distance, and etiquette), interpersonal relationships involving authority, peers and patients, time orientation,
gender/sexual orientation, family obligations, moral and religious beliefs, personal hygiene, clothing and accessories,
and longstanding historic rivalries between groups.

Cross-Cultural Communication

Underlying the majority of conflict in the multicultural healthcare setting are issues related to effective verbal
or nonverbal communication. Even when dealing with staff from the same cultural background, it requires
administrative skill to decide whether to speak with someone face to face, send an electronic or paper
memorandum, contact by telephone, or opt not to communicate about a particular matter at all. The nurse manager
must exercise considerable judgment when making decisions about methods for effectively communicating with staff
members and patients from diverse cultural backgrounds, including a sense of timing, tone and pitch of voice, choice
of location for face-to-face interactions, and related considerations. Communication difficulties caused by
language/accent issues become compounded on the telephone. It sometimes is necessary to counsel recent
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immigrants from non-English-speaking countries to refrain from giving or receiving medical orders by telephone until
their English language skills have developed. Approximately 32 million people (14% of the total U.S. population) speak
languages other than English. In rank order, the most frequently spoken languages are Spanish, 54%; French, 6%;
German, 5%; Italian, 4%; and Chinese, 4%. As the 21st century draws near, it is estimated that the United States will
continue to attract approximately two thirds of the world's immigrants, 85% of whom will come from Central and
South America (U.S. Bureau of the Census, 1993). Figure 2 identifies strategies for promoting effective cross-cultural
communication in the multicultural workplace.
Figure 2. Strategies to promote effective cross-cultural communication in the multicultural workplace.
Cultural Perspectives on Space, Distance, and Touch

Although there are wide variations in spatial requirements, people of the same culture tend to act similarly.
Because people usually are not consciously aware of their personal space requirements, they frequently have
difficulty understanding a different cultural pattern. For example, sitting closely to another may be perceived as a
sign of warmth and friendliness by some staff members but as a threatening invasion of personal space by another.
Anglo and African American nurse administrators may find themselves backing away from staff members of Hispanic,
East Indian, or Middle Eastern origins, who seemingly invade their personal space.

In general, nurses from Asian cultures are less tactile and show affection in a more reserved manner than Anglo
or African American nurses, who may be perceived as boisterous, loud, ill-mannered, or rude by comparison. In some
cases, staff members from different cultures may send messages through their use of touch that are not intended.
Special attention is warranted for male-female relationships in the multicultural workplace. In general, it is best to
refrain from touching staff members of either gender unless warranted for accomplishment of a job-related task,
such as the provision of safe patient care. Nurses who tend to be more tactile should consciously refrain from placing
their hand on another's arm or shoulder, as frequently happens during ordinary conversation.

Cultural Perspectives on Etiquette and Interpersonal Relationships

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Etiquette refers to the conventional code of good manners that governs behavior. Etiquette is included in this
discussion of the origins of conflict because it concerns culturally appropriate ways for people to show respect in
their relationships with one another and promotes effective cross-cultural communication. For example, some people
from Hispanic, Middle Eastern, and African cultures expect the nurse manager to engage in social conversation and
establish personal/social rapport before giving assignments or orders for the day's work. In developing interpersonal
relationships, there is a high value placed on getting to know about a person's family, personal concerns, and
interests before discussing job-related business. The nurse administrator's reluctance to engage in self-disclosure
about personal matters or inquire about the staff member's family may leave the impression that he or she is
uncaring and disinterested. These behaviors by the administrator are not conducive to building productive,
harmonious relationships and may be misunderstood by staff members from diverse backgrounds. Similarly, some
cultures value formal greetings at the start of the day or whenever the first encounter of the day occurs, a practice
found even among close family members. Although most people appreciate a courteous greeting, staff members from
some cultures may view the nurse administrator's failure to begin conversations with formal greetings as a
disrespectful breech of etiquette that conveys the message that they are not valued or appreciated.

Cultural Perspectives on Time Orientation

In some instances, cultural differences in time orientation create difficulty in the workplace. This may manifest
itself when staff members are tardy, take excessive time for breaks, or fail to complete assignments within the
expected time frame. These differences may be interrelated with the cultural meaning of work, religious practices,
and cross-cultural communication issues. Administrators must be explicit in the job-related expectations about
punctuality, schedule for breaks, and time allotted for assignments.

If a staff member develops a pattern of tardiness, the reason(s) should be explored. Although there needs to be
a uniform standard applied to all staff members concerning punctuality, it may be useful to listen to the staff
member's explanation and ask what he or she thinks might rectify the problem. Reasons for punctuality problems may
range from child care to car repair needs. Solutions may include the mobilization of cultural resources, such as using
extended family members to look after dependents or networking with coworkers who might be able to recommend a
reliable auto mechanic. Listen attentively without rendering judgment or dictating solutions to which the person has
not agreed.

It sometimes is useful to divide an assignment into subtasks with specific time lines for each activity. If the staff
member has difficulty completing the assignment within the allotted time, follow-up with a discussion of the reasons
why there were problems. This follow-up should be conducted in a positive, proactive manner and viewed as an
opportunity to promote cross-cultural communication, not as a punitive or disciplinary measure.

Cultural Perspectives on Gender and Sexual Orientation

The complex interrelationship between gender and culture frequently challenges nurse managers. Nurses of both
genders may face the biases and preconceptions of physicians, nurse colleagues, other healthcare providers, and
patients. The issue is further complicated by cultural beliefs about relationships with authority figures and cross-
national perspectives on the status or prestige of various healthcare disciplines.

In the multicultural healthcare workplace, both men and women face the gender biases that exist in society.
These issues frequently emerge in verbal and nonverbal communication and in interpersonal relationships. Our
language also belies covert gender biases and preconceptions. For example, the expression male nurse sometimes is
used but seldom does one hear about the female nurse because it is considered redundant and unnecessary.
Workplace issues concerning gay, lesbian, and bisexual staff also are important in the multicultural setting.

Cultural Perspectives on Family Obligations

Although family is important in all cultures, the constellation (nuclear, single-parent, extended, same-sex, etc.),
emotional closeness, social and economic commitments among members, and other factors vary cross-culturally. Both
staff nurses and those in administrative positions frequently report difficulty with requests from nurses of diverse
cultural background that pertain to family obligations.

Some nurses from diverse cultures have been labeled as uncommitted to their work or disinterested in their
nursing careers because their family is a higher priority than their profession. From an administrative perspective,
the most useful approach is to focus on the problematic behavior. For example, if excessive absenteeism is the
undesirable behavior, the nurse administrator should arrange for a face-to-face meeting in which the problematic
behavior is discussed. If used judiciously, peer pressure by coworkers can be helpful in changing the undesirable
behavior as fellow workers communicate to the individual why his or her behavior is troublesome. It generally is
useful to identify the reason(s) for the excessive absenteeism and to explore culturally appropriate strategies for
resolving the problem, such as utilization of the natural social support that is culturally expected of extended family
members.
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Ideas about the importance of anticipating and controlling the future vary significantly from culture to culture.
Whereas some staff members place a high priority on planning for retirement, accumulating sick days, and purchasing
insurance, other staff, particularly recent immigrants with family obligations in their homeland, might be more
concerned with current obligations and living in the present. Similarly, some workers in high-risk positions participate
actively in preventive immunization programs, such as those aimed at hepatitis and influenza, whereas others
demonstrate a fatalistic view of future illnesses.

Cultural Perspectives on Moral and Religious Beliefs

In some circumstances, moral and religious beliefs may underlie conflicts in the multicultural workplace.
Consider the following dilemmas. A staff nurse who believes that it is morally wrong to drink alcohol refuses to carry
out a physician's order for the therapeutic administration of alcohol as a sedative/hypnotic or to administer
medicines with an alcohol base. A nurse who believes that humankind should not unleash the power of nuclear energy
refuses to care for irradiated cancer patients. A Roman Catholic nurse working in the operating room refuses to scrub
for abortions, tubal ligations, vasectomies, and similar procedures because of religious prohibitions. A nurse who is a
member of Jehovah's Witnesses refuses to hang blood or counsel patients concerning blood or blood products. A
Seventh-Day Adventist nurse who cites Biblical reasons for following a vegetarian diet is unwilling to do patient
education involving diets that contain meat. Muslim and Jewish staff members express concern that the hospital
cafeteria fails to serve foods that are halal or kosher.

In the clinical world, the options available to accommodate the diverse moral and religious beliefs of staff
members frequently depend on the size of the organization, moral and religious proclivities of coworkers, attitudes
and beliefs of nurse managers, organizational climate, fiscal constraints, and related factors. In some cases, it may
be impossible to provide the services demanded by the organization's mission if all nurses were to refuse to engage in
a particular activity because of moral or religious prohibitions. There may be legal implications for refusing to
provide patients with certain services, such as those related to reproductive health. The challenge facing nurse
administrators is to balance the conflicting moral and religious beliefs of diverse groups with achievement of
organizational goals in a manner that is respectful of the moral and religious beliefs of staff members and patients.

Cultural Perspectives on Personal Hygiene

Among the more sensitive issues faced by nurse administrators is counseling a staff member about offensive body
odor. In some cultures, people are not bothered unduly by body odors and they refrain from masking nature's original
smells. In some cases, the staff member may come from a country in which water is scarce and bathing is restricted.
The staff member may be following religious or cultural practices that prohibit bathing during certain phases of the
menstrual cycle, after delivery of a baby, and at other times. Nurse managers and other supervisors frequently find
the sensitive topic of hygiene difficult to discuss with staff members from diverse cultural backgrounds.

Cultural Perspectives on Clothing and Accessories

Most healthcare organizations have a dress code or policy statement about clothing and accessories worn by staff
members, with some variation for specialty units such as the operating room. These documents should be reviewed
periodically from a cultural perspective. For example, modification of the dress code might be necessary to
accommodate Hindu women dressed in a sari, Sikh men who wear a turban, Amish and Mennonite women who wear
bonnets, Muslim women and Catholic nuns who cover their heads with veils, Arab men who cover their heads with a
khafia, or Jewish men who wear a yarmulka (skull cap). Special consideration may need to be given to some African
Americans and others who wear jewelry and other accessories in their hair, particularly when the hair is braided.
Care should be exercised to establish policies that incorporate both cultural and gender-related sensitivities.

Long-Standing Historic Rivalries

Some historians have referred to the 1900s as the Century of War. On occasion, the multicultural workplace
becomes a battleground on which long-standing historic rivalries and more recent geopolitical differences are
re-enacted in the form of interpersonal conflict between two or more staff members. After ruling out other potential
sources of conflict, it may be worth examining the ethnic heritage and national origins of staff for possible reasons.
For example, the nurse manager may observe a pattern of strained relationships between an Israeli physician and
Palestinian physicians, nurses, laboratory technicians, physical therapists, and other healthcare providers. Similar
observations may be made concerning staff from known rival countries, such as North and South Koreans, Russians
and Armenians, Iranians and Iraqis, Indians and Pakistanis, and so forth. Cues that may signal underlying historic
rivalries include: 1) the expression of high levels of emotional energy when interacting with a person from a rival
group when the topic does not seem to warrant it; 2) sudden, uncharacteristic behavior changes when in the
presence of a person from the rival group, for example, an ordinarily cordial staff member unexpectedly becomes
acrimonious for no apparent reason; 3) the repeated expression of strong opinions about historical, political, and
current events involving rival nations or factions; and 4) inappropriate attempts to persuade others to adopt partisan
views about the rivalry.

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International Perspectives on Conflict

Discrepancies in role expectations tend to create intrapersonal and interpersonal conflict. For example, nurses in
Taiwan, the Philippines, and many African nations may expect the families of patients to bathe and feed their loved
ones. Because of the shortage of qualified healthcare providers in many less developed countries, there usually are
fewer interdisciplinary differences about the nature and scope of practice for various healthcare disciplines. Nurses
frequently have considerably expanded roles, and their scope of practice is correspondingly broader. For example,
the Nigerian Board of Nursing and Midwifery allows nurses to diagnose and treat common illnesses, such as malaria,
typhoid, cholera, tetanus, and many other communicable diseases.

In many nations, nurses and nurse midwives primarily are responsible for obstetric care. To graduate from a
nursing program in the Philippines, nursing students must deliver a minimum of 25 babies unassisted and assist at
major and minor surgeries. In Haiti, nurses routinely start intravenous lines, perform episiotomies, and repair
lacerations. There also are various categories of licensed and unlicensed healthcare providers who contribute to the
overall health and well-being of people in countries around the world.

Nurse administrators may be called on to resolve conflict related to role expectations that involve graduates of
foreign nursing programs, physicians, patients, visiting family members, and others. Sometimes altercations may
involve security guards, police, and other authority figures, especially among nurses who have experienced
government oppression in their country of origin. It should be noted that physicians, auxiliary staff members, and
others in the healthcare setting who have been educated abroad also may bring different role expectations to the
multicultural workplace.

Working Together in the Multicultural Workplace

Throughout this article, considerable attention has been given to assessing the cultural needs of individual staff
members from diverse groups and communicating effectively with them. In the multicultural healthcare setting,
nursing administrators frequently are challenged to balance the needs of individual staff members from diverse
cultures with the overall good of the healthcare team. Nursing administrators are expected to create an
organizational climate that values and recognizes diversity, yet supports team work and accountability in a manner
that is fair and equitable for all staff.

Nursing administrators must review carefully the criteria for evaluation for cultural bias and ensure that they are
worded in a manner that enables staff from diverse cultures to achieve standards. These standards must be
communicated to all staff members, at the time of initial employment and at periodic intervals. Ensure that staff
members understand what is meant by working together or building teams or other expressions that reflect
organizational values.

In most instances, staff members expect nursing administrators to establish and enforce policies that avoid giving
preferential treatment to any individual or group. At the same time, they want a work environment that allows
sufficient flexibility to accommodate their individual needs. Although staff members expect the nursing
administrators to be fair in their expectations concerning work load and job-related responsibilities, they also want
their performance evaluations to reflect accurately the effort and hard work that they have put forth. If staff
members perceive that a peer from a diverse cultural background is doing less work or being evaluated less
rigorously, they may lose confidence in their manager, engage in behaviors that undermine the group's effectiveness,
or show evidence of morale problems. While being responsive to individual staff needs, the nursing administrator
must focus on the overall organizational mission, goals, and objectives and encourage staff members to work
collaboratively.

Conclusion

Given the demographic trends, nurse administrators in the next decade will continue to search for cultural
origins of conflict in the multicultural workplace. As a microcosm of society at large, healthcare organizations,
institutions, and agencies consist of staff members and patients from increasingly diverse backgrounds.

Culture influences the manner in which people communicate with one another and how they perceive, identify,
define and solve problems in the workplace. Among the complex and interrelated factors that must be considered
when addressing workplace diversity are cultural perspectives on values, the meaning of work, interpersonal
relationships, cross-cultural communication patterns (including touch, space/distance, and etiquette), interpersonal
relationships involving authority figures, peers and patients, gender and sexual orientation, moral and religious
beliefs, hygiene, clothing and the use of accessories, and long-standing historic rivalries between groups.

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When cross-cultural miscommunication and conflict involves nurses, physicians, or others who have been
educated abroad, nursing administrators must explore cross-national differences in role expectations, scope of
practice, status or prestige associated with various health-related disciplines, exposure to oppressive governments,
attitudes toward authority, and global politics. Characteristics of the staff member, such as individual preferences,
biases for and against certain groups, prejudice, educational background, and prior experiences living and working in
culturally diverse settings, also must be considered.

Understanding cultural differences in the workplace and developing skill in conflict resolution will continue to be
needed in transcultural nursing administration as the next millennium approaches. The successful transcultural nurse
administrator will behave respectfully toward others from diverse backgrounds and will implement policies that
promote cultural understanding, knowledge, and skill in the workplace. They also will be sensitive to the overall
needs of the entire healthcare team and work toward using the differences in achieving organizational goals.

References

1. U.S. Department of Health and Human Services, Bureau of Health Professions. Fact Sheet: Selected Facts About
Minority Registered Nurses. Washington, DC: U.S. Government Printing Office; 1993. [Context Link]

2. U.S. Department of Health and Human Services. Healthy People 2000: National Health Promotion and Disease
Prevention Objectives. Boston, MA: Jones and Bartlett; 1992. [Context Link]

3. U.S. Bureau of the Census. Place of birth of foreign-born persons.In: 1990 Census of Population, Social and
Economic Characteristics, United States. Series 1990. CP-2-1. Washington, DC: U.S. Government Printing Office;
1993:12. [Context Link]

4. Leininger MM. Founder's focus: transcultural nursing administration: an imperative worldwide. J Transcult Nurs.
1996;8(1):28-33. [Context Link]

5. Flarey DL. The social climate of work environments. J Nurs Adm. 1993;23(6):9-15. Buy Now [Context Link]

6. Andrews MM, Boyle JS. Transcultural Concepts in Nursing Care. Philadelphia, PA: Lippincott-Raven; 1998. [Context
Link]

7. Henderson G. Cultural Diversity in the Workplace. Westport, CT: Praeger; 1994. [Context Link]

8. Morgan G. Images of Organization. Thousand Oaks, CA: Sage Publications; 1997. [Context Link]

9. Schwartz RH, Sullivan DB. Managing diversity in hospitals. Health Care Manage Rev. 1993;18(2):51-56. Buy Now
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