By Yolanda M. VanRiel

With every new census that gets taken, the data is loud and clear: the United States population is becoming more and more diverse, and this is likely to only continue. From the perspective of healthcare this is a critically important fact to consider. For many years, in business, it has been considered common sense that if your business caters to different cultures then you must have at least a basic knowledge about those cultures. Why should the business of healthcare be any different? Especially considering the various challenges that healthcare faces today, and the fact that hospitals increasingly can’t afford to ignore issues relating to quality of care, it behooves decision makers in both nursing programs and hospital settings to consider ways to boost the level of cultural competence among their students and nurses, respectively.

Why cultural competence matters
It is well known that BIPOC communities in the U.S. experience a variety of health disparities and unequal health outcomes. These include higher rates of mortality and chronic diseases as well as unequal access to health services. These underserved populations also frequently face unequal treatment in healthcare settings and often mentally prepare themselves for unfair treatment or try to ward off such treatment by dressing nicely and paying extra attention to their appearance to try to circumvent biased perceptions on the part of healthcare staff. When they do receive unfair or unprofessional treatment, it only reinforces the feelings of mistrust that they might already have.

The reasons for these health disparities are many, but research suggests that one reason may be lack of cultural competence. “Cultural competence” in healthcare settings can be defined as the ability of healthcare organizations, providers, and staff to deliver quality care to patients of diverse cultural backgrounds and languages while respecting their experiences, values, and beliefs. It also involves, when needed, the customizing of care to meet patients’ unique social, cultural, and linguistic needs.

It’s important to also realize that cultural competence does not apply only to immigrants and people of color. It applies to any underserved and underrepresented group that may have certain experiences, values, and beliefs that differ from the dominant mainstream culture. This includes the LGBTQ+ community, people of different religions, and disabled communities. All of these communities have their own internal cultures that may not be understood by everyone in the dominant culture. For example, not everyone understands why pronouns are important for trans and non-binary people, but they are important and not showing understanding can make people in these communities feel alienated.

Why does this matter so much? Let’s start with the most obvious cultural barrier that can get in the way of delivering effective care, language differences. As of 2021, 25.7 million people have limited English proficiency. That is a lot of people. At the same time, a 2016 study by the American Hospital Association showed that out of 4,586 h hospitals only 56 percent offered any kind of interpreter or translation services for patients who spoke limited or no English. The ability to communicate is the most basic condition necessary for effective care, and when it is absent many adverse effects can occur such as confusion about medication, adverse reactions due to incorrectly taking the medication, difficulty accessing care, and not seeking care when needed out of fear of not being able to understand their healthcare providers. [other problems too]

It isn’t just language barriers that lead to problems. Lack of cultural understanding can also lead to patients delaying or forgoing treatment, decreased compliance on the part of patients, and leads to patients experiencing dissatisfaction with the care they receive and developing negative perceptions of their healthcare providers. Meanwhile, high levels of cultural competency result in the opposite outcome, with high levels of patient satisfaction, higher levels of trust and adherence to treatment, and overall better health outcomes.

Nurses are the 'front line' for cultural competence
Ideally, every type of healthcare professional, including physicians and administrative staff, should have cultural competence. But nursing is the largest healthcare profession and nurses have the most interaction with patients on a daily basis. This makes it especially urgent that they receive cultural competence training, especially with the increasing demographic shifts and diversity in the U.S.

The good news is that cultural competence training works and it is effective. The research shows that it boosts nurses’ cultural competence and that nurses found such training useful and thought-provoking. When nurses are equipped with this knowledge and confidence, the positive health outcomes discussed above are much more likely. However, it’s important to start teaching cultural competence as early as possible since nursing students can start working with real-life patients quite early into their nursing education. It’s never too late to teach and learn cultural competence, but it’s best to do so before student nurses start working in clinical settings. Fortunately, the research shows that teaching cultural competence training to master’s level nursing students has also resulted in positive benefits including cultural safety, better care, and better health outcomes.

Finally, we should remember that the quality of patients’ experiences and the quality of care are directly linked to hospitals’ financial health and profitability. It’s logical that if patients are not satisfied with the care they receive, or if going to a specific hospital does not result in improved health, they are going to look elsewhere for their medical needs.

For nursing schools as well, training culturally competent nurses who will help hospitals succeed in a future with increasingly diverse populations will benefit the universities as well as the hospitals they serve. Unfortunately, many graduating nursing students do not feel culturally competent and feel unprepared. Furthermore, cultural competence shouldn’t be taught to just nursing students but also to the faculty. Nursing programs with faculty who possess cultural competence result in higher retention and graduation rates which leads to higher revenue for the university.

No one pretends that improving cultural competence would be easy. It would take a lot of work and time, and budget might understandably be a concern for both nursing programs and hospitals. But there’s a strong business case for investing in cultural competence anyway because it leads to financial rewards that justify the investment. On the other hand, not investing in it is almost guaranteed to be costly, and this will only be more true in the years ahead. Nursing programs and hospitals that want an edge in the increasingly competitive future of healthcare should definitely get to work on this immediately.

About the author: Dr. Yolanda M. VanRiel is an RN associate professor and department chair of nursing at North Carolina Central University.