How can nurses truly celebrate cultural diversity?

American feminist psychologist and theorist Carol Gilligan once said that without voice there cannot be relationship, and without relationship there cannot be voice. (1) How do we have relationships with people who are different from us? How do we and the other person have a voice in the relationship, if we don't know what our common ground is?

The 2006 Census reveals European New Zealanders make up 67.6 percent of the population, 14.6 percent of people self-identify as Maori, Pacific peoples make up 6.9 percent of the population, Asians 9.2 percent and Middle Eastern, Latin American and African people, 0.9 percent. (2) The Census also revealed that nearly 23 per cent of New Zealand's population was born overseas, compared with 19.5 per cent in 2001. In terms of religious affiliation, 55 per cent said they were Christian, down from 60.6 per cent in 2001. And 1.3 million New Zealanders said they had no religion. The number of Hindus increased by 61.8 percent to 64,392, Muslims went up 52.6 percent to 36,072 people and the number of Sikhs was 9507, up 83 percent. (2)

This religious and cultural diversity has implications for nurses and those we care for. How do we have relationships with people of different cultures and religions? How can we, as nurses, cultivate relationships and ensure we have a voice, and ensure our colleagues and clients who are "diverse", have a voice too? What does celebrating cultural diversity actually mean for nurses, other than taking part in a cultural festival or having friends from diverse backgrounds? What does it mean for systems that are primarily monocultural and are striving to be bicultural? And what does that mean for the increasing number of people from diverse ethno-religious communities?

New Zealand has a long history of migration, but the range and number of migrants in New Zealand has been on an unparalleled scale since 1987. With that have come demographic changes. I recently gave a two-hour talk about diversity, and afterwards a nurse asked "What about our (Pakeha) identity? What is going to happen to it?" She is not the only person worded about the loss of identity, as witnessed by the cry "What has happened to my country?" in letters to the editor and heard on talkback radio. For those of us who have migrated here, it is hard to understand why people from the dominant culture feel marginalised, when we are surrounded by Pakeha/white New Zealand culture, in terms of all the institutions and power bearers.

Interaction rather than co-existence

These concerns highlight a need for dialogue and I am reminded of the work of Lebanese-Australian anthropology professor, Ghassan Hage, who suggests the way forward is through interaction, rather than co-existence. (3) When we co-exist, we can idealise or demonise the other, but never really get to know them. But when we interact, it requires us to move forward in relationship, even when it is tough and frustrating. There are potential gifts of working from a place of interaction and these occur when we can say "Let's take the best of both/many cultures and see what new and wonderful things we can create".

Richard Florida has written about the creative class where new ideas and technologies have been developed in the United States as a result of attracting the best and the brightest from around the world and harnessing the creativity inherent in diversity. (4) This is where interaction comes in--we have to rub up against one another, experience conflict and find a way forward for creativity to kick in.

To harness such potential in health in New Zealand we need to address the political and policy Landscape of health. Nursing Council statistics show that migrant nurses made up 51 percent of new registrations in 2005-2006. (5) This percentage raises many questions: What do we have in place to assist the effective integration of new migrant nurses? What is good practice for those who employ migrant nurses? Who is responsible for ensuring that this happens well? What support mechanisms need to be in place to create innovation in health? How do receiving nurses create new spaces and places for cultural diversity?

Migration has always had an element of economic necessity, a tap which could be turned on and off, as and when we needed more labour. But, increasingly, receiving countries are beginning to realise people don't just migrate for a job. They migrate for a life and for their dreams and aspirations. This means they put down roots and settle and want a home and a voice in their new country. In the short-term period of settlement, it is about such things as getting a job, financial independence, establishing a social network and adapting to various aspects of lifestyle. In the long-term period of integration, it is about career advancement, income parity, accessing institutions, redefining cultural identity, adapting or reassessing values, and participating in political parties and socio-political movements.

I have a number of suggestions about how we move forward with diversity: use it for our creative endeavours; see newcomers as a source of innovation; along with maintaining our obligations to Maori under Te Tiriti o Waitangi, ensure all who live in Aotearoa/New Zealand enjoy equitable access to services and enjoy equal rights, responsibilities and opportunities to participate in, contribute to and benefit from all aspects of life. Finally, recognise that we all share responsibility for the continuing development of Aotearoa New Zealand as a cohesive and harmonious society. Contributing to our own communities and venturing outside them, would be a great start.

References

(1) Gilligan, C. (1982) In a Different Voice: Psychological Theory and Women's Development. Cambridge, Massachusetts: Harvard University Press.

(2) New Zealand's 2006 Census of Populatino and Dwellings. (2006) 2006 Census Date. Statistics New Zealand. http://www.stats.govt.nz/census/default/htm. Retrieved 20/04/07.

(3) Hage, G. (2002) Against Paranoid Nationalism: Searching for Hope in a Shrinking Society. Australia: Pluto Press.

(4) Florida, R. (2002) The Rise of the Creative Class and How it's Transforming Work, Leisure, Community and Everyday Life. http://www.amazon.com/Rise-Creative-Class-Transforming-Community/dp/ 0465024769. Retrieved 20/04/07.

(5) Clark, M. and Ayling, B. (2006) Workforce Statistics 2006 Update. Presentation to Nursing Council Forums. http://www.nursingcouncil.org.nz/forum.html. Retrieved 20/04/07.

Ruth DeSouza, RN, MA, is the centre coordinator/senior research fellow at the Centre for Asian and Migrant Health Research, National Institute for Public Health and Mental Health Research, Auckland University if Technology, Te Wananga Aronui o Tamaki Makau Rau.