DiversityNursing Blog

The U.S. has grown more diverse with every passing year, and healthcare is feeling that shift directly. Nurses are increasingly caring for patients whose cultural backgrounds, languages, and belief systems differ from their own. Many of these patients — particularly those from African, Latino, and Asian communities — face some of the steepest barriers to healthcare access and carry a disproportionate share of the country's health disparities. Since COVID-19, "disparity" has become a household word, but the underlying problem it names — that race and ethnicity still shape health outcomes across nearly every measure — is far from new.

Nursing sits at the center of this challenge. As the largest group of healthcare providers in the country, nurses show up in every setting where care happens: hospitals, outpatient clinics, rural health centers, detention facilities, and beyond. That reach means nursing education has an outsized role to play in whether the profession helps close health disparities or unintentionally reinforces them.

What Cultural Sensitivity Actually Requires

It's tempting to think of cultural sensitivity as simply knowing that different cultures exist. But real cultural sensitivity goes further — it means understanding and respecting each patient's background, from their religious practices to their family structure to their social circumstances, and letting that understanding shape how nurses communicate, what they recommend, and how they deliver care.

Cultural sensitivity is best understood as one piece of a larger picture that includes cultural competence and cultural humility. Competence is built through education, immersion experiences, and stronger communication skills — but a nurse's age, self-awareness, and training also shape how culturally attuned they become.

Nursing decisions are never made in a vacuum. Every day, nurses draw on core ethical principles — autonomy, justice, non-maleficence, and beneficence — to guide patient care. Cultural sensitivity training helps nurses apply those principles more effectively across diverse patient populations, and it fosters a more collegial workplace for an increasingly diverse nursing workforce.

The Weight of Bias

None of this works without confronting bias directly. Every person carries both implicit and explicit biases — attitudes shaped by upbringing, personal experience, and even social media exposure. Explicit bias is the kind we're consciously aware of holding. Implicit bias is trickier: it operates below conscious awareness, but it still shapes how caregivers treat patients and colleagues, often leading to unintentional discrimination and worse health outcomes.

Left unexamined, these biases calcify into stereotypes that damage both patient care and student-faculty relationships. That's not abstract — it plays out in real careers. Decades ago, as a pre-licensure nursing student struggling through my first college chemistry class, I sought guidance from my faculty advisor. Instead of support, I was told, "Maybe you should be a social worker." I pushed through, passed chemistry that summer, and more than forty years later, I hold a doctoral degree in nursing. I've heard nearly identical stories from other Black nurses — being warned the program "could be tough" for them, or that it "might be financially challenging" given their background. These aren't isolated incidents; they're a pattern underrepresented students still face, which is why mentorship and cultural sensitivity training need to be built into how we prepare the next generation of nurses.

Accrediting bodies have taken notice: The Joint Commission and the American Nurses Credentialing Center's Pathway to Excellence program now require healthcare organizations to assess their diversity, equity, and inclusion efforts. That accountability matters — but only if it's backed by real change in how nursing students are taught.

Take the DiversityNursing.com "Unconscious Bias" Quiz Today

Why Cultural Humility Matters More Than Checklists

At the heart of good nursing care is a simple idea: every patient deserves to be treated with dignity. Cultural humility is what makes that possible in practice, asking nurses to bring empathy and genuine curiosity into every patient interaction rather than imposing their own assumptions.

Cultural humility differs from a rigid, fact-based approach to competence: it treats self-awareness as an ongoing practice, not a box to check, requiring nurses to critically examine their own biases continuously. Done well, this fosters what researchers call cultural fluidity — a seamless exchange between a nurse's own values and those of the patients and colleagues around them.

Research backs this up. Arruzza and Chau (2021) found that nursing students are eager to learn about cultural competence but often start out without a clear sense of their own strengths and gaps; structured education leaves them more satisfied and better able to identify their own learning needs. Antón-Solanas and colleagues (2021) found something more sobering: unaddressed implicit and explicit bias can take a real toll on students' mental health and academic performance. This isn't only about patient outcomes — it directly affects whether nursing students, especially those from underrepresented backgrounds, succeed and stay in the profession.

What the Research Says About Getting This Right

The broader literature reinforces the same conclusion: nursing can genuinely help close healthcare disparities when academic programs fully integrate culturally competent education and invest in training faculty to teach it well. But the training itself has to evolve — early cultural competency education often leaned on stereotypes that have since been discredited, and outdated versions can do more harm than good.

Faculty can't be exempt from this work either. Nurse educators need their own cultural competency training to prepare students for multicultural patient care. Yet studies show students still witness racial stereotyping from academic and clinical staff, creating what researchers describe as pressure to be "exceptional to be considered average." Combine that with reduced social support and a shortage of diverse faculty role models, and it's easy to see how it wears down even capable students. Proposed remedies include focusing more on social determinants of health, building genuinely safe clinical learning spaces, and prioritizing the retention of diverse faculty.

Much of today's thinking traces back to Madeleine Leininger's Transcultural Nursing Theory, which established that nurses must recognize and respect the cultural backgrounds, beliefs, and practices of every patient. Programs built around this theory report stronger empathy, sharper critical thinking, and deeper commitment to the profession. The American Association of Colleges of Nursing has since built on this foundation with its Essentials framework. Not every intervention shows the same staying power, though — unconscious bias training shows mixed long-term results, suggesting deeply ingrained biases don't always shift easily.

There's also a broader accountability question. A health profession school's "social mission" should mean more than teaching science well; it means embedding equity into the curriculum itself. Yet a review by Orbán and colleagues (2021) of nine health profession accreditation standards found that none of the nursing accreditation bodies examined explicitly required curricula to address student diversity or health disparities — a real blind spot in how the profession holds itself accountable.

Moving Forward

Cultural competence is necessary, but it's not sufficient on its own. Real progress requires systemic change across healthcare organizations, academic institutions, and the broader socioeconomic conditions that shape health. Every nurse has a role to play: examining personal biases honestly, collaborating openly with colleagues and students, and creating space for students to speak up when something conflicts with cultural sensitivity — an act of patient advocacy in its own right. Clinical training programs should also make room for real-world exposure: rotations in community health clinics, neighborhood health centers, international clinics, and cultural immersion experiences give students something no textbook can — direct contact with the communities they'll eventually serve.

The goal isn't a nurse who has memorized facts about every culture they might encounter. It's a nurse who walks into any room ready to listen, willing to be corrected, and committed to treating the person in front of them with the dignity they deserve.

References

American Association of Colleges of Nursing. (2023). The essentials: Competencies for professional nursing education [PDF]. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf

Antón-Solanas, I., Tambo-Lizalde, E., Hamam-Alcober, N., Vanceulebroeck, V., Dehaes, S., Kalkan, I., Kömürcü, N., Coelho, M., Coelho, T., Casa Nova, A., Cordeiro, R., Sagarra-Romero, L., Subirón-Valera, A. B., & Huércanos-Esparza, I. (2021). Nursing students' experience of learning cultural competence. PLOS ONE, 16(12), e0259802. https://doi.org/10.1371/journal.pone.0259802

Arruzza, E., & Chau, M. (2021). The effectiveness of cultural competence education in enhancing knowledge acquisition, performance, attitudes, and student satisfaction among undergraduate health science students: A scoping review. Journal of Educational Evaluation for Health Professions, 18, 3. https://doi.org/10.3352/jeehp.2021.18.3

Chae, D., Kim, J., Kim, S., Lee, J., & Park, S. (2020). Effectiveness of cultural competence educational interventions on health professionals and patient outcomes: A systematic review. Japan Journal of Nursing Science, 17(3). https://doi.org/10.1111/jjns.12326

Etienne, S., & Lewis, L. (2024). Racial implicit bias: Perspectives of nursing students. Journal of Professional Nursing, 50, 95–103. https://doi.org/10.1016/j.profnurs.2023.10.007

Hughes, V., Delva, S., Nkimbeng, M., Spaulding, E., Turkson-Ocran, R.-A., Cudjoe, J., Ford, A., Rushton, C., D'Aoust, R., & Han, H.-R. (2020). Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty. Journal of Professional Nursing, 36(1), 28–33. https://doi.org/10.1016/j.profnurs.2019.06.005

Joseph, O., Flint, S. W., Raymond-Williams, R., Awadzi, R., & Johnson, J. (2021). Understanding healthcare students' experiences of racial bias: A narrative review of the role of implicit bias and potential interventions in educational settings. International Journal of Environmental Research and Public Health, 18(23), 12771. https://doi.org/10.3390/ijerph182312771

Key data on health and health care by race and ethnicity. (n.d.). KFF. Retrieved April 3, 2025, from https://www.kff.org/key-data-on-health-and-health-care-by-race-and-ethnicity/?entry=health-coverage-access-to-and-use-of-care-access-to-and-use-of-care

Nursing workforce fact sheet. (n.d.). Retrieved April 3, 2025, from https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet

Ogundipe, A., Hylton, D., & Alexander, P. (2023). Inclusion of cultural competence and racial awareness in nursing education: An exploration of the nurse educator role. Nurse Education Today, 120, 105611. https://doi.org/10.1016/j.nedt.2022.105611

Orbán, J., Xue, C., Raichur, S., Misak, M., Nobles, A., Casimir, J., & Batra, S. (2021). The scope of social mission content in health professions education accreditation standards. Academic Medicine, 97(1), 111–120. https://doi.org/10.1097/acm.0000000000004437

Pryce-Miller, M., Bliss, E., Airey, A., Garvey, A., & Pennington, C. R. (2023). The lived experiences of racial bias for black, Asian and minority ethnic students in practice: A hermeneutic phenomenological study. Nurse Education in Practice, 66, 103532. https://doi.org/10.1016/j.nepr.2022.103532

The future of nursing 2020-2030: Charting a path to achieve health equity. (n.d.). https://nap.nationalacademies.org/catalog/25982/the-future-of-nursing-2020-2030-charting-a-path-to

U.S. Census Bureau. (n.d.). 2020 U.S. population more racially, ethnically diverse than in 2010. U.S. Department of Commerce. Retrieved April 3, 2025, from https://www.census.gov/library/stories/2021/08/2020-united-states-population-more-racially-ethnically-diverse-than-2010.html

Vela, M. B., Erondu, A. I., Smith, N. A., Peek, M. E., Woodruff, J. N., & Chin, M. H. (2022). Eliminating explicit and implicit biases in health care: Evidence and research needs. Annual Review of Public Health, 43(1), 477–501. https://doi.org/10.1146/annurev-publhealth-052620-103528

Vella, E., White, V. M., & Livingston, P. (2022). Does cultural competence training for health professionals impact culturally and linguistically diverse patient outcomes? A systematic review of the literature. Nurse Education Today, 118, 105500. https://doi.org/10.1016/j.nedt.2022.105500

Racial concordance signifies the connection between the racial or ethnic backgrounds of patients and their healthcare providers, showcasing its profound impact on patient care, communication, trust, and overall health outcomes.

While racial concordance in Nursing offers various benefits, it's important to recognize it's not always feasible or practical to match every patient with a Nurse of the same racial or ethnic background. Emphasizing racial concordance should not overshadow the importance of Diversity, Equity, and Inclusion (DEI) within the Nursing workforce. 

Improved Communication 

This shared background fosters a sense of understanding and connection that goes beyond mere words - it's a deep-rooted familiarity with traditions, beliefs, and values that allows for seamless communication and empathy. Patients feel validated and heard when they can freely express their concerns and health needs in a language that resonates with their cultural identity. This bond of shared ethnicity or race creates a safe space for open dialogue and mutual respect, paving the way for a more holistic and personalized approach to healthcare.

Enhanced Trust 

Trust is a crucial component of the patient-provider relationship. Racial concordance can contribute to building trust between patients and Nurses, as patients may feel that their Nurse understands their unique experiences, challenges, and perspectives. This trust can lead to greater adherence to treatment plans and better health outcomes.

Cultural Competence

Nurses who share the same racial or ethnic background as their patients may possess a deeper understanding of cultural beliefs, practices, and health-seeking behaviors. This cultural competence enables Nurses to provide more personalized and culturally sensitive care, which can positively impact patient satisfaction and outcomes. Nurses of all backgrounds should receive training in cultural competence and communication skills to effectively care for patients from all backgrounds.

Reduced Health Disparities 

Racial and ethnic minorities often face disparities in healthcare access, quality, and outcomes. Racial concordance in Nursing can help mitigate these disparities by improving communication, trust, and cultural competence. Patients from marginalized communities may feel more empowered to seek care and engage in preventive health measures when they have Nurses who understand their unique needs and experiences.

Opportunity For Learning

Having a diverse workforce not only provides Nurses with the opportunity to learn from each other's unique life experiences and cultures but also fosters a rich environment for collaboration and growth. Nurses from different racial and ethnic backgrounds bring a wealth of knowledge and perspectives to the table, allowing for a dynamic exchange of ideas and practices. This diversity enriches the overall care provided to patients, as Nurses can draw upon a wide range of insights and approaches to address the needs of individuals from various backgrounds. Embracing diversity within the Nursing profession not only enhances the quality of care but also promotes a culture of inclusion and understanding that benefits both healthcare providers and patients alike.

Racial concordance in Nursing can play a significant role in improving patient care, communication, trust, and health outcomes, particularly for racial and ethnic minority populations. However, it's essential to address the broader issues of Diversity, Equity, and Inclusion within the healthcare workforce to ensure all patients receive high-quality, culturally sensitive care, regardless of the racial or ethnic background of their providers.

In our growing diverse society, health care workers need to understand that applying only traditional westernized medical practices isn't appropriate for many patients and families. Health professionals must have an awareness of different cultural practices and spiritual beliefs in order to reduce racial and ethnic disparities in health care.

According to the American Hospital Association, cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients' social, cultural and linguistic needs.

There can be language barriers so make sure you know your patient’s preferred method of communication and arrange an interpreter. Non-verbal communication may differ across cultures. Don’t make any assumptions without knowing the person's customs.

Many cultures have special dietary considerations. Hospital staff should be educated about food culture, which is a term used to describe the non‐nutritive, yet nonetheless significant, aspects of food, such as when food is eaten and how it is served.

For example, Jewish patients do not eat pork or shellfish. Muslim patients also do not consume pork. Muslims will eat only permitted food (halal) and will not eat or drink anything that is considered forbidden (haram). Halal food requires that Allah's name is invoked at the time the animal is killed. Lamb, beef, goat and chicken, for example, are halal as long as a Muslim kills them and offers a prayer. Fish and eggs are also halal. Buddhist are mostly vegetarian, though Buddhists may eat meat if it has not been killed for them specifically.

Health care workers should use effective communication to increase their understanding about the patient's spiritual beliefs and practices. Your workplace should offer spiritual counselors like a chaplain or a rabbi. It is a good idea to have a non-denominational prayer and meditation room which can serve as an inclusive sacred space for staff and patients of all religious backgrounds.

Management should take an active role in promoting culturally competent workplace training courses and resources.

Our calendar of cultural dates is a great tool to assist staff with respectful scheduling and diversity celebrations.

Healthcare organizations strive to provide culturally competent care for individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). Recent changes in society, including the legalization of gay marriage have raised public awareness of LGBTQ issues. Yet many healthcare professionals lack knowledge in some areas when caring for LGBTQ patients.

Michael Johnson, PhD, RN, understands the barriers faced by LGBTQ patients and the assumption often made by healthcare professionals that all patients are heterosexual. 

According to a Nurse.com article, Johnson said, “Some members of the LGBTQ community avoid seeking healthcare services because of previous negative experiences in which they faced discrimination. Studies have shown most LGBTQ patients want to be able to share their sexual orientation or gender identity with their healthcare provider, but are often reluctant to open up because they fear they may be treated badly or even refused care."

LGBTQ individuals have a long history of discrimination at the individual and institutional levels, including the healthcare system. They may check to see if the environment is a safe place to reveal personal information, especially about sexuality. Some things an individual may take note of during their time in your waiting room area include:

• Your organization’s nondiscrimination policy: Is it in a visible location?
• A rainbow flag, pink triangle, or other symbol of inclusiveness
• Availability of unisex restrooms
• Health education literature with diverse images and inclusive language, including information about LGBTQ health
• Posters announcing days of observance such as World AIDS Day, Pride, and National Transgender Day of Remembrance

To understand LGBTQ populations and their health needs, it is important to first define the distinct core concepts of sexual orientation and gender identity. You can read about key LGBTQ terms here.

LGBTQ health requires specific attention from health care and public health professionals to address a number of disparities, including:

• LGBT youth are 2 to 3 times more likely to attempt suicide.
• LGBT youth are more likely to be homeless.
• Lesbians are less likely to get preventive services for cancer.
• Gay men are at higher risk of HIV and other STDs, especially among communities of color.
• Lesbians and bisexual females are more likely to be overweight or obese.
• Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals.
• Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.
• LGBT populations have the highest rates of tobacco, alcohol, and other drug use.

 

Nurses should avoid asking any unnecessary questions. People are sometimes curious about LGBTQ people and their lives, which can lead them to want to learn more by asking the patient questions. However, like everyone else, LGBTQ people want to keep their medical and personal lives private. Before asking any personal questions, first ask yourself: “Is my question necessary for the patient’s care, or am I asking it for my own curiosity?" If for your own curiosity, it is not appropriate to ask. Think instead about: “What do I know? What do I need to know? How can I ask for the information I need to know in a sensitive way?"

Effectively serving LGBTQ patients requires you to understand the cultural context of their lives, and to modify your procedures, behavior, and language to be inclusive, non-judgmental, and helpful at all times. By doing this, healthcare staff can help ensure that LGBTQ patients receive the level of care that everyone deserves. What helpful information can you add regarding this topic?