DEFINITIONS

The term workplace diversity is a common term today, but it is one that has to be carefully analyzed as its impact on the health care environment and workplaces is considered. An internet search returns many sites containing discussion of actions in pursuit of workplace diversity or multiple applications of or for workplace diversity initiatives. But the question remains as to what is an appropriate definition for workplace diversity, especially as it relates to health care.

Nurses deal with diversity in their workplaces every day, and this diversity comes from many perspectives. Some work with patients’ families from diverse cultures; some work with co-workers from diverse cultures. The institution has its own culture, as does each nurse or clinician.

In order to make a positive contribution to the effective treatment of patients, it is critical that nurses or clinicians first recognize that they are dealing with this multiplicity of cultures. They include the culture of:

A culture can be defined by characteristics such as the following:

However, when looking at areas from which cultural values are drawn, it is important not to assume that the criteria for a certain cultural group are true for every person who belongs to that racial, ethnic, or cultural group. Patients and/or their families, clinicians, and other individuals should not be put into restricted, culturally specific “boxes” nor labeled by virtue of culture and race. Learning cultural values requires moving beyond the group generalization to the individual’s specific values. History shows that the differences between the two extremes of any group are usually greater than the differences between the midpoint of two different groups. As President Obama said, “culture matters but that culture is shaped by circumstance” (Obama, 2006, p. 255).

Henry (2012) gives an example about assuming that the criteria for a certain cultural group are true for every person in that group. He tells of the Dalai Lama reflecting on a trip he took to Israel and a discussion he had with one of the chief rabbis. When queried about what doctrine(s) united Jews all around the world, the rabbi responded that there wasn’t such a doctrine, and that in fact it was the rituals practiced by Jews that united them. Henry (2012) further noted the non-universality of doctrine in the Roman Catholic Church: “Whatever the few required tenets are that all Catholics must believe, certainly they do not include opposition to birth control, legalized abortion and gay marriage” (p. 1).

There is a large percentage of Roman Catholic women, more than 90% according to some polls, who have practiced some form of birth control. He explained that “This figure is so high because many priests tell women in the confessional to follow their conscience on this issue” (Henry, 2012, p. 1).

Workplace diversity for nurses encompasses not only their nursing colleagues and other health care workers. Just as importantly, it encompasses the patients and families the nurses work with. The U.S. Census (U.S. Census Bureau, 2011b) shows that not only is the nation changing to less and less of a White society, but also it is becoming less identified as a Christian society (Table 11-1). However, race and religion are just two of the things that factor into diversity. What really is diversity?

In the 1990s the U.S. Department of Commerce and the Vice President of the United States created a task force that issued the benchmark study: Best Practices in Achieving Workforce Diversity. That task force (U.S. Department of Commerce, 1999, p. 7) verbalized a wide ranging conceptualization of diversity:

HISTORY

In the United States, as elsewhere in the world, social unrest and the evolution of a cultural response to issues of diversity have tended to occur periodically and typically have revolved around one diversity issue at a time. From the ratification of the U.S. Constitution in 1790, it was more than three quarters of a century before the Constitution was amended (13th, 14th, and 15th amendments) in the late 1860s to provide some equality for African Americans. It was still a century later before the 1960s civil rights movement brought about some semblance of equality for African Americans in the United States through the adoption of the Civil Rights Act of 1964, the Fair Housing Act of 1968, and other civil rights laws and related measures. It was 130 years after the adoption of the U.S. Constitution before it was amended to give women the right to vote.

In the mid twentieth century there was significant discussion about religious diversity in the United States. Roman Catholics were frequently denied equal treatment in social and cultural arenas. The election of John F. Kennedy as the first Roman Catholic President of the United States saw a significant reduction in the discrimination experienced by Catholics. The tragic events of September 11, 2001, not only resulted in nearly 3000 deaths but also saw an upswing in Muslim Americans being denied equal treatment in social and cultural arenas. Jews in the United States have experienced their own brand of discrimination, and Mormons and other religious affiliations have experienced theirs. The U.S. Census Bureau reported that religious diversity in the United States continues to increase (see Table 11-1) (U.S. Census Bureau, 2011b).

In the early years of the twenty-first century, gay marriage became the focal point for denial of equal treatment in social and cultural areas. Many health care and legal matters are impacted by the gay marriage question, including insurance, Medicaid, and hospital visitation.

It is interesting to look at why humans generalize or categorize so much when dealing with the “unique qualities” that the Vice President’s workforce diversity task force (1999) said “each of us possesses.” Some believe that the human mind generalizes because it cannot deal with a multitude of variables at the same time. Halford and colleagues (2005, p. 70) reported on a study where “the conceptual complexity of problems was manipulated to probe the limits of human information processing capacity… These findings suggest that a structure defined on four variables is at the limit of human processing capacity.” This is perhaps an explanation as to why the mind classifies things for us. However, such classification can lead to significant errors when the mind makes inferences about an individual from the group classification it has created. For example, Hilton (2007) provided an in-depth look at the positions of various religions on abortion (Table 11-2), demonstrating diversity and variance.

Although followers of Roman Catholicism, Judaism, Protestant faiths, or Islam may hold given positions on abortion or contraception, many adherents of each faith undoubtedly practice something different than what their faith espouses. Those who generalize about Catholics being pro-life or anti-contraception would many times be wrong when applying those characteristics to individual Catholics. As an example, “nearly 70 percent of Catholic women use sterilization, the birth control pill or an IUD” according to a 2011 report from the Guttmacher Institute, the nonprofit sexual health research organization (Reuters, 2011, p. 1).

At times it seems that most if not all of the “unique qualities” that the Vice President’s workforce diversity task force (U.S. Department of Commerce and Vice President Al Gore’s National Partnership for Reinventing Government Benchmarking Study, 1999) said “each of us possesses” can become a point of contention both between workers and between workers and those they care for. It is essential for nurses to understand those “unique qualities” of their co-workers and their patients/families as they seek to respond in a holistic way to the needs of those they are responsible for.

The field of health care, and especially nursing practice, must recognize and respond to diversity as much if not more than any other industry in the twenty-first century. That is because workplace diversity in the health care setting includes the following:

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