24.11.2020 | Kommentarer

Working as a Foreign Nurse in Finland

Working as a Foreign Nurse in Finland
The Challenges of working in a Multicultural Team

Alira Bianca Mae Gade, Nursing student, Novia UAS
Supervisor: Anita Wikberg RN, RM, PhD, Senior lecturer, Novia UAS

Abstract

As of today, Finland has become more open to health care providers that are foreign nationals, that have a different background and begin to work in Finland’s health care system. Having this kind of situation, there are potential risks that may affect the patient safety and care, it is necessary that every person who works in the health care industry has knowledge and understanding on how cultural diversity can effectively be managed in this multicultural environment. This will give awareness to an individual in a multicultural environment in the hospital, which has workers from different cultures that work and interact with each other and take care of the patient in Finland. If there is a lack of knowledge in Finnish culture among foreign nurses that works in the hospital, this can lead to cultural conflicts and misunderstanding among Finnish people. Being mindful of our cultural differences and having cultural knowledge can help people to interact without problem. It is advisable that before working in Finland that foreign nurses needs to be educated about the cultural background of Finnish patient and nurses, as well as educating Finnish nurses about their co-workers and other patients’ culture because this will benefit both foreign and Finnish born nurses to increase the possibility of cultural harmony.

Introduction

In Finland, there is an increase of diversity when it comes to ethnicity, culture, color and origin. According to Statistics Finland (2020) there are about 423,494 people that has a foreign background that lives in Finland by the end of 2019. In the latest update with Statistics Finland in September of 2020, it was stated that the total population of Finland by the end of August is 5,532,333 and the reason why there is an increased number of population in Finland is because of the people who are immigrating from abroad. This also makes the number of people who are speaking Finnish, Swedish or Sami as their native language decrease and there are an increased number of foreign-language speakers (Statistics Finland 2018).

According to Ministry of Social Affairs and health, Finland’s health care system is built for preventive health care and up to date, extensive health services. The Finnish Nursing Association (2013) write that there are 3 580 Finnish nurses that are working abroad and there are 1,190 nurses of non-Finnish descent employed in Finland. The statistics indicates that multiculturalism is increasing in Finland most especially in the nursing field.

Foreign nurses must learn the language and be familiar with the culture differences, this make it a challenging experience and has a different setback than the Finnish born-Finnish speaking nurses have (Korpela, S. 2007). Karhe (2020) stated that there is an increased nursing migration in 2010’s, and since 2015 there are more nurses that moved out from Finland each year than coming to Finland. Because of this Finnish born nurses need to adapt to the international working environment and the non-Finnish speaking foreigners also need to find a way to build a connection to Finnish nurses to be a better health care team.

2 Background

This chapter aims to provide important information about culture, working in a multicultural team, communication and being a health care professional that work in a different county.

2.1 Culture

There are a lot of definitions of culture but according to Leininger (2012) culture is a set of values, beliefs and traditions that are conducted by a certain group of people and it is passed down from one generation to another.

In Finland, people carefully think about the words that they want to say, since they make sure that their words are taken seriously, Finnish people are better listeners than speakers and they consider it rude when you interrupt a person who is talking. However, there are several other culture-specific considerations that foreigners need to be mindful about because Finnish people set value on their words, that’s why they tend to say little and stay away from needless small talk. There is also a high level of equality between men and women in Finland, women have an advanced position not just in politics but also in other areas of the society (Alho, 2010).

2.2 Multiculturalism and Multicultural Team

There are a lot of definitions for multiculturalism and that is why it is difficult to define since the concept of ‘multiculturalism’ changes all the time. According to the International Federation of Library Associations and Institutions (IFLA) (2020) multiculturalism is to exist together even though there are a lot of differences with regards to an individual’s culture, values, religion, the way of thinking and the style in communication.

According to Friedemann et al., (2008) multicultural teams are groups of people that have different cultures and ethnicities. Having a multicultural team appears to have an advantage regarding collection of data, still there will be some challenges in mixing different groups of individuals together that have different values, beliefs and cultures if they will not overcome the cultural differences.

2.3 Advantage and Disadvantage of having a Multicultural team

There are advantage and disadvantage of having an individual with different culture in your team. According to Jordan (2020) the first advantage is having increase creativity, having a lot of people in a team from different culture can provide different ideas and perspectives. The second advantage is you can learn and expand your knowledge about other culture, and lastly by having a diverse team the patient can feel safe if there is someone in the hospital that can communicate with them and will address their needs. Brett, et al. (2007) expressed that the first disadvantage of having a multicultural team is through direct and indirect communication. In Finland, Finnish people are uncomfortable with small talks which makes them more reserved and they tend to be more direct when communicating in work or business while others can be chatty and are more indirect, and this can cause conflict because one can find the other as offensive (Communicaid, 2020). The second disadvantage is the accents and fluency, since it is a multicultural team the members do not speak the same language, in Finland people speak Finnish more than English or Swedish and this can cause isolation from other members that is not good with the language. And lastly are conflicting decision-making norms, since members are from different cultures every member makes decisions differently and this can cause conflict when one culture makes decisions faster than the others (Brett et al., 2007).

Li and Liao (2015) suggest that in order to have a harmony and a better team, they recommend having a broaden mind by ways of reading books, watching movies and travelling. Raising awareness of the cultural differences of the members by expanding cultural knowledge and embracing other cultures.
Lanig, et. al. (2013) conclude that having a positive relationship within the health care professionals can provide a positive outcome to the well-being of the patients and all the professionals in the health care organizations.

2.4 Working as a nurse in Finland

According to Finnish Nurses Association if you want to work in Finland as a nurse you need to have a license to practice. However, in order to have a right to practice in Finland even if you are a nurse in a different country they are still required to contact the National Supervisory Authority for Welfare and Health (Valvira). Valvira (2020) registers all the professional person who have the right to practice and maintains all the information with regards to all the registered nurses. In addition to that, they require all medical or health care professionals that are planning to work in Finland to speak well enough either Finnish or Swedish language and a person who do not have a license and is discovered working as a healthcare professional in Finland will be sentenced to either a fine or imprisonment.

2.5 Migration Nurses

Since there is a shortage of nurses not just in Finland but globally, nurses are pushed to leave their home countries to transfer and find their luck in a different country (Li et al., 2014). Having lack of resources to work effectively and limited career opportunities are some of the reason why nurses move to a different country. Moreover, the low salary and nurse-patient ratio, unstable and dangerous working conditions and lack of employee benefits also make a huge factor that lead nurses to migrate (Li et al., 2014). However, there are some hindrance to nurses who are migrating. They need to adopt to the culture of the country where they are moving as well as learning their language and cover the expenses that they will encounter while moving (Kingma, 2007).

2.6 Communication

Communication is an essential part in nursing with regards to all areas of activity, most specially in providing interventions to the patient such as prevention, treatment, therapy, rehabilitation, education and health promotion. Therefore, good communication between nurses and patients to nurses are important for a successful outcome of each patient’s condition, but it is also important that the communication and relationship between the nurses are stable and should be enhance to increase the outcome of the care that they are providing. Thus, creating a culture of quality and safety often depends on nurses’ ability to work together (Kourkouta & Papathanasiou, 2014)

Language is our main source in communicating with others and it is also one of the reasons why there are barriers and problems when there is cross-cultural communication (Cagiltay, et. al. 2015). In Finland, people tend to keep distance or have a personal space while communicating, whereas for other countries body gesture or contact is important part of their communication (Alho, 2010).

Lanig, et al., (2013) indicate that nurses who have experienced poor nurse to nurse interactions are more likely to avoid asking questions or try to approach other nurses for help, and have a possibility of increasing mistakes and causing much danger in the patient care.

When associates communicate in unfamiliar language, misunderstanding can be crucial and is most likely expected. Enunciations, articulations and non-verbal communication can be a reason for misperception and everyone else might not be at ease in explaining or reiterating themselves for most of the things they will be saying most especially during tensed circumstances. It is always best to be transparent when misunderstanding happens to promote better relationship, it’s much better to ask the person to repeat themselves than to pretend as if you were understanding when it’s completely the opposite (Scott, 2019).

Social, language and non-verbal communication can cause misunderstanding, especially if two people communicating comes from a different culture. Emotions of people will most likely rule nurses over, but it should never let nurses consume them. Nurses need to contemplate on the objective that they need to reach and to be sure to use the best option. There will always be times when things are not going as planned, then it is better to take a step back to try to understand the other person’s perspective and reflect about the suitable approach to have a mutual understanding. Working along with associates from other nations and with other principles in most cases can be thought-provoking, however mutual understanding can be influenced by assumptions from previous experience and understanding of the situation. (NurseKey 2017).

2.7 Cultural Awareness

Campinha-Bacote (2002) define cultural awareness as the exploration of one’s own cultural and professional background. This involves recognizing one’s biases, prejudices and assumption about different individuals. There is a fine line between being aware of culture differences and stereotyping. Stereotyping is making an assumption, that all people from one county, race, status, beliefs acts or behave in a certain way, it will be better to have an awareness of certain norms, to be open-minded about beliefs of others to avoid misconceptions (Moran, 2016).

Kouta, et al. (2016) emphasize the importance of having a professional knowledge, understanding, sensitivity and communication skills of a health care provider in a multicultural team. It is also important to respect the patient’s beliefs, lifestyle, values and then considering the patient’s own will when providing different care to the patient. Lanig, et. al. (2013) conclude that having a positive relationship within the health care professionals can provide a positive outcome to the well-being of the patients and all the professionals in the health care organizations.

Conclusion

A whole lot of things that one has become used to, might not be acceptable in another culture. However, not everyone is aware of the cultural patterns of one place and at times people can act inadvertently and provide unsuitable commentaries or behave in a way someone is not accustomed to. Nurses also need to make sure to be aware of the manner patterns that is customary in the associates' country, study their societies and way of life. In addition, nurses need to be definite to mind what they are saying until they learn what is tolerable for this individual. As well as having composure and patience will help nurses to accustomed to dealing with their patient.

To conclude, being sensitive and aware about other cultures will bring harmony in the health care professionals and this can also help to provide better care for the patient. For nurses to have knowledge about different culture is one of the best things that they can do for themselves, their patients and their colleagues.

Reference:

• Alho, O. (2010). A Guide to Finnish Customs and Manners. This is Finland. https://finland.fi/life-society/a-guide-to-finnish-customs-and-manners/ (retrieved 21.09.2020)
• Brett, Behfar, & Kern. (2007). Managing Multicultural Teams. Harvard Business Review. https://opentextbc.ca/principlesofmanagementopenstax/chapter/multicultural-teams/#ch15rfin-12. (retrieved 25.09.2020)
• Cagiltay, K., Bichelmeyer, B., & Akilli, G.K. (2015). Working with multicultural virtual teams: critical factors for facilitation, satisfaction and success. Smart Learning Environment, 2 (11). https://slejournal.springeropen.com/articles/10.1186/s40561-015-0018-7#ref-CR26 (retrieved 22.09.2020)
• Campinha-Bacote, J. (2002). The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care. Journal of Transcultural Nursing, Vol. 13 No. 3, July 2002 181-184. https://rampages.us/LENDfiles/Campinha-Bacote%20Process%20of%20Cultural%20Compentence.pdf (retrieved 25.09.2020)
• Communicaid. (2020). Working relationships in Finland. https://www.communicaid.com/country/finland/#:~:text=directness%20%e2%80%93%20finns%20have%20a%20very,to%20make%20pauses%20while%20conversing. (retrieved 25.09.2020)
• Finnish Nurses Association. (2013). I can, I know, I care. https://nurses-fi-bin.directo.fi/@Bin/8e1ddb557ddb11a65ba3a011d06447a3/1521769121/application/pdf/201545/SHL_ESITE_ENG_auk.pdf (retrieved 21.09.2020)
• Finnish Nurses Association. (n.d). Working as a nurse in Finland. https://www.nurses.fi/nursing_and_nurse_education_in_f/working-as-a-nurse-in-finland/ (retrieved 19.09.2020)
• Friedemann, M.L., Pagan-Coss, H., & Mayorga, C. (2008). The Workings of a Multicultural Research Team. J Transcult Nurs, 19 (3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809833/pdf/nihms512566.pdf (retrieved 06.11.2020)
• International Federation of Library Associations and Institutions. (2020). Multiculturalism. https://www.ifla.org/publications/defining-multiculturalism. (retrieved 21.09.2020)
• Jordan, A. (2020). The Importance of Diversity in Healthcare & How to Promote it. ProvoCollege. https://www.provocollege.edu/blog/the-importance-of-diversity-in-healthcare-how-to-promote-it/ (retrieved 06.11.2020)
• Karhe, L. (2020). Emigration and relocation. Sairaanhoitajat. https://sairaanhoitajat.fi/ammatti-ja-osaaminen/tilastoja-sairaanhoitajista-2/ (retrieved 08.11.2020)
• Kingma, M. (2007). Nurses on the Move: A Global Overview. Health Services Research. 42 (3) https://www.ncbi.nlm.nih.gov/pmc/articles/pmc1955376/ (retrieved 06.11.2020)
• Kourkouta, L., & Papathanasiou, L. (2014). Communication in Nursing Practice. Mater Sociomed. 26(1): 65-67
• Kouta C., Vasiliou M., & Raftopoulos V. (2016). Improving the Cultural Competence Level of Community Nurses through an Intervention. Journal of Family Medicine, 3(9): 1088.
• Korpela, S. (2007). Finnish Healthcare goes Multicultural. This is Finland. https://finland.fi/facts-stats-and-info/finnish-healthcare-goes-multicultural/ (retrieved 06.11.2020)
• Lanig, H., Leahy, C., Moore, L., & Sublett, C. (2013). Understanding Nurse-to-Nurse Relationships and Their Impact on Work Environments. MedSurg Nursing, 22 (3) 173
• Leininger, M. (2012). Transcultural Nursing. Nursing Theories. http://currentnursing.com/nursing_theory/transcultural_nursing.html (retrieved 06.11.2020)
• Li, H., Li, J., Nie, W. (2014). The benefits and caveats of international nurse migration. International Journal of Nursing Sciences. 1 (3) p 314-317
• https://www.sciencedirect.com/science/article/pii/S2352013214000787 (retrieved 20.09.2020)
• Li & Liao. (2015). Cultural Competence: Why it Matters and How You Can Acquire It. IESE Insight. https://opentextbc.ca/principlesofmanagementopenstax/chapter/multicultural-teams/#ch15rfin-13. (retrieved 25.09.2020)
• Ministry of Social Affairs and health. (n.d). Health services. http://stm.fi/en/health-services (retrieved 07.11.2020)
• Moran, G. (2016). 5 Essentials To Managing Multicultural Teams. Fast Company. https://www.fastcompany.com/3058037/5-essentials-to-managing-multicultural-teams. (retrieved 20.09.2020)
• NurseKey. (2017). Misunderstanding and Communication. https://nursekey.com/misunderstandings-and-communication/
• Scott, C. (2019). How to Avoid Miscommunication in the Workplace. Quickbooks. https://quickbooks.intuit.com/r/employees/how-to-avoid-miscommunication-in-your-workplace/ (retrieved 07.11.2020)
• Statistic Finland. (2020). As many as one-half of Finland's population with foreign background are living in Greater Helsinki. http://www.stat.fi/til/vaerak/2019/02/vaerak_2019_02_2020-05-29_tie_001_en.html. (retrieved 19.09.2020)
• Statistic Finland. (2018). Decrease in the number of persons speaking national languages as their native language accelerated. http://www.stat.fi/til/vaerak/2017/vaerak_2017_2018-03-29_tie_001_en.html. (retrieved 19.09.2020)
• Statistic Finland. (2020). Finland's preliminary population figure 5,532,333 at the end of August. http://www.stat.fi/til/vamuu/2020/08/vamuu_2020_08_2020-09-22_tie_001_en.html. (retrieved 19.09.2020)
• Valvira. (2020) Professional practice rights. https://www.valvira.fi/web/en/healthcare/professional_practice_rights (retrieved 06.11.2020)