Registered Nurses' Association of Ontario

External/ System Recommendations


1. Nursing curriculum and nursing students – To support the development of a culturally competent workforce, leaders in academia:
1. Set an initial and over-arching tone of inclusivity, and set expectations regarding understanding and embracing diversity.
2. Provide special consideration in the curriculum to teaching about:

• respect, acceptance, empathy, inclusivity, collegiality, and valuing differences

• Canadian society, the health care system, and nursing as a profession in Canada

• Language nuances and social norms

• Psychosocial skills

• Human rights

• Mentoring

3. Incorporate and evaluate theoretical cultural competence models as part of the nursing curriculum.
4. Develop and implement core competencies in humanities that include concepts and skills related to cultural competence and addressing racism and discrimination.
5. Incorporate diverse learning styles and strategies into the development and delivery of the curriculum.
6. Monitor and evaluate the impact of cultural competence education.
7. Identify and address the professional, theoretical and cultural biases in curriculum content.
8. Identify and monitor the cultural demographics of students in all programs (undergraduate, graduate). Questions about issues such as ethnic background, place of origin, or sexual orientation must be asked with sensitivity, kept confidential, and not used against the subjects being questioned. Answering these kinds of questions is always optional, with no penalty attached to choosing not to answer.
9. Undertake purposeful outreach initiatives to encourage applications from First Nations’ peoples students and students from other culturally diverse backgrounds.
10. Include cultural competence as part of student orientation, development and expectations of professional behaviour.
11. Identify and meet the specific learning needs of the growing population of culturally diverse students coming into nursing programs.
12. Monitor the academic success and attrition rates of students in relation to in relation to cultural, ethnoracial, linguistic, and demographic characteristics to determine the presence of correlations and identify areas.
13. Adopt formal policies and transparent processes that are consistent with the Canadian Charter of Rights and Freedoms to address discrimination, harassment, and intolerance occurring within the school or during academic activities.
2. Research and Researchers – To support the development of a culturally competent workforce, researchers:
1. Make every effort to include diverse populations as subjects of research.
2. Direct funding to explore diversity issues as topics of research in order to reduce disparities across populations (e.g. the impact of diversity variables on job satisfaction and retention).

3. Conduct research to:

• Determine the contributions, strengths, and benefits of the inclusion of health professionals from diverse cultures

• Identify key challenges and barriers regarding cultural diversity in the workplace

• Evaluate the impact of strategies (e.g. cultural competence education) implemented to address diversity challenges in work and education settings

4. Conduct research to identify strategies to embrace diversity challenges in workplace and educational settings, with special attention to attracting, graduating and retaining nurses from diverse cultural backgrounds, including First Nations’ peoples nurses.
3. Governments – To support the development of a culturally competent workforce, governments:
1. Develop, disseminate and operationalize accountability expectations of employers around mission statements, hiring policies, promotion opportunities, and career advancement that maximize the potential of all health system employees and seek out under-represented groups.
2. Require that employers, schools and regulators measure and describe the cultural demographics of the Canadian nursing workforce and Canadian nursing students.
3. Fund programs and research in which diversity, discrimination, vulnerable populations and disparities will be a focus, or are a foundational theme.
4. Include and monitor cultural diversity of workforces and populations being served in the criteria for budgets/funding applications submitted by hospitals, community agencies and other publicly-funded service providers.
5. Package and disseminate accessible data on the cultural demographics of communities to employers and educational institutions to assist them shape their strategic plans regarding diversity initiatives.
4. Accrediting Bodies – To support the development of a culturally competent workforce, accrediting bodies:
1. Embed diversity proactively and systematically throughout all mission statements, values, corporate strategic plans and outcome measures.
2. Develop, test and modify (as appropriate) clear cultural competence indicators in standards for accreditation.
3. Collaborate with employers or educational institutions they accredit to collectively monitor the diversity of the workforce or the student body and the extent that diverse cultural and linguistic communities, ethnoracial groups, and demographic characteristics are represented.
4. Work with employers or educational institutions they accredit to collectively establish mechanisms to address barriers to the recruitment and retention of underrepresented groups within the workforce and educational institutions.
5. Regulators – To support the development of a culturally competent workforce, regulators:
1. Embed cultural competence in the behavioural indicators of Professional Practice Standards and guidelines and Codes of Ethics and Conduct.
2. Treat professional misconduct infractions related to discrimination against peers in the workplace in the same manner as those involving clients.
3. Reflect requirements for cultural competence in entry examinations and continuing competence programs.
4. Collect data, identify trends and make recommendations to assist policy makers, employers, unions and educators to strengthen cultural competence.
5. Streamline the process for registration for all nurses, both Canadian and internationally educated, to maximize nurses’ contribution to the profession. The registration process must be sensitive to the needs of a diverse applicant pool.
6. Continually assess licensing/registration examinations and related processes for nurses for cultural bias and revise when necessary.
6. Professional Associations – To support the development of a culturally competent workforce, national and jurisdictional professional associations (such as the Canadian Nurses Association, Academy of Canadian Executive Nurses, Registered Nurses' Association of Ontario, Canadian Association of Schools of Nursing, and their member organizations):
1. Serve as role models by including diverse representation within their workforce, memberships, leadership, board and committees, and staff.
2. Establish outreach programs, and purposefully encourage the participation of members and leaders from diverse groups.
3. Consistently embrace diversity in policies and procedures, values, mission statements, and codes of conduct.
4. Reflect the importance of diversity and cultural competence in guidelines and educational materials developed by the association.
5. Establish mechanisms and structures that foster transparency and encourage feedback from members.
6. Develop and communicate common lobbying messages for diversity in collaboration with other associations to achieve more effective political lobbying.
7. Educate members and the public regarding positions on diversity, inclusively and cultural competence.


Healthy Work Environment
Embracing Cultural Diversity in Health care: Developing Cultural Competence
Healthy Work Environment Recommendations