Global workforce brings in other cultures
Don’t let employee health get lost in translation
Hospitals have long been at the forefront of hiring salaried and hourly staff from other continents. This trend becomes more apparent during periods of nursing and physician labor shortages. From a hospital employee health perspective, this can mean addressing communication and cultural issues that might impact delivery of safety and wellness education.
"One of the biggest obstacles I’m seeing in California is language and literacy," says Dawn Stone, PhD(c), RN, associate professor at Western University of Health Sciences in Pomona, CA. "These are very important considerations for workers from around the globe. Being able to communicate with them is critically important for their health and safety."
Having access to bilingual staff or interpreter services is a first step.
"The harder part and real test of comprehension is having a supervisor or health and safety team whether it’s a supervisor, certified safety professional, or certified industrial hygienist make sure that what is taught is implemented," Stone says. "That’s the true test of comprehension."
Whether an employee is lifting patients and using the correct lifting procedures or using sharps and following blood-borne pathogen exposure precautions, someone needs to make sure all employees understand what to do and how to do it safely, she adds.
While health care professionals from other countries typically know English, this may not be true of all immigrant workers in a hospital, notes Julia Faucett, PhD, RN, professor emeritus at the University of California-San Francisco. Faucett has conducted research in occupational health and has experience working with immigrant farm workers.
"I’m concerned about [immigrant] facilities management staff, the janitors, cafeteria workers, and other people who don’t have a high level of English or education," she explains.
Stone and Faucett suggest employee health programs address an increasingly multicultural workforce by initiating these efforts:
Identify your workers’ country of origin: "Find out where the workers are coming from," Stone suggests. "Know which countries, which cultures, races, and ethnic groups are involved."
Developing an employee demographics profile can be helpful in understanding cultural issues as they arise.
"Look at the laws and standards in countries where they come from because this can tell you about the kind of exposures they’ve had and what their labor laws are like," she says. "Do they have an OSHA or workers’ compensation?"
Employees from other nations might have had injuries that were unreported because of a lack of health and safety protections in their country of origin. So if they are injured while at the U.S. hospital, it might be challenging to obtain records related to earlier injuries or illnesses, Stone says.
Nurture rapport between employees and employee health: Extra efforts need to be made to reassure immigrant staff that employee health is there to help them when they have any aches and pains.
"You want people to feel comfortable coming to the occupational health nurse and to understand that these visits are confidential," Faucett says. "You want this to be an open door for all employees."
The key is to create an overall environment of safety, which contributes to employees’ well-being at work, she adds.
"Engage with informal leadership for both non-immigrant and immigrant workers," Faucett explains. "Make sure you have people on the unit who are supporting this."
Informal leaders among workers can help spread the word about employee health’s benefits and promote vaccinations and other hospital health initiatives. Hospital leadership support of employee health is crucial for a hospital’s entire workforce, Stone notes.
"Especially in this economy, American workers could be fearful of reporting an injury or illness," Stone says. "They could be under-reporting out of fear of losing their jobs, so you have to explain that you are here to take care of them and to keep them well while they are working."
This strategy works for both American and immigrant workers who are hesitant to report their health issues to their employer, she adds.
"I have found it to be very effective," Stone says. "When they find that you really care about the worker and their health, they’ll tell you more."
Another strategy is for employee health to educate workers about the most common causes of illness and injury, letting employees know that they are there to protect them from these and other problems, she adds.
With this type of workplace culture, employees would be more likely to ask for assistance from employee health.
Take histories with a translator: When working with international employees who might not have complete immunization and health records on file, it’s important to screen for exposure to hepatitis, tuberculosis, and other diseases.
"Assess workers individually by getting a careful history and using a certified medical interpreter," Stone says.
It goes without saying that employee health professionals must know which hazards are associated with various workers’ jobs.
"Think about the common hazards in health care: biological exposures, blood-borne pathogens, lifting, moving, and transferring people," Stone says. "How do we assess and screen for those once someone is hired?"
During the post-hiring physical exam, it’s a good time to reassure workers that the hospital wants to protect the employee’s health, so they need to be honest about their health history, she adds.
Include global staff on advisory committees: When a hospital has a significant population of workers from different regions and countries, it helps to have those groups represented on an advisory committee, Faucett suggests.
"If you are designing a program for people from a different culture then go to them that makes all of the difference," she adds. "Ask them: These are the health and safety issues we’ve identified in our setting. How do you suggest we present them to workers?’"
"If there’s a large contingent of folks newly arrived from the Philippines, then I might have a separate focus group," Faucett adds.
Focus groups: Questions a focus group might address include:
• Should we be presenting health, safety, and vaccination information bilingually?
• How would you phrase these questions?
• Would you use more picture or only text information?
• Which words should we avoid because it might have a different connotation in another culture?
Faucett recalls a problem with words when she was conducting research among migrant farmworkers. When investigators held focus groups they found that workers did not like it when asked by occupational health nurses to report pain related to musculoskeletal problems.
"They said they didn’t want to use the word dolor,’ which is pain in Spanish when talking about musculoskeletal problems because that’s when they’re working, and they don’t think of that as pain because they are not disabled from work yet," she explains.
Even illustrations can be misinterpreted. In another study researchers used line drawings to illustrate a work situation. One picture showed a man bent over in a field with a star coming from his back. Health care professionals thought this indicated pain, but the migrant farm workers thought it meant the sun was coming up while the man worked, Faucett says.