Dealing with staff diversity in German hospitals: A comparative analysis of doctors and nurses

Abstract Background Germany is increasingly recruiting foreign healthcare staff due to the shortage of skilled workers. This diversity of professional and cultural backgrounds poses a challenge to everyday life in inpatient care. Previous studies have focused on the renegotiation of professional identities and competencies in nursing or medicine. In contrast, this study sheds light on group-specific mechanisms through a comparative analysis: How do doctors and nurses deal with diversity in the workplace? Where do profession-specific differences emerge and what does this mean for future interventions? Methods Eight group discussions (June 2019 to October 2020) were conducted with groups of doctors and nurses with and without a migration background in four hospitals in two federal states in Germany; including 22 nurses and 10 doctors (n = 32). The data were analysed using the documentary method to examine professional meaning-making processes. The results were validated intersubjectively. Results The respective handling of diversity in the workplace is influenced by different professional group identities. The situation is precarious for nurses with a migration background - especially for those with an academic degree, as nursing is still an apprenticeship profession in Germany. In the medical profession, on the other hand, diversity does not lead to significant controversies, even if cultural differences are discussed. Conclusions Dealing with diversity is negotiated within professional groups. As nursing or medical ‘communities of practice’ (E. Wenger), these have a mediating role through which they can mitigate institutional and individual barriers to the integration of migrants in the workplace. Key messages Physicians and nurses need more specific, iterative cross-occupational and cross-cultural education. Management should support in accommodating different expectations and abilities.


Background:
Germany is increasingly recruiting foreign healthcare staff due to the shortage of skilled workers. This diversity of professional and cultural backgrounds poses a challenge to everyday life in inpatient care. Previous studies have focused on the renegotiation of professional identities and competencies in nursing or medicine. In contrast, this study sheds light on group-specific mechanisms through a comparative analysis: How do doctors and nurses deal with diversity in the workplace? Where do profession-specific differences emerge and what does this mean for future interventions? Methods: Eight group discussions (June 2019 to October 2020) were conducted with groups of doctors and nurses with and without a migration background in four hospitals in two federal states in Germany; including 22 nurses and 10 doctors (n = 32). The data were analysed using the documentary method to examine professional meaning-making processes. The results were validated intersubjectively.

Results:
The respective handling of diversity in the workplace is influenced by different professional group identities. The situation is precarious for nurses with a migration background -especially for those with an academic degree, as nursing is still an apprenticeship profession in Germany. In the medical profession, on the other hand, diversity does not lead to significant controversies, even if cultural differences are discussed.

Conclusions:
Dealing with diversity is negotiated within professional groups. As nursing or medical 'communities of practice' (E. Wenger), these have a mediating role through which they can mitigate institutional and individual barriers to the integration of migrants in the workplace.

Background:
Health professionals face a variety of professional challenges in today's plural societies. Sciences propose a specific skill set can help to meet those challenges. Various terms and sometimes extensive concepts are provided for diversity competence. The related learning processes are time-consuming and demanding to implement in hectic clinical realities, so that a basic, easy to deplore training package of essential skills would be desirable in order to enable health professionals to take equally good care of all patients including migrants and minorities.

Methods:
A two-round Delphi study was conducted to prioritise teaching objectives; 31 clinical and academic migrant health experts from 13 European countries participated. A round of open questions was followed by a standardised rating round of 65 items. Data was descriptively analysed (m, M, SD) and consensus defined as 80% of experts assigning high importance to a competence.

Results:
The process identified essential competences as well as high priority cognitive, affective and pragmatic competences, leading to a minimal definition of diversity competence for health professionals which includes respectfulness, empathy, diversity awareness and reflection, knowledge on social determinants as well as ethics and human rights; Further skills are: being able to listen, observe and communicate understandably, including professional usage of interpreters, shared decision-making and individual, need-based care.

Conclusions:
The panel reached consensus on many of the competences. In general, attitudes and practical skills were considered essential. Basic trainings that meet the needs of professionals and help them cope with everyday challenges can be designed on the grounds of these findings. We provide a working definition of 'diversity competence of health professionals' for scientific exchange and investigation and propose the conscious use of a 'diversity' instead of 'intercultural'' terminology. Key messages: In the light of various diversity and cultural competence definitions, we need to specify essential competences for health workers to meet the needs of diverse patient populations. Experts' prioritisations of key diversity competences can be used to prioritise teaching objectives to train health professionals to take equally good care of all patients.