Nurses as Immigrant Advocates: A Brief Overview

Mary Ellen Biggerstaff, DNP, MSN, RN, FNP; Taiyyeba Safri Skomra, JD


Online J Issues Nurs. 2020;25(2) 

In This Article

Individual Advocacy

Individual advocacy is demonstrated when nurses know and implement the highest quality of care possible to immigrant patients. For example, one essential practice is the use of a professional, medical interpreter who fluently speaks the immigrant's primary language. Providers should not rely on family members, untrained, or informal interpreters. The use of qualified medical interpreters has a profound effect on positive clinical outcomes and patient's satisfaction (Karliner et al., 2007).

In addition to using interpreters, nurses need to self-evaluate their understanding of racial and cultural biases. While cultural competency has been the dominant framework for reducing healthcare disparities, there is neither consistency, nor evidence that this is sufficient or results in improved patient outcomes (Renzaho et al., 2013; Sequist et al., 2010; Tervalon & Murray-Garcia, 2009; Truong, Paradies, & Priest, 2014). Further development of the concept of cultural competency needs to include research that addresses both cultural humility and anti-racist frameworks. Tervalon & Murray-Garcia noted in 1998 that, "cultural humility is a lifelong process of self-reflection and self-critique whereby the individual not only learns about another's culture, but one starts with an examination of her/his own beliefs and cultural identities, as a commitment and active engagement … on an ongoing basis with patients, communities, colleagues, and with themselves" (Tervalon & Murray-Garcia, 1998, pg 1).

A nursing concept analysis of cultural humility expands to say "implies one being aware of power imbalances and being humble in every interaction with every individual and requires time, education, reflection, and effort, it should be employed daily with all individuals in the basic interest of kindness, civility, and respect" (Fitzgerald, Myers, & Clark, 2016, n.p.).

There is no single approach that an individual nurse uses to develop cultural humility. This process can be especially difficult for white nurses working with non-white populations, because "In nursing as a whole whiteness is an unacknowledged source of structural advantage and the identification that being a caring profession inadvertently creates and maintains identity of color blindness" (Schroeder & DiAngelo, 2010, pg 246).

Nurses should engage in critical self-reflection of personal biases, develop an understanding of their own cultural perspective and the basis for structural health inequalities. Nurses need to learn the skills to ask the right questions and understand the needs of individual patients. This can be as simple as asking patients about their cultural and personal beliefs, their identity and understanding of their own health. (Mcgee-Avila, 2018).

Another way to advocate for immigrants may be uncomfortable for many and involves speaking up when witnessing prejudiced or racist actions or language. Fitzgerald, Meyers, and Clark (2016) outlined this ethical imperative in addition to practical tools that help nurses stand up against discrimination. "Dealing with the problem of incivility toward vulnerable populations in the healthcare setting starts with taking a stand against disrespectful conduct by voicing opposition to all forms of incivility." Be well informed on facts surrounding immigration and become comfortable with identifying and addressing prejudice. Table 2 contains examples of free online resources to educate yourself about biases, cultural humility and intercultural health.