Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines


For the detailed discussion of evidence and framework, please consult the full guideline, available for download at

Individual Recommendations

1. Self Awareness – To learn to embrace diversity in individuals:
Perform self-reflection of one’s own values/beliefs, incorporating feedback from peers.

  • Express an awareness of one’s own views of differences among people (e.g. different opinions, different world views, different races, different values, different views of society).
  • State and continually explore, through reflection and feedback, how one’s own biases, personal values, and beliefs, affect others.
  • Identify cultural differences among clients and colleagues in the practice setting.
  • Acknowledge one’s own feelings and behaviours toward working with clients, families and colleagues who have different cultural backgrounds, health behaviours, belief systems, and work practices.
  • Explore one’s strategies for resolving conflicts that arise between self and colleagues and/or clients from diverse groups.
  • Identify and seek guidance, support, knowledge and skills from role models who demonstrate cultural proficiency.
  • Recognize and address inequitable, discriminatory, and/or racist behaviours or institutional practices when they occur.
  • Acknowledge the presence or absence of individuals from diverse cultural backgrounds at all levels in the workplace, reflecting the cultural makeup of the clients or community being served.
  • Reflect and act on ways to be inclusive in all aspects of one’s practice.

2. Communication – To develop communication skills that promote culturally diverse settings:

  • Are aware of different communication styles and the influence of culture on communication.
  • Are aware of one’s preferred communication style, its strengths and limitations, and how it affects colleagues and recipients of care.
  • Seek feedback from clients and colleagues, and participate in communication validation exercises (e.g. role-playing exercises, case studies).
  • Use a range of communication skills to effectively communicate with clients and colleagues (e.g. empathetic listening, reflecting, non-judgmental open-ended questioning).
  • Seek and participate in learning opportunities that include a focus on communication and diversity.

3. New Learning – To attain cultural competence in individuals:
Acquire knowledge of the range of cultural norms, beliefs and values relevant to clients and colleagues as a starting point to foster understanding – and further inquiry.

  • Are aware of the disparities (e.g. health outcomes, access to care, economics, job opportunities) that exist for diverse populations and understand the factors and processes that contribute to them.
  • Recognize how culture and diversity influence behaviours and interactions.
  • Develop and apply cultural competence knowledge and skills in the areas of communication, care planning, conflict resolution and change management.
  • Access, utilize, and partner with cultural resources.

Organizational Recommendations

(consult the full guideline at for detailed organizational recommendations, pg. 35 - 45)

1.  Workplace policies and procedures – To move forward on environment of cultural safety organizations:

  • Articulate, implement, and evaluate the effectiveness of a mission statement, values and corporate strategic plans that emphasize the value of cultural diversity and competence.
  • Develop policies, guidelines and processes to address change and conflict.
  • Implement and evaluate strategies to develop leadership skills for succession planning that target under-represented populations to address the organization’s identified gaps and inequities.

2. Recruitment – To recruit a diverse nursing workforce, employers and unions:

  • Identify and monitor the cultural, ethnoracial, linguistic and demographic profile of the workforce in the organization and in the communities it serves on a systematic basis.
  • Purposefully seek applications from qualified professionals of diverse cultural backgrounds to recruit to all levels of the organization, including leadership roles so that the organization is reflective of the communities served.

3. Retention – To retain a diverse nursing workforce, employers and unions:

  • Plan employee orientation and continuing education programs, based on culturally sensitive preferred learning styles, assumptions and behaviours within culturally diverse groups.
  • Provide employees with ongoing continuing education on concepts and skills related to diversity and culture including:
    • Communication
    • Cultural conflict
    • Competence models
    • Culturally-appropriate assessments

4. Internationally educated nurses – To better support internationally educated nurses:

  • Establish support and mentoring programs for internationally educated nurses and the existing members of the workforce who will work with them.

External Recommendations- Academia, Government, Regulators and Professional Association

(consult the full guideline at, pg. 46 -56, for all external recommendations)