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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

Multicultural staff in Nursing Homes: Contemporary challenges, opportunities and the potential for the future

Alternative title: Det mangekulturelle stabsfellesskap i sykehjem: muligheter og utfordringer

Awarded: NOK 17.9 mill.

The municipal health care sector is increasingly a gateway to the labour market for immigrants in Norway, in particular women. We have found that immigrant women oftentimes work in the lower tiers in this sector, as assistants and healthcare workers, and that their formal qualification is a lengthy and tedious process. This leads to precarious labour situations for many immigrant women where they must accept and be in positions as on-call assistants, temporarily employed or employment in positions with low percentages (ex. 13,9%) over many years. On the other hand, this kind of worklife attachment seem to represent a benefit for the employers in terms of keeping costs low, and we observe that the sector is inherently inclined to flexible work arrangements.. Regarding how ethnicity and skin colour are made relevant in interaction between minority staff and others, the findings in the study point in different directions. On the one hand, the study indicates that at least some minority staff experience discrimination based on ethnicity and/or skin colour, in particular in interaction with residents and their family members. Discrimination of minority staff which is more region specific was also identified, like stigmatization and marginalization of Russian-born workers in participating nursing homes in Norther Norway. On the other hand, and contrary to what has often been found in other organizations, competence was not primarily discussed as a matter of educational level or background, skin complexion or whether staff members spoke the majority language with a foreign accent. Rather, a competent care worker was perceived as a) having good professional knowledge on how to care for nursing home residents (regardless of the worker's educational level), b) either having the ability to speak well or working hard to improve one's skills in the majority language, c) exhibiting ?a genuine interest? in working in a nursing home despite the relatively harsh working conditions, and d) having the ability to prioritize to ensure that all tasks and duties were completed on each shift. Staff members' perceptions of competence were hence interrelated with educational, racial, linguistic and social dimensions, but in unexpected and transgressing ways, paving the way to ethnic equality among staff. Leaders turn out to play a significant role in creating an inclusive work environment where the workers? skills and competences are recognized across educational and migration backgrounds. A significant interpretation of data have focused on how migrants? moral identity may be threatened in that some of the migrants? core values from country of origin is felt to be in tension with some values in the nursing home, and that these core values are not recognised by the management in the nursing home. There is e.g. no systematic collection of information going on from the side of the managers when it comes to the migrants? cultural and spiritual background. The findings also show that healthcare personnel with migrant background in many cases form close relationships with the patients, and that these relationships are characterised by a mutual vulnerability, and makes the death of a patient very sad and disturbing for the migrant healthcare worker. The research highlights that there is more to communication than language, which is mostly stressed in the integration processes. This in particular becomes visible in interaction between migrant workers and residents, where it appears that that migrant workers frequently lack content for communication in specific routine activities. The research also indicates that decisions made by the predominately Norwegian born leaders take their own cultural background and understanding for granted in their communication with minority staff, which, amongst other things, has consequences for how tasks and work shifts are organized. As part of the research project, a Post-qualifying education program has been developed implementing new knowledge for developing multi-cultural leadership in nursing homes Four researchers have been involved, and with extensive participation of non-academic partners: nine leaders from four nursing homes in two municipalities and leaders of two of the Centres for Development of Institutional and Home Care Services (USHT). This included cooperation on process, form and content of the course, available at the following webpage: (in Norwegian).The course was piloted in all the four participating nursing home and experienced as relevant, involving, including and democratic by non-academic partners, and also as relevant by the nursing homes involved.

Anticipated outcomes and impacts was not part of the grant application form in 2015 when the application for this project was submitted to the Research Council of Norway.

This research project will investigate the links between the development of contemporary municipal health care services, municipal governance and workforce integration of an increasingly multicultural staff in Norwegian nursing homes (NHs). As the Norwegian population is aging, an increasing number of elderly are expected to live with dementia, severe frailty and multi-morbidity. Since Norway is among the OECD countries with the highest coverage of NH beds, NHs represent a vital part of municipal care services serving increasingly frail users in need of highly competent professional care. Recruiting and retaining sufficient and competent staff for NHs is presently a prime challenge for Norwegian municipalities. Immigrants constitute today an increasing share of NH staff. What an increasingly multicultural workforce entails for the NH residents, family and staff, or how it shapes care practices and service delivery, have received little research attention. This project proposes a cross-sectorial approach to this issue by focusing on integration of minority workers in the NHs, on how care work is performed by a multicultural staff community and on the various ways NHs organize, train and retain such a workforce.

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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester