Nurses are an integral part of building a culturally safe health system and the training and education that helps support them in this is ongoing. That education begins as early as the first year of nursing school.
At McMaster University’s School of Nursing, for example, first-year nursing students take a social determinants of health course, which lays the foundation for delivering care that is inclusive. In later years, students take a course called Indigenous Health Policy and Practice, which was developed in collaboration with indigenous partners as a direct response to the Truth and Reconciliation Commission of Canada’s Calls to Action, said Sandra Carroll, a registered nurse, vice-dean of the Faculty of Health Sciences and executive director of the School of Nursing at the university.
“As the largest health professional workforce in Canada, nurses are critical to continue to build a culturally safe system, and nursing education is foundational,” said Carroll. “Nursing is a trusted profession and this respect for differences is part of the trust.”
Last fall, an incident occurred at Brampton Civic Hospital that shocked members of the Sikh community and called into question the hospital’s commitment to respecting religious practices. An 85-year-old Sikh man had his facial removed without consent and without medical necessity.
In a statement following the incident, William Osler Health System, which operates the Brampton hospital, among others, apologized and “committed to learning from this and making changes to prevent this from happening again.”
Those changes include the creation of a new subcommittee called the Provision of Culturally Safe Care, and a series of specific questions that are now included as part of the initial assessment when a nurse is admitting a patient for the first time, said Mary Jane McNally, chief patient experience officer at William Osler Health System. Those questions include asking the patient to share what’s important to them and what they want to achieve during their admission, and whether there are any religious or cultural requirements that staff should know about.
William Osler has also partnered with the World Sikh Organization on educational materials for staff that can be found on the digital learning management system, as well as in-person learning events that they plan to replicate with other religious and cultural groups going forward, said McNally.
In April, in recognition of these “system-wide efforts to remove barriers and ensure equitable access to care,” William Osler Health System received the Canadian College of Health Leaders 2025 Excellence in Inclusion, Diversity, Equity and Accessibility (IDEA) Award.
Home to more than 600 Indigenous communities and with as much as 20 per cent of Canadians born outside of the country, recognition of and respect for Canada’s diversity and cultural differences is essential for care.
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“It improves communication, builds trust, and ensures the patient is provided personalized care,” said Carroll. “Cultural competence and ethical practice help reduce health disparities and ensures equitable and respectful care for all patients.”
Of course, Canadian diversity extends to the health care workforce as well. According to the Canadian Institute for Health Information, in 2022, internationally trained nurses represented an average of 12 per cent of newly licensed nurses across the provinces and territories. Ontario and Nova Scotia had the highest percentages of internationally trained nurses that year, at 22 per cent and 19 per cent, respectively.
“We have an obligation when we’re recruiting nurses to Canada that we set up the conditions for them to be successful,” said Valerie Grdisa, CEO of the Canadian Nurses Association (CNA). That means providing ongoing learning opportunities and having an understanding “that some of the things that occur in our health system are new to them.”
CNA works with many different nursing groups within the community, such as the Alliance of Filipino Nursing Professionals in Canada and Black nursing networks, to ensure that their voices are being represented in anti-racism education.
The 2025 CNA Code of Ethics for Registered Nurses, which is expected to be published later this month, has a specific focus on diversity, equity and inclusion with subsections focused on indigenous nurses and health and wellbeing, said Grdisa.
As a self-regulating profession, nursing in Canada is governed by professional associations and colleges. “The Code of Ethics really is a core underpinning of our profession. It’s the foundation of how we should interact with others and within an ethical framework,” said Grdisa.
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