Assertiveness remains an essential tool for a successful career in nursing. Although this quality is rooted in communication skills, possession of good communication skills does not guarantee assertiveness.

Many literature sources have highlighted the importance of assertiveness in care delivery, expression of needs, affirming self-values and building interpersonal relationships.

There is also evidence of non-assertiveness, predominant among overseas nurses, and its correlation to human factors, unfair treatments, and conflicts in workplaces.

We may observe that people from varying ethnic backgrounds assert themselves differently from the way we are used to

Ordinarily, certain factors affect assertiveness but there are factors peculiar to overseas nurses, which cause their assertiveness to wane over time.

This is an issue that deserves urgent attention to ameliorate the associated mental stress, under-representation, bullying, dissatisfaction, and poor retention.

Therefore, this piece is aimed at understanding how assertiveness may regress instead of improving timely for overseas nurses and useful tips for self-help and supporting them.

Communication is a means of exchange. By this, we can send different messages through both verbal and nonverbal means.

While we may be fluent in a language largely representing the verbal aspect, the non-verbal means which constitute an immense part of the communication piece remain greatly influenced by culture and learning; so is assertiveness.

Eye contact, tone, posture, hand gestures, and when and how they are used accord some cultural essence to our communication.

Therefore, there is no one way of being assertive. Under normal circumstances, everyone understands their individual needs and can express them in unique ways without being confrontational and that is assertiveness.

In other words, we may observe that people from varying ethnic backgrounds assert themselves differently from the way we are used to.

When we assert ourselves, we intend to transmit an honest, clear, and understandable message. In return, we expect an understanding, positive action, information, and a good experience.

However, many overseas nurses often find themselves in a different situation where their messages are often misunderstood, misinterpreted, denigrated, or blanked, producing a negative experience.

Nurses have reported being perceived as mean or aggressive, or unsure of themselves due to their hand gestures or tone of voice.

Also, the discouraging responses they received when they assert themselves are widespread. Typical examples include, and are not limited to:

Consequently, a once firm voice begins to waver. Eye contact becomes effortful, and an accumulated feeling of disrespect and being judged naturally put them on the defence.

At this point, it is pertinent to mention that nurses in a new environment may experience diminished self-reliance due to unfamiliarity; they are not surefooted and would be asking a lot of questions.

Invariably, they will assert their needs how best they know and should be understood and valued. Bear in mind that assertiveness requires some mental energy, and can be given up when constantly challenged with negative responses.

To buttress, even people who are developed in assertiveness may not always be mentally prepared to be assertive.

Nurses should accommodate and treat each other with utmost respect irrespective of background

So, without appropriate support, overtime, overseas nurses may begin to conceal their true feelings resulting in low self-esteem, compromised patient care, and a lack of courage to escalate concerns, or even venture for higher positions.

Therefore, there should be an empathic connection to their needs to lend them that mental empowerment to be assertive.

Nurses should accommodate and treat each other with utmost respect irrespective of background. An understanding that colleagues can do things slightly differently will create more room to sincerely connect to their needs.

It is also this understanding that will help you appreciate their normal behaviour. This is not synonymous with saying that overseas nurses do not have their weaknesses, just like every other human.

Instead, this is an awakening for nurses to be culturally aware of others to avoid picking the wrong message.

Just as the overseas nurses strive to understand and imbibe the culture in the UK, other colleagues should make a reciprocate attempt to understand them.

Evidence indicates that a positive work ethic facilitates the adjustment of overseas nurses to their new workplace environments.

On the other hand, overseas nurses should refrain from building their personal experiences around that of others.

Ward managers and other staff should support international nurses to be at their best

While there is evidence of unpleasant experiences among overseas nurses, nurses should learn from those experiences rather than personalise them. Rid yourself of biases and embrace your unique journey.

In addition, overseas nurses should normalise reflective practice. Reflections allow you to learn and improve from your experiences. Again, clarity of message cannot be over-emphasised.

Focus on making your message as clear as possible. Consider talking at a slower pace and steady pace to limit the number of aye, aye that you get each time you talk, as a feeling of not being understood can thug at your confidence.

Some are keen on achieving a near British accent at the detriment of clarity. While acquiring an accent can give you a sense of belonging, it should not be a primary focus. Importantly, negotiate with colleagues and consider a compromise where possible.

In conclusion, the international nurses in the UK are among the best in their nations. Therefore, ward managers and other staff should support them to be at their best.

We can collaboratively promote a culture that builds a trusting relationship and supports assertiveness among overseas nurses.

Chinenye Ubah is lecturer, adult nursing, Anglia Ruskin University

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'Easing the strain on overseas nurses' assertiveness' - Nursing Times