Part 1: Cultural Education Helps Recruiter Connect to India Nurses Amidst Dire Shortage

By K.E. Supriya, University of Wisconsin-Milwaukee

In early October 2002, the phone rang in my office at the University of Wisconsin-Milwaukee, and I picked it up expecting a student inquiry. To my surprise I found myself speaking with the head of Human Resources for Covenant HealthCare. Mr. Robert Scott informed me that he had been investigating ways to provide training to a group of healthcare professionals that was to travel to India in early November to recruit Indian nurses for Covenant. He asked if I would be interested in delivering a training program.

At first the conversation seemed surreal, since consulting for a company in the corporate sector, albeit a service-oriented one, was something I had not contemplated as an extension of my academic career. Then Mr. Scott explained his own prior experience as a professional in India and specified the desired outcomes of the program. He hoped to prepare the Covenant delegation with background training to better understand cultural norms and customs of India, understand gender differences in Indian culture, and learn to establish effective American-Indian cross-cultural communications.

I felt excited to be considered as someone who had the professional expertise and savoire faire to do the job, so to speak. I agreed, and we decided to talk terms and iron out details the following week.



Battleground: Globalization

Discussing the approach and success of the training program requires a brief detour through current intellectual and political perspectives on globalization. Some view it as being synonymous with American corporate hegemony, Western cultural imperialism, and exploitation of Third World resources. The devastating effects of globalization on the environment, for example, have provided the impetus behind an anti-globalization movement embodied by groups such as the Disobedients, which stages symbolic anti-corporate acts.

In light of legitimate criticisms of globalization, I determined to explore models for global business practices that could be more than defacto instruments for foreign worker exploitation and American cultural imperialism

Globalization’s critics have also argued against its negative effects on local business, labor, and community entities – whether on the cultural identities of exploited foreign populations or on the American labor force, which faces enormous economic uncertainty and job instability, with draconian layoffs and a neurotic stock market. The strategic practice of relocating businesses to Third World countries to keep down wages and maintain corporate control at the expense of an exploited labor force is seen as a symptom of a pernicious global condition many believe is inherent in “West-to-East” globalization.

Covenant approached me at a time when the global and local seemed to exist in a state of tension with one another. Globally, doors to employment were being opened for people from other countries, whereas doors were being shut to job-seekers in America. Doors have never been opened to members of dispossessed groups, who appear never to receive what it takes to be considered employable. This is partly because of a system of government that seems less interested in training its workforce and more interested in dogmatic adherence to “getting the biggest bang for a very small buck” approach to work.

And in the context of the nursing situation in particular, as I followed the nation-wide nursing shortages crisis stories in the press, I realized that foreign-worker recruitment was frequently a very alarming case of the revolving door.



A “Cultural Bottom Line”

Americans maintain hierarchies at one level and dissolve them at another through lateral or informal communication. This can be difficult for nurses from cultures where you are expected to maintain a specific social order.

In light of such legitimate criticisms, I approached the Covenant training cautiously, determined to explore models for global business practices that could be more than defacto instruments for foreign worker exploitation and American cultural imperialism.  Covenant’s case appealed to me as an opportunity for an ongoing intercultural conversation about healthy, wholesome, and ethical ways to work in the U.S. and worldwide. In fact, Covenant was commendably cognizant of cultural issues, which is what motivated it to seek out my services and undertake its international recruiting venture from a cross-cultural training-and-education point of view.

As an academically-driven practitioner who specializes in the relations among nation, culture, communication, and identity, I sought to devise a training approach that made the workplace not merely a bottom line-driven revolving door for foreign recruits, but a dynamic space of culturally-informed professional practices – ultimately better for both businesses and workers. In short, if there should be a bottom line approach to global recruitment, it ought to be cultural one!  The rest of it would be sure to follow.

To this end, my program’s main goal was to provide intercultural communication knowledge and skills to the healthcare staff.   Training sessions focused on challenges of cultural difference between Indians and Americans, effective communication strategies, and understanding the politics of organizational life from multiple points of view. Some cultural differences that employers like Covenant can encounter are:

1) Time: One risk of imposing an American work order on employees from other cultural backgrounds is a mutual misunderstanding of each other’s concepts of time. Cultures that consider time sacred and treat it in symbolic rather than commodity terms may be ill-prepared for the demanding pace of American corporate life. Indian workers courted by Covenant, for example, value a gradual and cyclical sense of time that equally includes work, family, sociability, community, and religion. This runs counter to the fast-paced, hyper-rapid, “cutting corners to get things done” approach to work and life that an employer may expect of recruits. New Indian recruits coming into a workplace in 2003 U.S.A. need to be aware that deadlines and pace are very important to be considered a successful professional. Open communication about time is important to avoid acute culture shock in the recruits.

Understanding fundamental differences helps employers and workers anticipate potential cross-cultural pitfalls, avoid miscommunications, and facilitate better employee acclimation and interaction.

2) Social “Space”: Americans maintain hierarchies at one level and dissolve them at another through lateral or informal communication. This can be difficult for nurses from India, where you are expected to maintain a specific social order. Lateral communication could be seen as a violation of an authority structure even though Americans do not see it as such. Recruits need to be gradually guided to understand that while there is a system of authority in a company like a hospital, lateral communication must also be practiced – with patients, for example, so that nurses combine a patient-advocacy approach along with care-giving, as is consistent with the hospital’s ethos.

3) Gender: In American companies, men and women are expected to work together in seeming gender-neutral professional environments. However, Americans are also cognizant that gender differences do exist and have practiced negotiating them to varying degrees of effectiveness. Despite being highly qualified and trained, an Indian woman may have reservations about communicating freely with male colleagues or superiors. This should be addressed in a semi-direct manner, since a number of Indians are not used to discussing gender issues directly.

4) Communication Styles: America is a low-context, direct culture where people are expected to “get to the point.” India’s is a high-context, affective culture where speakers do not directly express themselves out of respect for the receiver or listener.



Pitfalls to Watch Out For

Making diversity and cultural education anintegral part of foreign recruitment strategies can bring sensitive topics and potential staff conflicts to light in a safe, instructive forum before they get out of hand.

Understanding these fundamental differences helps an employer anticipate potential cross-cultural pitfalls, avoid miscommunications, and facilitate better employee acclimation and interaction.  Further, a culturally informed and sensitive employer aware of certain myths and stereotypes will find it easier to recruit, retain, and integrate Indian workers into a productive business environment. Common pitfalls to avoid include:

Cultural generalization: “What works for me works for everyone else” doesn’t work when colleagues or employees are from another culture. Culturally trained employers recognize that various cultures take things to mean differently: “Productivity” could mean “getting things done in a manner that ensures mutual respect and high regard” to a new recruit, emphasizing output notable for quality as well quantity or rapidity.

Myth of cultural neutrality: There is no “magic wand” to wave away cultural differences. One’s deep cultural identity cannot be neatly “put aside” in the workplace — nor should it be! Rather, cultural breadth can become another “resource,” if you will, to enhance your business practices and work culture. An employer sensitive to maintaining and fusing cultural differences in staffing can put its broader “knowledge base” to its advantage. Empoyers also need to rest assured that international recruits know how to bracket off their cultural differences to get the job done, and can be expected to do so in good faith as best they can. Nevertheless, it is best to be prepared for times when real differences are likely to surface and shape work.

Stereotypes: In a time of “PC,” anxiety and resentment, there is a tendency to not want to admit stereotypes exist and are expressed or acted upon – sometimes a result of not thinking enough, just reacting to conflict or an unfamiliar situation. Some Americans feel their personal freedoms are being controlled by minorities or foreigners; while others are unusually suspicious of unfamiliar cutlures because of post-9/11 global hostilities. In any case, unproductive stereotyping will not go away if it is not acknowledged and understood in those terms. Stereotypes can work both ways, of course, and can create “cold and unhealthy” working climates. Making diversity and cultural education an integralpart of your foreign recruitment strategy can bring sensitive topics and potential staff conflicts to light in a safe, instructive, and eye-opening forum before they get out of hand.


Any employer considering recruiting from abroad — and from South Asia in particular — should begin with acquiring a general understanding of these rudimentary concepts, challenges, and pitfalls.  The second part of this essay looks at the specific ways these issues are manifested before, during, and after recruiting trips abroad, and how they remain important management concerns even after a most successful recruitment campaign.



PART 2: What Recruiters Can Do to Improve Outreach, Avoid Pitfalls, and Build Better Cultural Communication

In Part 1, I discussed a number of general concepts, challenges, and pitfalls that lay before U.S. recruiters of workers from foreign countries – India in particular. Part 2 looks at specific issues that Covenant Healthcare addressed in enacting its strategy of traveling to India to recruit nurses.



“Not Business as Usual”

A company that has undertaken cross-cultural training, like Covenant Healthcare, will certainly be better prepared for a recruitment trip to India. Still, office training is one thing; entering and negotiating in a new country and culture is another. Especially in uncertain times like these, American employers may wonder how they will be received abroad. Yet, no matter how controversial or politically-charged the times are, recruiters should realize that there will be receptivity to them ifthey are willing to approach their outreach as something other than “American business as usual”.

First, employers should remember that as former colonial subjects, Indians have a long history of dealing with cultures very different from their own, through good times and bad. Being “Other-oriented” – and accustomed to living and working in multicultural environments – is a communication style. Further, the burgeoning middle-class in India is open to all kinds of professional possibilities.

In fact, it would not be an exaggeration to say that the majority of Indians know someone or of someone who has migrated to the U.S. or the West. Most non-Western cultures have established patterns of emigration to the West at least since the end of colonialism, if not earlier. However, employers recruiting abroad would do well to honestly ask themselves: Is the reverse true of Americans?

Returning from a successful recruitment trip with nurses regarded as “just bodies,” as one perceptive administrator put it, does not in itself mean that the education is complete.

Even if recruiters are not the stereotypical “ugly Americans” abroad, do they expect to be accommodated and treated in “American-style,” conducting business rigidly according to their own timelines, interview formats, etc.? Also, while Indians are highly experienced in adjusting, “blending in,” and working with others, is the same true of the American staffers?

In this respect, Americans have a lot to learn from the countries and cultures they see as recruiting grounds. A forward-looking company can seize in this global moment an opportunity: to break out of conventional and routinized recruiting practices, and reinvent itself for more effective global outreach and competition.

What is important is to be pro-active, sensitive to the culture of your recruiting environment, and demonstrate that this is not “American business as usual.” Recruiters need to communicate that they are making a concerted effort to become informed about and sensitive to the cultural backgrounds of their new potential employees. Eventually this approach will prove to be a two-way street, with both cultures arriving at a middle meeting point, no matter which party is in whose space.

In concrete terms, preparing for the recruiting trip means becoming culturally educated about: how to greet one another; what to expect in terms of gender differences; understanding the fine line between work and community; understanding how Indians see the recruiting encounter and being prepared for what may seem “unusual” practices; and recognizing that Indians need to see some sign that Americans are in this out of a sense of reciprocity.



Success! Well, Okay, but What Next?

Highly publicized cases of foreign workers rapidly quitting sponsored jobs for other companies understandably concern recruiters

Armed with new cross-cultural communication knowledge and skills, Covenant Healthcare enjoyed a highly successful recruitment trip to India. However, merely returning with nurses who are regarded as “just bodies,” as one perceptive senior administrator put it, does not mean that the education was over. Important staff development and retention issues remained, and an employer like Covenant will bear responsibility for facilitating recruits’ transition to a new environment and productive work path.  In practical terms, these are key considerations after a successful recruitment mission:

Employers should expect a measure of culture shock and be aware that it is normal. It can be lessened by providing opportunities for cultural immersion – taking steps to help the Indian nurses understand their tasks and company culture in a progressive, ongoing manner.   It can also help employers immensely to conduct outreach in advance to the local Indian community. Mentioning local temples, organizations, or even individuals like myself can reassure potential recruits that there will be culturally familiar elements available to help ease their transition to their new situation. Indian-American correspondents could help answer questions while a recruit is considering your offer.   Helping new arrivals locate such resources — even taking a “field trip” — can help lessen initial, immediate culture shock. In the longer term, connecting them to others who have had similar experiences can aid recruits’ cultural adaptation.


Host culture receptivity, too, will affect how well and quickly recruits will be integrated into the workflow. By “host,” I do not mean “showing hospitality,” though it could help a lot. “Host culture” means the environment into which an immigrant arrives. Management should make every effort to provide some “heads-up” and dialogue to prepare existing American staffers, counter preconceptions, and address feelings of uncertainty. Make clear that the recruitment initiative is not to be viewed as a disruption of work life, threat to personal gain, or yet another un-supported task to be done by an already stressed-out workforce. Stress the important contributions the new recruits will make to everyone’s benefit.

It is helpful to think in terms of “Identity Management” – from staff diversity education to hiring a bilingual liaison officer to training HR in  complex issues of immigration law.

A more ambitious goal is for progressive companies to realize that the minute they enter the global economy, they have set in motion a process of cultural change, whether people like it or not. Americans have difficulty grappling with global multicultural and economic realities; accustomed to feeling in control, the majority, or the norm, Americans may feel resentment or anxiety in coping with global change.

However, it is America that championed this new and bold “go where no country has gone before” approach to capitalism. So it behooves company management to “tell” those employees who interpret their new situation as a “foreign invasion” that this is yet another facet of the American dream and a way to ensure it. New recruits should not be put in the place of bearing the brunt of workplace hostility that comes out of acute denial of cultural and global processes at work.

Highly publicized cases of foreign workers rapidly quitting sponsored jobs for other companies understandably concern recruiters, who are making costly, complex outreach efforts to secure needed employees abroad. Recruiters may feel “used just to get a visa” or “hoodwinked”. Job-hopping by workers is partly a natural element of capitalism and competition. It may also occur because a foreign recruit feels undervalued, uneasy, or out of place at work. This is true of any worker, of course, but may be compounded by feelings of being culturally adrift and isolated from colleagues.



“Managing Identity Matters”

Training raises “identity” issues for the company, too. Trainees’ reflections on their own cultural orientations to time, space, relationships, and religion generated a seemingly infinite level of discussion.

Employers are challenged to view foreign recruits not only for what they do in the office, but also for their identity – for who they are. Indian nurses, for example, take on racial, cultural, political, religious, and legislated identities in the U.S. that may not usually be of direct concern to an employer. Employers must be sensitive, too, to conditions outside the office. Sweeping changes in immigration, “homeland security,” and social views of foreigners and immigrants may profoundly affect recruits. Government registration, rising hate crimes against South Asians in the U.S., and international tensions may weigh heavily on a recent recruit in ways neither of you expected – even compelling some recruits to turn right around and head home.

It certainly behooves recruiters to have the best possible understanding of immigration regulations and processes, and to contract expert advice on these.  It may be helpful for employers to think about supporting its staffing in terms of “Identity Management” – a virtual or actual department that manages “tools” ranging from staff education seminars to management diversity consulting, from hiring a bilingual liaison officer to training HR in issues of complex immigration law.

In another sense, foreign recruitment raises “identity management” issues for the company and “host culture” itself. In Covenant’s case, training was received well by the company staff, for whom learning about the recruits’ culture had the benefit of allowing them a fresh look at American culture, too. Trainees’ reflections on their own cultural orientations to time, space, relationships, and religion generated a seemingly infinite level of discussion that could have gone on for the duration of the entire program if I had let it. One trainee kept saying how time-conscious and stressed she was when she traveled, despite being assured that the culture she was visiting did things differently. When I said that if they missed a deadline or two in India, that would be “a-okay,” they laughed but took the point: Not everyone needs to feel perpetually rushed and stressed out in order to be productive.

Another trainee said how much he wanted to understand the meaning of a deity in an Indian patient’s room and wanted to touch it. My presentation made him more aware of norms and boundaries, he said, but also showed a way to communicate about it. A senior executive found the emphasis on communication style differences useful to work through a problem with a client “who could not be pinned down on details.”

Similarly, Convenant’s case challenges us to re-imagine the “host culture” of Wisconsin – stereotypically considered a quintessentially bland, “white-bread,” land-locked Midwestern province devoid of diversity. Although the state and its large cities – such as Madison and Milwaukee – have recently been publicized as being highly segregated, Wisconsin workers should understand the significance of culture because of the many immigrant cultures that took root here among equally diverse indigenous cultures – especially at the peak of industrialization. In this sense, Wisconsin can be a fertile state for bold global and diversity hiring initiatives, if long-time, rooted groups can recognize new global conditions, recall their own roots, and empathize with the experiences of new immigrants today. Its forward-thinking companies who are globalizing now can have a considerable early-mover’s advantage in attracting new talent and making broader cultural and market connections.



Rewarding for All Involved

Foreign recruitment raises “identity” issues for the company, too.  Trainees’ reflections on their owncultural orientations to time, space, relationships, and religion generated a seemingly infinite level of discussion.

The success of the program can be assessed both in terms of the goals I wanted to accomplish and the outcomes Covenant sought to obtain as a consequence of the training. First, Covenant’s India trip proved highly productive, and it made offers to a large number of nurses after only the first of a few planned trips. As significantly, its staff was better prepared to sensitively interact with the Indian nurses before and after the trip.

I was struck by the depth of the participants’ attentiveness and respect, and the brightness of their questions. I was also moved by their sincerity. They were enthusiastic about the cultural training not merely because the recruitment project and inevitable changes made it obligatory, but because they wanted the training outcome to be meaningful for the potential nurses, themselves, and even me.

As a consultant from an academic background, I benefited from the program, too. It allowed me to better connect with and understand Americans who are engaged hands-on in the process of globalization, in a work sector that is not the hermetically sealed space of academia. As an Indian woman schooled in several different institutions and cultures, my background calls for suspension of personal judgment and a commitment to make connections across difference when the opportunity presents itself to me. In Covenant, I had an opportunity to present important cultural and political issues in a program to professionals tremendously enthusiastic about understanding Indian culture.

Of Interest from the Career Center

Clicking launches new window

Featured jobs in Recruiting and Human Resources

or do your own advanced search

Without papering over the politics of globalization, constructive academy-business forums like this training program can have positive, pragmatic effects on intercultural communication, labor conditions, and other aspects of international relations. They can provide workers a rare forum for mutually-enriching conversations about work culture and work values. They can also help concerned, conscientious businesses figure out how to work out the politics of globalization in everyday American work and business practices—in ways that do not reduce Indian nurses to “just bodies.”

Finally, optimizing these (largely unexplored) opportunities when they present themselves can in turn can help make work a more fruitful human, humane, and healthful practice for all parties — globally-speaking of course.


Related Readings


Dr. K.E. Supriya is an international business consultant and Assistant Professor of Communications at the University of Wisconsin-Milwaukee, where she teaches Intercultural Communication, International and Global Communication, and Gender Communication. Her research interests include Cultural Identity and Memory, Intersections of Gender and Culture, and Communication of British Empire. She is author of numerous publications including the book, Shame and Recovery: Mapping Identity in an Asian Women’s Shelter. New York: Peter Lang, 2002. Learn more or contact the author at is committed to presenting diverse points of view. However, the viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at IMD. is committed to presenting diverse points of view. However, the viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at IMD.