Cross-Cultural Nursing Leadership: A Comparative Reflection On Managing Healthcare Teams In The Philippines And Abroad
Master of Arts in Nursing (MAN) Students, University of Perpetual Help System Dalta, Las Pinas City
Professor, University of Perpetual Help System Dalta, Las Pinas City May 2, 2025
Abstract
This reflective journal explores cross-cultural nursing leadership as experienced by Filipino nurses working in diverse healthcare systems—specifically in the Philippines, the United Kingdom (UK), the United States of America (USA), and the Kingdom of Saudi Arabia (KSA). Drawing from our multifaceted roles as bedside nurses, educators, and administrators, we examine the interplay between cultural expectations, leadership styles, team dynamics, and systemic structures. This reflection identifies common values, contextual differences, and lessons that can be applied to shape resilient and culturally responsive nursing leadership education in the Philippines. Through critical introspection grounded in personal and collective experiences, this journal aims to contribute to the cultivation of globally competent, ethical, and adaptable Filipino nurse leaders.
Keywords: nursing leadership, Filipino nurses, cross-cultural nursing, health systems, administration, cultural intelligence, global healthcare
Introduction
Leadership in nursing extends beyond administrative roles—it is a practice that embodies influence, adaptability, and ethical stewardship. As Filipino nurses pursuing a Master’s in Nursing Administration, we bring insights from working in four healthcare systems, exposing us to diverse cultural and organizational practices that influence how leadership is conceptualized and enacted. Our experiences span hospital wards, academic institutions, and administrative offices, all of which enrich this comparative reflection.
This journal examines nursing leadership across multiple countries and contextualizes how Filipino nurse leaders navigate varying expectations, constraints, and opportunities. In doing so, we propose actionable recommendations for nursing leadership education in the Philippines that reflect both the grounded realities of local practice and the demands of global healthcare leadership.
Nursing Leadership in the Philippine Context
Nursing leadership in the Philippines operates within a complex ecosystem shaped by limited resources, high patient acuity, and a deeply familial work culture. Leadership tends to be relational and collectivist in orientation, rooted in Filipino values such as pakikisama (getting along with others), utang na loob (debt of gratitude), and bayanihan (communal unity).
Filipino nurse leaders often function as servant-leaders—offering emotional support, assisting in clinical duties, and prioritizing team harmony. This approach fosters trust and loyalty, but may also inadvertently suppress dissent or critical feedback (Alonto, 2021). Transformational leadership is evident, particularly among managers who emphasize vision, mentorship, and shared governance (Cabrera et al., 2019).
However, systemic challenges persist. Staffing shortages, delayed promotions, and budget constraints often lead to role ambiguity. Nurse leaders must juggle multiple responsibilities while advocating for both staff and patients—a balancing act that demands resilience, improvisation, and unwavering commitment.
Nursing Leadership Abroad: Perspectives from the UK, USA, and KSA
Leadership abroad often contrasts sharply with the Philippine setting. In the UK and USA, healthcare systems are highly regulated, protocol-driven, and emphasize accountability, efficiency, and performance metrics. Nurse managers adhere to standardized leadership frameworks such as the Magnet model, Six Sigma, and Shared Governance (Kelly et al., 2021). These tools support quality improvement but can sometimes feel rigid to those accustomed to flexible, relationship-centered approaches.
Leaders are expected to use data analytics, audit trails, and key performance indicators (KPIs) to justify decisions and assess outcomes. Feedback is formal, structured, and often candid—a stark difference from the indirect communication norms in the Philippines.
In Saudi Arabia, nurse leaders face the unique challenge of leading culturally diverse teams within an Islamic, male-dominant society. Filipino nurse managers often lead units comprised of multiple nationalities, requiring not only managerial acumen but also intercultural diplomacy (Alshammari et al., 2020). Navigating religious practices, gender norms, and hierarchical expectations becomes part of daily leadership responsibilities.
Leaders are also required to comply with CBAHI and JCI standards, necessitating ongoing education, documentation, and adherence to best practices. The multicultural environment demands cultural humility, effective multilingual communication, and adaptive conflict resolution skills.
Reflections on Similarities and Differences
Across all contexts, certain leadership principles remain consistent: accountability, ethical practice, effective communication, and commitment to team and patient outcomes. However, their manifestations differ. In the Philippines, leadership is often informal, emotionally connected, and shaped by collectivist norms. Abroad, it is more formalized, impersonal, and systems-oriented.
Filipino nurses abroad often describe feeling emotionally disconnected from their leaders initially, but eventually come to appreciate the clarity, fairness, and structure that Western leadership offers. Conversely, many foreign colleagues admire the warmth, compassion, and work ethic of Filipino nurse leaders, making them valuable assets in multicultural teams (Choi & Pak, 2020).
Our ability to integrate interpersonal sensitivity with clinical expertise allows us to serve as cultural bridges—facilitating cohesion in diverse settings. This adaptability is not merely a soft skill but a strategic leadership asset in today’s globalized healthcare environment.
Challenges Encountered in Cross-Cultural Leadership
The transition to leadership roles abroad is rarely seamless. Filipino nurses often experience "cultural dissonance"—a misalignment between deeply ingrained values and the expectations of new environments (Giger & Haddad, 2022). Assertiveness, self-promotion, and direct confrontation—traits encouraged in Western leadership—may feel uncomfortable or even disrespectful to Filipino leaders.
Gender dynamics further complicate leadership in Saudi Arabia. Female nurse leaders, particularly from non-Arab backgrounds, must continuously prove their legitimacy in male-dominated structures. Language barriers and varying definitions of respect or authority also influence how leadership is perceived and received (Tumulty, 2001).
Despite these challenges, Filipino nurse leaders consistently demonstrate flexibility, humility, and a strong work ethic—enabling them to overcome biases and earn respect over time.
Implications for Nursing Administration Education in the Philippines
The evolving global landscape necessitates a recalibration of nursing administration education in the Philippines. If we are to prepare future nurse leaders who are globally effective and locally grounded, we must reimagine our curriculum and leadership development strategies:
- Integrate Global Leadership Competencies: Include modules on intercultural communication, systems leadership, and crisis management. This prepares nurses for both international roles and culturally diverse local environments.
- Enhance Data Literacy: Train nurse administrators in using KPIs, dashboards, and digital tools for evidence-based decision-making.
- Foster Experiential Learning: Simulate leadership scenarios across varied healthcare contexts using real-world case studies, role-plays, and interdisciplinary collaboration.
- Cultivate Ethical and Advocacy Skills: Emphasize leadership that is not only operational but also values-driven—focusing on justice, inclusivity, and social responsibility (ANA, 2015).
- Build Global Mentorship Pathways: Establish partnerships with Filipino nurse leaders abroad to serve as mentors, fostering aspirational leadership and career growth.
By embedding these strategies into nursing administration programs, we can nurture nurse leaders who are not just locally competent but globally competitive, ethically aware, and culturally fluent.
Conclusion
Leadership in nursing is not confined to position or geography. It is a practice of influence, adaptation, and unwavering service. As Filipino nurses navigating diverse healthcare systems, we recognize both the common threads and contextual distinctions of leadership. Our ability to lead with compassion while embracing evidence-based strategies makes us uniquely positioned to contribute meaningfully on both local and international stages.
To lead effectively, one must understand not only systems and protocols, but also people and culture. As future nursing administrators, we carry the dual responsibility of honoring our Filipino roots while evolving into globally responsive leaders. Our journey underscores that leadership is not about authority—but about accountability, service, and continuous growth.
In this journey of leadership, reflection is not a luxury—it is a necessity. Through it, we learn not only how to lead but why we lead.
References
- Alonto, J. F. (2021). Cultural dimensions of Filipino nurse leaders: Leadership, ethics, and care. Philippine Journal of Health Research and Development, 25(2), 104–112.
- Alshammari, F., Pasay-An, E., & Alshammari, E. (2020). Cultural competence in leadership among nurse managers in Saudi Arabia. Journal of Nursing Management, 28(3), 567–574. https://doi.org/10.1111/jonm.12941
- American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA.
- Cabrera, A. B., De Los Santos, J. A. A., & Cruz, A. R. (2019). Leadership styles and job satisfaction of Filipino nurses: Implications for nursing management. Philippine Journal of Nursing, 89(1), 25–34.
- Choi, Y., & Pak, A. (2020). Multicultural healthcare teams: Understanding cultural competence among health professionals. Nursing Outlook, 68(5), 522–530. https://doi.org/10.1016/j.outlook.2020.06.006
- Giger, J. N., & Haddad, L. M. (2022). Transcultural nursing: Assessment and intervention (8th ed.). Elsevier.
- Kelly, L. A., Lefton, C., & Fischer, S. A. (2021). Nurse leader impact: A review. Nurse Leader, 19(1), 61–67. https://doi.org/10.1016/j.mnl.2020.09.009
- Tumulty, G. (2001). Professional development of nursing in Saudi Arabia. Journal of Nursing Scholarship, 33(3), 285–290. https://doi.org/10.1111/j.1547-5069.2001.00285.x