Extending cultural competence through systems change: academic, hospital, and community partnerships.

Work on cultural competence has a long history in nursing, yet we have not successfully institutionalized these attitudes and skills throughout education and practice. An effective approach to promoting widespread cultural competence is to work at the system level in which coalitions of community agencies partner with academic and health care organizations. A systems approach includes all health practitioners, reducing current discrepancies across disciplines, and establishes cultural competence as the standard. Work in and with communities places students and practitioners more consistently in cross-cultural circumstances. Implementing this vision will require national as well as local leadership across public and private sectors.