The memory of my first shift in an operating theatre in Australia remains vivid. I was surrounded by unfamiliar accents, unfamiliar protocols, and a quiet fear that my silence would be mistaken for incompetence.
I was a young nurse from Asia, trained in a system where silence signifies respect and speaking up can feel like crossing a line. What I did not yet understand was that in Western healthcare systems, silence has often appeared to be misinterpreted not as humility, but as a lack of confidence or capability.
My perioperative professional journey has taken me from my country of origin to the United Kingdom, and ultimately to Australia. I have worked in high-acuity operating theatres alongside some of the country’s leading surgeons, including teams pioneering robotic and minimally invasive surgery. Alongside advanced clinical skills, I carried cultural expectations, language barriers, and the burden of being perceived as “different” at times because of my race and accent.
I began my nursing education in a healthcare system deeply rooted in discipline, precision, and respect for hierarchy. From the earliest days of training, nurses were taught that professionalism meant humility, obedience, and maintaining harmony. Questioning authority was discouraged, and silence was often interpreted as competence. While this training fostered resilience and attention to detail, it also conditioned me to suppress my voice even in situations where speaking up was critical to patient safety and professional collaboration.
Transitioning into Western healthcare environments was confronting at times. Although I had limited prior exposure to Western culture through volunteer work supporting people with disabilities, nothing prepared me for the pace, accents, colloquial language, and assertive communication expected in Western hospitals.
In the operating theatre where anticipation, decisiveness, and verbal communication are essential, I struggled. My hesitation was sometimes met with impatience or dismissal, reinforcing a perception that my quietness reflected incompetence rather than cultural difference.
There were moments that profoundly affected me. I recall a senior colleague questioning my capability in front of others: “Do you even understand what’s going on?” It was not simply a matter of language proficiency; it was the cumulative impact of being judged through the lens of accent, ethnicity, and culturally ingrained communication styles. I was spoken over, excluded from informal learning spaces, and at times made to feel invisible. Racism was not always overt, but it existed in subtle assumptions, lowered expectations, and unequal opportunities.
As my career progressed across multiple hospitals, I realised that cultural bias did not disappear, it merely presented itself in different forms. At the same time, I began to change. I learned to speak up, not aggressively, but with clarity and intention. I developed confidence without abandoning my cultural identity. I found allies who valued diversity and recognised the strength that varied perspectives bring to healthcare teams. Over time, I became not just a nurse who adapted, but one who led quietly, consistently, and with conviction.
Importantly, I also witnessed positive change. Many healthcare organisations have recognised the impact of unconscious bias and systemic racism and have implemented strategies to address these challenges. Initiatives such as cultural safety training, diversity and inclusion frameworks, anti-racism policies, and structured reporting pathways reflect genuine organisational commitment to creating safer and more equitable workplaces. These efforts matter. They signal progress and provide a foundation upon which meaningful change can occur.
However, policy alone is not enough. Lived experience reveals that the effectiveness of these strategies depends on how deeply they are embedded into everyday practice, through leadership behaviour, mentorship, accountability, and psychological safety. For migrant nurses, true inclusion is felt not only in policy documents, but in whether their voices are invited, respected, and acted upon during clinical care, education, and decision-making.
Each country I worked in shaped me differently. My country-of-origin instilled discipline, patience, and humility. The Western healthcare system can at times reveal how easily voices can be silenced in unfamiliar systems due to my difference. Australia challenged me to step into my professional voice and advocate not only for myself, but for others navigating similar journeys. I came to understand that being quiet does not equate to lacking knowledge, and that cultural difference should never be mistaken for weakness.
Through years of navigating bias and breaking through invisible barriers, I have come to believe that nursing education and leadership must continue to evolve. Learning environments must be intentionally inclusive, where students and staff from diverse backgrounds feel seen, supported, and safe to develop confidence. Diversity is not a symbolic gesture, it is fundamental to patient safety, workforce sustainability, and innovation in healthcare.
Not long ago, after a demanding surgical case, a junior nurse from overseas approached me and asked, “How do you stay so calm and confident?” I smiled, not because confidence comes easily, but because I recognised myself in her. I replied, “I used to be just like you. You will find your voice and when you do, use it to lift others.” In that moment, I realised how far I had come not only across continents, but into a sense of professional belonging I once believed was unattainable.
My journey has not been easy, but it has been transformative. I carry my culture, my scars, and my growth with pride. By sharing my story, I hope to empower migrant nurses, challenge persistent inequities, and contribute to a more compassionate and inclusive nursing culture. It is time to listen to voices that have long been unheard. It is time to teach differently, lead differently, and care more deeply not only for our patients, but for one another.
Footnote: This story is about the experiences of a colleague of Indra who shared this story one day in the tearoom. Indra felt this story needed to be shared as she believes we can educate ourselves to be better people and nurses for a better world.
Author:
Indra Jolayemi, Clinical Nurse Specialist (Perioperative Nursing), Casey Operating Theatre/Victorian Heart Hospital, Monash Health
