An increasingly diverse U.S. population and a shortage of RNs challenge schools of nursing to educate nurses from diverse cultural backgrounds whose first language is other than English.
In the last decade, nursing programs in this country have experienced an increase in
the English as a second language (ESL) population, says Marianne Jeffreys, RN, MA, MED, EdD, professor, City University of New York, College of Staten Island (CSI), Staten Island. These students have been identified as at-risk, yielding higher rates of attrition and demonstrating unique educational needs, she says.
Language Problems Plus
ESL students struggle with understanding the colloquialisms and idioms of a difficult language. They confront the hurdles of learning and using conversational English and the academic nursing language.
Frequently, ESL students find teaching-learning strategies, multiple-choice-question formats, and ways of interacting with faculty and peers, foreign to them.
Clearly, language development considerations need to be addressed, but nonacademic factors can outweigh language barriers and adversely affect learning, achievement, and retention, says Jeffreys. Acculturation stress, adaptation, assimilation, cultural values and beliefs about education, experiences with a second language, and expectations, can greatly affect learning, achievement, and retention.
Many of the ESL students admitted to nursing programs are living on their own for the first time, without their usual support systems. Some are experiencing culture shock as they attempt to keep up with an academic program. Some lack the physical, emotional, or financial resources to tend to basic needs. Although many students have been successful in their own countries, they face self-esteem issues with starting over.
When ESL students make the transition to schools of nursing, they do not always find help with their communication difficulties. Some find discrimination from other students or from faculty who are not prepared to work with nontraditional ESL students in a culturally competent manner or who do not understand different learning styles among ESL students.
Nursing Neighborhood nicheAt CSI, peer mentor-tutors serve as role models for other ESL students.
At CSI, multicultural groups of ESL students and English as a first language (EFL) students are encouraged to interact both inside and outside the classroom to decrease acculturation stress, promote professional integration and socialization, and foster use of English through group dialogue.
For the past 10 years, peer mentoring and tutoring have been integral components of a formally designed multi-service, empirically based retention program aimed at enriching the total student nursing experience. Services include orientation, mentoring, tutoring, newsletters, career advisement and guidance, workshops, study groups, networking, transitional expansion of educational horizons through technology, and referral. Specific suggestions for ESL students are incorporated within various services. The enrichment program designed by Jeffreys evolved into a Nursing Neighborhood in which culturally and linguistically diverse peer-mentor tutors assist students in the Nursing Student Resource Center and the Nursing Student Test Prep Center.
The ‘neighborhood’ is the focal point where all points come together all phases and components of nursing education become integrated and seek to elevate learning to a higher level between all components, Jeffreys says. At CSI, where approximately 30% to 40 % of new students were educated in another country and/or are ESL students, peer mentor-tutors, who are culturally and linguistically diverse, serve as role models for other ESL students and provide guidance for ESL students.
The U.S. Department of Health and Human Services Office of Minority Health National Standards on Culturally and Linguistically Appropriate Standards (CLAS) mandates that patients receive healthcare information in their preferred language, further emphasizing the value that linguistically diverse nurses will have in health care, says Jeffreys.
Interventions aimed at enhancing ESL nursing student success and swift entry into the workforce are underscored by multiple compelling rationales that will benefit society overall.