An increasingly diverse U.S. population and a shortage of RNs challenge nursing schools to educate students whose first languages are those other than English.
The good news is that in the past decade, nursing programs in this country have experienced an increase in English as a second language (ESL) students. The bad news is that these students have been identified as at-risk, yielding higher rates of attrition, according to a consortium formed by Philadelphia-area schools of nursing — Thomas Jefferson (TJU), Holy Family and La Salle universities.
The National League for Nursing reports that 17.6 percent of nursing students are from nonwhite populations, while the U.S. Bureau of Census notes that 13.8 percent of the U.S. population speaks English poorly or not at all.
"The burden is on educators to do a better job to recruit and retain diverse students," says Mary Powell, RN, CRNP, PhD, assistant professor and coordinator of the Adult Nurse Practitioner Program at TJU School of Nursing in Philadelphia.
Culture shock
ESL students often find teaching and learning strategies, multiple-choice question formats and Western ways of interacting with faculty and peers to be a challenge. "ESL nursing students need assistance because they struggle with colloquialisms and language idioms as well as cultural issues," says Powell.
Many ESL students enrolled in nursing programs are living on their own for the first time, without their usual support system. Some are experiencing culture shock in addition to the rigors of the academic program. Inadequate social, physical, emotional or financial resources can increase their stress level.
Although many of these students were successful in their native countries and previous careers, Powell says, they might face self-esteem issues related to entering a new profession coupled with the challenges of learning a new language and culture.
Help is on the way
Three schools of nursing in Philadelphia have come together to respond to the needs of ESL students. "Project ESL: Enhancing Student Learning for ESL Nursing Students" is a collaboration between TJU, Holy Family and La Salle to address the challenges of educating diverse students. In July 2007, Powell received a three-year, $653,797 grant from the Health Resources and Services Administration's Bureau of Health Professions, Division of Nursing, for the project.
Beginning this August, the project will provide resources for 40 junior and senior nursing undergraduates — 20 from TJU and 10 each from Holy Family and La Salle, Powell says. A pre-entry summer program includes needs assessments, language proficiency, communication-skills development, socialization to professional education and small-group work to foster self-confidence and cultural integration.
Students from the three campuses attend workshops together and then meet in small groups on their own campuses for camaraderie and support. Task-oriented sessions will walk students through clinical scenarios where they problem-solve or role-play issues related to being an ESL student as well as patient-nurse scenarios.
Faculty in tune
In January, the program provided its first workshop for 45 faculty members at TJU. Chinese student Shen Xinying (who is called Jessica by her American friends), BSN, shared her story of being a nursing student in the U.S., including how she overcame the challenges of working with some faculty who were not understanding or supportive. Jessica, who is now a graduate student at the University of Pennsylvania School of Nursing and a teaching assistant at TJU, credits her success to faculty who encouraged her abilities.
The program will continue to provide developmental support for nursing faculty, who might not be prepared to work with nontraditional ESL students in a culturally competent manner. Educators will learn how to ensure an optimal learning environment for the students. This support will be directed by Lyn Buchheit, RN, MS, TESOL, grant consultant and faculty of Community College of Philadelphia, whose expertise is in faculty development related to cultural diversity and educationally disadvantaged students, especially those for whom English is not the first language.
"International students bring such richness to the classroom," says Powell. "We want to honor their cultures as they become acculturated into a new profession in the U.S. These graduates will make a considerable contribution to the health needs of multicultural populations and contribute to the diversity of the nursing workforce."
