Nursing Education and English What is a Second Language?

English as a Second Language (ESL) refers to the use of English by students who have been educated in grade schools outside of the United States and primarily use a language other than English in their daily lives (Scheele, Pruitt, Johnson, & Xu, 2011). ESL nursing students constitute a specific group of minority students who are bilingual and often immigrants, bringing with them diverse cultural backgrounds and linguistic experiences.

Need for a Second Language in Nursing Education

The ability to communicate effectively with classmates, faculty, and patients is critical for academic and professional success in nursing programs, which are inherently demanding and rigorous. Nursing programs require international students to demonstrate adequate English proficiency through standardized tests like the Test of English as a Foreign Language (TOEFL) or the International English Language Testing System (IELTS). These tests are intended to gauge academic success potential. However, many schools recommend additional English language courses for international students to further develop their proficiency before they enter the nursing program.

Even after passing these exams, many ESL nursing students struggle with the linguistic demands of nursing education. This challenge stems from a lack of fluency in academic and medical English, which requires a higher level of cognitive language skills than everyday conversational English (Salamonson, Andrew, Clauson, & Cleary, 2011). As a result, these students may face higher dropout rates and lower passing rates on the National Council Licensure Examination (NCLEX), with a reported 21% lower pass rate than native English speakers (Choi, 2005; Olson, 2012).

Advantages of Second Language in Nursing Education

1. Improved Patient Care: The ability to speak multiple languages is a significant advantage in nursing. Research shows that delivering care in a patient’s own language improves compliance rates and health outcomes (Olson, 2012). As the demographic diversity of patient populations continues to increase, the ability of nurses to communicate in languages other than English becomes essential. This capability allows for better patient understanding, satisfaction, and overall healthcare delivery.
2. Enhanced Cultural Competence: Nursing programs that admit culturally and linguistically diverse students help maximize patient care and satisfaction by fostering a nursing workforce that reflects the diversity of the community. This approach is particularly important given the growing complexity of care and the increasing diversity of the patient population (Choi, 2005).
3. Support and Retention of ESL Students: Students with ESL backgrounds often require higher levels of support to succeed academically and meet clinical expectations. Early identification of ESL students who are struggling and providing them with targeted support—such as writing centers, additional English courses, language support programs, or peer tutoring—can contribute to successful program completion (Boughton, Halliday, & Brown, 2010).
4. Improved Communication and Teamwork: Formulating mixed study groups consisting of ESL and native speakers has been shown to enhance language skills, clarify complex concepts, and promote knowledge sharing. This strategy helps ESL students develop language proficiency while also fostering collaboration and mutual understanding among diverse groups of students (Brown, 2008).
5. Reduction in Cultural Shock: Activities such as “Culture Day” or “International Student Committee” meetings, where students bring dishes from their native countries and wear traditional attire, can help reduce cultural shock, promote cultural exchange, and enhance understanding among students and faculty. Such activities encourage ESL students to feel more included and valued in their academic environment.

Outcomes of a Second Language in Nursing Education

1. Enhanced Student Support: With the growing number of ESL students, it is essential to understand their specific educational needs and cultural backgrounds. Providing culturally sensitive support and effective communication training can help these students achieve their academic goals and succeed in their nursing programs.
2. Improved Academic Performance: By addressing the unique challenges faced by ESL students, such as language barriers, educational institutions can help improve their academic performance. Faculty members can implement various teaching strategies, including summarizing lectures, encouraging questions, and providing test-taking strategies that accommodate ESL students.
3. Broader Research on ESL Education: There is currently limited research on the specific challenges faced by ESL nursing students and the effectiveness of various support systems. Future research should focus on evaluating these challenges and exploring the best practices for supporting ESL students from diverse cultural backgrounds.
4. Fostering a Diverse Nursing Workforce: Supporting ESL students through tailored education strategies ultimately contributes to building a more diverse nursing workforce. This diversity enhances the overall quality of patient care by promoting cultural competence and improving communication between nurses and patients from different backgrounds.

Conclusion

English as a Second Language is a critical component in nursing education, especially given the growing linguistic and cultural diversity in patient populations. While ESL students face unique challenges in nursing programs, they also bring significant advantages, such as improved cultural competence and enhanced patient care. To harness these advantages, nursing education programs must implement effective support strategies, promote inclusive environments, and conduct further research to understand and address the specific needs of ESL students. By doing so, nursing programs can help these students achieve academic success and contribute meaningfully to a diverse and effective healthcare workforce.