As a research scientist actively engaged in advancing the careers of immigrant nurses, the matter of cross-cultural language competence among internationally educated nurses (IENs) has emerged as a delicate and pressing issue in my field. With over 30 years of experience in healthcare, I observe that as IENs continue to integrate into the U.S. healthcare workforce, their contribution to alleviating nursing shortages becomes increasingly significant. Immigrant nurses represent 15.6 percent of the registered nurse workforce in the U.S., with states such as California, Nevada, and New Jersey exhibiting even larger proportions. By 2022, one in six nurses in the U.S. was internationally educated, underscoring the diversity they contribute to the healthcare system. Nonetheless, precise and effective communication is vital for optimal patient care and safety.

Context and under-recognized issue

While considerable focus has been placed on English-speaking nurses interacting with non-English speaking patients, less attention has been directed towards instances where skilled IENs possess limited English proficiency. This situation presents risks such as medication errors and compromised teamwork. Ongoing discussions revolve around the potential relaxation of English language proficiency (ELP) standards for IENs. While some believe that language competency tests are unwarranted, research suggests that rigorous language evaluations are essential for safeguarding patients.

Current federal regulations require ELP assessments for IENs from non-English speaking countries seeking employment in the U.S. However, these assessments are predominantly academic and may fall short in healthcare environments. Varying ELP requirements established by state licensure boards result in inconsistencies.

The objective of ELP testing is to assure patient safety, yet any reduction in these standards introduces risks. Language barriers can obstruct the gathering of critical patient information, resulting in misdiagnoses or ineffective treatment. Furthermore, they affect communication within healthcare teams, impacting patient safety.

Benefits of English language proficiency for nurses

Improving IENs’ language abilities leads to better patient outcomes. Research indicates a strong correlation between ELP and enhanced patient care in areas such as cardiac units. Effective communication assists nurses with tasks including report writing, patient handovers, and adherence to medical guidelines, thereby enhancing professionalism and autonomy.

Solutions and calls to action

The Illegal Immigration Reform and Immigrant Responsibility Act requires English proficiency tests for foreign healthcare professionals. However, there is a push to reduce ELP standards, citing cultural biases in testing formats and associated financial implications. Nonetheless, enforcing strict standards is vital for patient safety and quality care. Enhanced ELP promotes learning and increases nurses’ confidence.

Conclusion

Integrating IENs into the U.S. workforce necessitates the maintenance of robust ELP testing standards as part of clinical competence. On-the-job training should also ensure mastery of medical terminology. It is essential to shift the discussion from viewing ELP as a hindrance to recognizing it as critical for ensuring safe patient care and teamwork. IENs are integral to the success of American healthcare, and sustaining high ELP standards is advantageous for all.