Introduction
Nursing profession is regarded as an attractive career that draws the attention of many students in America. The fact that America has some of the best nursing schools and programs in the world, has compelled many international students to move into the country and enroll as nursing students. International students face numerous challenges in nursing schools, but they have no option other than overcoming the challenges and adapting effectively in the new environment. They are supposed follow rules, norms, and traditions, which govern nursing schools and programs, compete with their counterparts in course work and pass the National Council Licensure Examination (NCLEX) (Olson, 2012). According to the provisions and regulations of nursing profession, all nursing students should meet the minimum qualification required in nursing career and pass the National Council Licensure Examination before working as a nurse in any health care facilities. In order to pass this examination, nursing students are required to show high level of competence in English language so that they can articulate, express, and elaborate concepts and issues leant in class professionally. However, mastery of English language poses a challenge to most international students (ESL nursing students) and lowers their academic performance because English is regarded as a second language to them. In certain instances, most of English-as-a Second Language (ESL) nursing students have reported that English language may not be their second language, but rather a third or fourth language; an idea that affirms that mastery of English language remains a salient need affecting ESL nursing students. A report released by Sullivan commission (2004) articulate that ESL nursing students form an integral part of the minority group in United States, but account for less than nine percent of all medical practitioners in the healthcare system. This aspect can be attributed to high attrition rates coupled with difficulties in passing NCLEX among ESL nursing students. A report released by Rector and Gilchrist 2007 indicates that ESL nursing students recorded a high attrition rate (85%) than the native English speakers. Sim-Gibbens (2002) established that ESL nursing students recorded below 21% passing rate in NCLEX than natives; an idea that was seconded by a report released by Bosh and Bowels 2008.
Based on this assertion, the paper discusses needs and bridge for success factors that ESL nursing students require and provide viable recommendations on the issue.
Four needs of ESL nursing students
In the last few years, the number of ESL nursing students enrolling in nursing schools has increased steadily, but addressing the unique needs of these students remains the key issue. ESL nursing students face numerous challenges ranging from cultural shock, climatic change, intimidation, isolation to racism, to highlight, but a few. However, English language barrier and deficiency remains the salient need and challenge that ESL nursing students experience daily in their respective nursing schools and programs in America; an idea that hinders students’ academic success and performance.
Previous studies articulate that ESL nursing students report that they have a problem in reading speed and internalizing what they have read in class. In other words, most ESL nursing students are unable to understand, retain and disseminate the information they have learnt in class effectively thus affecting their academic performance and success. Sims-Gibbens (2002 argues that this need is further complicated by the time ESL nursing students take in translating the words from English to their native languages. The fact that many ESL nursing students cannot understand, internalize, and comprehend what they have learnt in course work materials, and lecture notes affect the students’ writing skills. In most instances, nursing educators have seen ESL nursing students struggle with grammar, syntax, and vocabulary when reading and analyzing patient-nursing care documents.
It has been established that ESL nursing students attain low grades in class and do not pass NCLEX as they lack listening and speaking proficiency skills. Learning is an interactive process that requires a student to develop listening and speaking skills in order to understand, express, and internalize ideas and concepts learnt in class effectively. However, most ESL nursing students fear speaking or asking questions in class because they fear being looked down upon by other students and teachers. Some believe that they pronounce English words incorrectly and their colleges in class cannot understand them. Listening skills remain of paramount importance in class as it enables the student follow the teacher’s direction, argument, and lecturer notes. However, most ESL nursing students are unable to cope with the instructor’s speed, argument, and direction as they struggle with grammar, syntax, and vocabulary thus lowering their retention capacity.
Nursing instructors established that ESL nursing students have language difficult in terms of communicating with the patients. Bosher & Bowles (2008) established that ESL nursing students failed to maintain eye contact when talking to their assigned patients; a move that affect nurse-patient relationship. Bosher also established that ESL nursing students faced difficult in terms of understanding patient’s instruction, striking a small argument, and understanding the medical instructions. Under the provisions of nursing profession, a nurse (ESL nursing student) should create and maintain rapport with the patient so that understand the patient’s needs, requests and concerns. Lack of the cordially relationship between the involved parties affects the way a patient respond to the treatment.
In a clinical setting, Bosher affirmed that ESL nursing students failed to understand, comprehend, and internalize medical reports, abbreviations, and medical terminologies thus lowering the students’ academic success and performance. ESL nursing students reported that communicating with nurse instructors was a challenging task because the later used medical terminologies and abbreviation to convey the medical information. However, many ESL nursing students do not understand such terminologies and abbreviations, but they fail to ask questions and clarifications from the nurse. The reason behind this stand is that ESL nursing students fear being embarrassed, looked down, and discriminated by the nurses for asking such questions. Based on this assertion, ESL nursing students score lowly in the course work and NCLEX as they fail to follow the instructions to the latter.
Analysis of effective techniques as bridge for success
It is obvious that ESL nursing students experience numerous challenges, but English language barriers and deficiency remains the key issue in most nursing schools and programs in United States. However, these problems coupled with unique needs of ESL students can be addressed through the implementation of effective bridging for success constructs.
Improvement of language skills remains the key bridging for success factor in addressing needs of language barrier and deficiency among ESL nursing students. Many ESL nursing students with speed-reading and comprehension challenges should be provide with lecture notes, audiotapes, and class slides so that they can enhance their language skills. This move will enable ESL nursing students to follow the teacher’s argument and direction effectively thus improving their language skills. Nursing schools and programs should allow ESL nursing students pronounce key words in their native language; an idea that would enhance verbal and language skills.
It has been established that allowing ESL nursing students verbalize key concepts in their native language enable them understand and master English language thus easing the learning process. Nursing schools should introduce mixed group discussion forums where ESL nursing students can interact with native English speakers. In case a clarification is needed, native students would provide it thus improving language skills of ESL nursing students.
ESL nursing students lack listening and speaking proficiency skills, but this need can be addressed through the implementation of language support programs. In most cases, language support programs focus on improving grammar, vocabulary, and syntax of students in order to enhance their listening and speaking skills. Similarly, language support programs create a platform where an ESL nursing student would be able to understand the local dialet used by patients; an idea that that would enhance nurse-patient relationship (Gilchrist & Rector, 2007). In other words, rather than using the medical jargon and terminologies in articulating issues, the program allow nurse educators to convey the information using the local language that is understood by all students. The program also allow the teacher to offer tutorial on pronunciation, vocabulary building, and syntax; an idea that enhance verbal and listening skills of ESL nursing students. Based on this assertion, language support programs should be integrated in nursing course in order to improve listening and verbal skills of ESL nursing students.
Numerous studies have affirmed that ESL nursing students experience challenges when communication with nurses and nurse educators. In most cases, ESL nursing students fail to understand instructions, medical reports, and information conveyed by nurse educators because they cannot understand the medical terminologies, abbreviations, and vocabulary. However, ESL students do not ask questions or seek clarification because of cultural barriers such racism, discrimination, and intimidation. Nurse educators believe that ESL nursing students are lazy and incompetent because they belong in minority groups. However, nursing schools should introduce culture competence forums so that to sensitize and educate nurse educators about the importance of embracing cultural diversity. This move will improve language skills of ESL nursing students, as it would promote interaction among the students.
The fact that ESL nursing students have low self-esteem affects their academic performance and success. As a result, they are unable to interact, associate, and relate with their patients because they fear being embarrassed, looked down upon and discriminated. However, nursing schools should organize seminars and educational forums in order to sensitive communities on the importance of embracing cultural diversity and competence. This move would enable patients to value and appreciate the efforts done by ESL nursing students when rendering their services.
Recommendations
ESL nursing students have diverse and unique need, but nursing schools have the moral obligation of enhancing success and academic performance of the students. In order to achieve this goal, nursing schools should implement the following recommendations. Firstly, school management should employ effective methods in establishing ESL nursing students with language deficiency and barriers; a move that will promote early intervention. Secondly, nursing schools should organize visiting days where parent, relatives, and friends can visit ESL nursing students; an idea that will prevent loneliness and speculation. Thirdly, language support programs coupled with cultural competence forums should be introduced so that to enhance cohesiveness and interaction between educators and ESL students; as envisioned in Christian teachings.
Conclusion
In the recent past, the number of ESL students coming in America to pursue nursing has increased steadily. This paradigm shift has been fuelled by the fact that America has some of the best nursing schools in the region. ESL nursing students face numerous challenges ranging from racism, discrimination, culture shock to climate change, language barriers and deficiency remains the main challenge. Despite these challenges, enhancing academic performance and success of ESL nursing students is of paramount importance to nurse educators. ESL nursing students have needs in reading speed and comprehension, communicating with patients and nurses, and lack of listening and speaking skills. However, these needs and challenges can be addressed through introduction of language support programs, mixed discussion groups, organization of cultural competence forums, and educational campaigns and improving language skills.
References
Bosher, S., & Bowles, M. (2008). The effects of linguistic modification on ESL students' comprehension of nursing course test items. Nursing Education Perspectiv, 1(29), 165-172.
Gibbens, S. (2002). Graduation and success rates of Mexican-American undergraduate nursing students in an associate degree nursing program. Journal of Transcultural Nursing, 18(3), 277-285, 1(1), 45-67.
Gilchrist, K., & Rector, C. (2007). Can you keep them? Strategies to attract and retain nursing students from diverse populations: Best practices in nursing education.. Journal of Transcultural Nursing, 18(3), 277-285, 18(3), 277-285.
Olson, M. A. (2012). English-as-a Second Language: Nursing Student Success:A critical Review of the Literature . Journal of Cultural Diversity, 19(1), 26-31.
