English As A Second Language

[Santa Monica]

Hi. I am a nursing student in second year. I came here 15 yrs ago. Spanish is my native language. I know English, but I have a strong accent. I am doing good in school and clinicals. However, a medsurg nurse told my instructor that I have issues with pronunciation and that makes me less competent as a nurse. My instructor got into an argument with her about me. I cried because I really try to do my best in school. I feel depressed and so insecure now. I need to grow thicker skin.

The nurse was so friendly with me. However, she turned out to be so hipocrite. I haven't work with her, and she just decided to tell my instructor that about me. I understand that sometimes I have a hard time pronouncing medication names and medical terms. But, she doesn't know me enough to make that statement. How can I improve my pronunciation? Thank you!

[NurseCard, ADN]

Well... someone said basically, it all falls on the listener, not the person speaking.. and I suppose I can agree with that. Or, I can see the argument that, should a person whom, for WHATEVER reason, cannot clearly communicate verbally, be given a job in which good verbal communication is important?

If someone can be clearly understood, in all three examples which you provided KatieMI... then there should be NO reason not to hire, or keep that employee.

The argument can be made that there are going to be people who say that they cannot understand anything a person says.. and then there are going to be people who say that they have no problem whatsoever, understanding that same person.

It is a hard argument. I'm going to agree to agree with all sides at this point.

[Ruby Vee, BSN]

You are learning new words and in a new environment. There are only so many brain cells in your head, so maybe she could be a bit more patient.

I think that with your education you'll be getting lots and lots of practice in English. It's too soon to decide that you can't speak well enough to practice. And there are tons of Spanish speaking positions.

I think she was mean to draw a conclusion after one shift, but you may need to speak slowly in the future for the accent impaired listeners.

I'm not sure that the issue is with the staff nurse. If she was asked for an evaluation of the student after their shift together, she probably provided an evaluation. One shift isn't enough to say the student will be incompetent, but it is enough to identify a concern about the student's ability to be understood in spoken English. It is enough to identify something for the student to work on. I think the bigger issue is with those who have decided that it is discriminatory to correct the pronunciation of an English as a second language student.

Medicalspeak is a foreign language to all of us when we start. Learning to pronounce medical terms is a huge thing for all of us -- to use them correctly is another. We all have to learn. Whether or not English was the students first language isn't the concern. The concern is understanding and being understood. The student with the thick accent is going to have more trouble pronouncing the names of drugs and medical terms, this is true. But requiring that she learn to do so is not discriminatory. It's a safety issue.

[Lunah, MSN, RN]

If I had a nickel for every native English speaker who mispronounced "Phenergan" or "larynx," I could fill a big bag with nickels and whack those people on the knuckles for it. Haha. Seriously ... I was raised overseas, I am used to accented English and I think that gives me an advantage in understanding others whose first language isn't "'Merican." I was also taught that someone speaking accented English was smart enough to master more than one language, a feat worthy of respect.

[UrbanHealthRN, BSN, RN]

On the complete flip side of things...

At one of the health centers I worked at, at least half of our patient population spoke Spanish, many exclusively. I learned to speak a good amount of Spanish while I worked there, which made my job a whole lot easier when I no longer needed an interpreter every second of the day.

I also learned how to pronounce English medical terms with a Spanish accent, and that was sometimes just as important as speaking Spanish itself. For example, teaching a family about fever control with acetaminophen and Motrin was much more effective if I could pronounce those two words the way the family did. Otherwise, I'd be met with blank stares.

On another not-quite-related point, sometimes we also need to factor in the literacy level of our patients, and question if that may be why they're not understanding certain medical words pronounced with an accent: they may not even understand the word when it's pronounced in their own accent/language.

Language is incredibly fluid, and when it comes to effective communication and patient safety, there's probably a whole multitude of factors we have to consider. It can be easy to target people's accents as a one of these factors, but I can also think of folks who sound just like me that probably have no business working with people because of how poor their communication skills are.

[Skippingtowork]

Great discussion topic and interesting perspectives. Language or accents are not related to competence in any field. The only problem I have with this topic, is the strain placed on some employees when their co-worker cannot either speak enough english to be understood or the accent is so heavy too much time is spent trying to understand. I'm a strong proponent of everyone speaking at least two languages (although I don't) and tolerating those who are trying to learn english, but I have been in situations where patients were put at risk because we didn't understand instructions being given due to the accent. Having lived in multiple countries and having relatives with heavy accents, accents are the norm for me, but sometimes it can really be difficult. I have also had patients tell me they did not understand a thing their doctor said to them, because of their heavy accent. These patients had serious illnesses and were given very important instructions to follow.

Communication in medical care is of paramount importance and should not be taken lightly. Each one of us has a responsibility to be understood clearly, whether it be with speech or writing. Legally, it may be called language discrimination if an employee or student is counselled or worse because of their accent. What do we call it when a patient is harmed because of the accent?

I like the suggestion that one poster had regarding making a game of correct pronounciation. We can all benefit from making a game of trying to improve our diction and medical pronounciation.

[Here.I.Stand, BSN, RN]

Someone needs to call the police, because somewhere there is a village missing their idiot!! 

Seriously, that is an incredibly ignorant thing to say. She needs reeducation!!

I work in a very diverse area, and work with MANY foreign-born staff. I would trust any of them with my life. They are not competent -- they are exceptional.

Way back when I took developmental psych, I remember reading that until about 6 months of age, a baby responds to sounds from ANY language. Think African clicks, the German "ch" and umlaut'ED vowel sounds, that long-O-as-a-diphthong that you hear in Australian English, rolled "R's" etc. Around 6 months of age, the baby's ear will start to tune to the sounds of the languages spoken with him.

Almost ANY person learning a 2nd language later in adolescence or adulthood is going to speak with an accent. My husband moved to the US as a young adult without speaking English; he's 46 now. To this day, if I correct him when he says "royal" instead of "loyal," he'll say "that is what I said." His English is actually very good, but having no clear "L" or "R" sound in his native language, his ear has a hard time with those sounds. (For what it's worth, he has a master's degree and works in high finance...so clearly his accent hasn't been an issue.)

I can almost guarantee that if that nurse were to learn Spanish and go to work in Spain or Mexico etc., she would have an accent!

I'm glad your instructor stood up for you. Your instructor, by the way, wouldn't pass you if she felt you weren't competent. (((Hugs)))

[Here.I.Stand, BSN, RN]

KatieMI said:

Without all those "what ifs..." and such, because, somehow, huge hospital complexes in NYC and many other places are run just fine with pretty much everyone there speaking with some sort of an accent. If they can do it in NYC, I do not see what can be a problem in Omaha, NE, or Pleasant Lake, KS

Excellent point. I was actually thinking while typing my reply, nearly half of the RRTs I work with hail from the same African country. A good chunk of our staff physicians/surgeons are foreign-born too...and yes, many RNs. Somehow, they manage to provide safe care. Amazing.

I'm sorry that harassment happened to you, by the way. It's disgusting.

[emtqro88]

Sorry that happened. Actually, I worked for several years in Mexico as a Paramedic and I had to learn Spanish. There were a few times when some nurses made fun of me, and one time a medical student made fun of me. I was a bit hurt, but I just used it as motivation to get better. I learned every word, every phrase, every joke. I learned how to speak with professionals, and to speak slang with my younger coworkers, in a more relaxed atmosphere. I perfected (nearly) my accent. When I talk to people in Spanish, they just can´t believe that I am from the states. Now I am a translator, and get paid more at my hospital to be a translator (Hey thanks! the nurses and med student that made fun of me actually made me richer!)

So, just use any criticism as motivation to get better.

[klone, MSN, RN]

Now I am a translator, and get paid more at my hospital to be a translator (Hey thanks! the nurses and med student that made fun of me actually made me richer!)

I think you mean "interpreter"?

[KatieMI, BSN, MSN, RN]

I think you mean "interpreter"?

People can become "interpreters" or "translators" and be hired to assist non-English speaking patients and families, translate for international medical teams, etc. They can be simultaneously hired by the same facility as RNs or in any other position they qualify for as long as they do not directly participate in care of the patient(s) they do translation for, or do that through independent agencies. Depending on state/place, there are different tests to confirm bilingualism and knowledge of medical terminology.

It is a popular job and, in fact, good $$$ to make.

[Lunah, MSN, RN]

Most hospitals where I have worked do make a distinction between "interpreter" and "translator." As I understand it, in the medical setting, they are interpreters. Very valuable skill! Ours had to take a proficiency exam even if they were native speakers of whatever language they interpret.

[klone, MSN, RN]

Most hospitals where I have worked do make a distinction between "interpreter" and "translator." As I understand it, in the medical setting, they are interpreters. Very valuable skill! Ours had to take a proficiency exam even if they were native speakers of whatever language they interpret.

An interpreter is someone who helps interpret verbal speech from one language to another. Translators create documents from one language to another (such as consent forms, patient education, signage).

The two terms are not interchangeable, and I would expect anyone who does interpreting should know the difference.

It's quite possible that he was hired by his hospital as a translator, but I suspect he actually meant to say "interpreter."