Serious advice needed

[KatieMI, BSN, MSN, RN]

Sorry.... this will be long but I'm in real need of wise advice.

RN BSN, just above one year after NCLEX. Landed first job right away in step down but was told "not to be a good fit". Transferred for temporary 6 months new grad position in mixed ICU in same place. Did quite well, although "interpersonal skills" were mentioned more than once as something to improve. Left on good terms after 6 months in search of greener pasture. Found another position in SICU, worked my butt out for two months. Very soon, there appeared "concerns". Never had any problems with knowledge level, techniques, HIPPAA, critical thinking, being caring, being an advocate, etc. Assessment skills noted as being almost too good to believe, no question about being not smart enough. But I'm a foreigner and do have heavy accent which some people like and some find difficult to understand. No problems with grammar and words, just the accent. I do know it, speak very slowly, ask to repeat, apologize, etc. I also definitely have very unusual and different body language (like, I was told since childhood never look directly to the people and so have to make efforts to maintain eye contact). I try to copy others to manage it but apparently with no success. I read what I could about interpersonal skills and small talk, do it all, try to be as nice and flattening as possible - it doesn't help. The last episode happened when I was told to speak louder in certain situations, I did that next time and my response was definitely way too much exaggerated and that was cited as unprofessional behavior in patient care area worth instant termination.

At this point, I seriously question my career choice. However hard I try, the accent and behavior cultural issues are unlikely to disappear and I will be seen just as a weirdo and "that" nurse forever. We live in a place with very few immigrants around, so I am sticking out of the stack and moving is not an option. I love critical care and wanted to be APRN but now I doubt being ever able to do it as communication issues won't disappear. I also love to teach others and do it well person - to person but again, the accent won't go away. I can tolerate stress and multitasking, but "appear" for others to be too uptight and straight in my talk and expressions which, apparently, makes people uncomfortable to work with me. Similarly, my emotional expressions always seem to be either too much or too little, and this adds to the trouble.

I am trying to figure out if it is worth, after all being said and done, to attempt returning to bedside. The place I was doing good and where people were relatively comfortable with me has an open spot now, so I am tempted to try. On the other hand, there are openings for RN chart reviewers popping from time to time, and I think that maybe working from there and up to data analysis or utilization control will be more suitable. I am not interested in management or leadership, and will be fine and happy low on the totem pole as long as the job is mentally stimulating and allows me to apply my diverse medical knowledge and analytical skills. I thought about research but these jobs are not available in my area. Nursing IT looks as another option but it looks like all these positions require more than one interrupted year of bedside. I'm almost afraid to think about other bedside or the like options (dialysis, home care, etc) because I am so tired of being isolated, ridiculed and bad-mouthed behind my back as "that" nurse.

I would appreciate an honest advice.

[lub dub]

You said that you are a "foreigner". Have you spoken with other nurses who are of your nationality? Perhaps you could get some pointers as far as developing American customs & behaviors within the workplace. That might help. Being intelligent and having good assessment skills sound like assets to me, so fine-tuning your interpersonal skills may be what you need.

[scaredsilly, BSN, RN]

This post makes me feel ill! In nursing school we take classes on cultural diversity, we are tested on it and then one of our own has an accent and gets treated this way? I think that is outrageous and it really makes me a bit angry.

Assessment skills "to good to be believed"..that makes you so perfect for bedside! I'm sorry but the supervisors on your unit(s) have a lot to answer for if they are letting an accent get in the way.

That said...I don't know how to advise you. If you really want to leave bedside nursing, that is what you should do. If you are happier in direct patient care though, you shouldn't have to leave. You mentioned that there were not many immigrants in your area, does that mean you are in a small town? Is there a more metropolitan city close enough to commute? If so, I would see about getting hired at a hospital there. In most large cities, we are used to a true melting pot of different cultures (and accents) and people in general are more tolerant of differences. You may find you can do what you like without any issue in a bigger place.

After all is said and done, you made a good enough impression to get hired right after NCLEX, some of us wait months or even years to get to that point. To me that says that it is nothing you are doing wrong that is causing your issues. Management needs to lighten up and embrace employee differences, not to try to create a cookie cutter society of Stepford nurses!

[meanmaryjean, DNP, RN]

I know that our local urban college offers an accent reduction program for persons who are not English-as-a-first-language. (Indianapolis is home of the largest med school and one of the largest nursing schools in the nation- this program is tailored to person in the health professions and academia). Perhaps you could find such a program- either in person or online?

I'm so sorry this is happening to you- anyone who can complete nursing school in a foreign language has my respect.

[KatieMI, BSN, MSN, RN]

Thank you, guys!

I tried accent reduction courses, with no effect. In fact, I did everything but Botox to no avail. I realize that everyone and my patients being put first have the right to be spoken with the way they can understand and I do the best I can to make it easier, but it only can go so far. I think that if I can effectively teach patient with zero baseline knowledge things like gate theory of pain, then my English should be good enough. But, apparently, it is not.

We live in an area where foreign born nurses are rare birds, and the closest place where I can find someone from my own country is 2.5 hours away, so it is not possible for me to commute. I'd seen many foreign-born doctors with accents way worse than mine and they seem to have little problem communicating. Apparently, there is different standard in nursing, as everyone afraid of customer satisfaction scores falling. I like bedside care and would be happy doing it, but I am just tired of being an object of constant "concerns" that someone "might" be unhappy/upset because of my speech. I own mistakes I did and realize that some of them, while being totally innocent, were less than the best examples of professional behavior, or so they looked like. That won't be repeated, I learned my lessons. But I am afraid that this alone won't solve the problem of being "that" nurse.

[HouTx, BSN, MSN, EdD]

What a pickle. While it is true that we (healthcare) espouse an ethos of valuing and respecting diversity... it is a one-way street. WE (care givers) are supposed to value patient diversity, but patients have their own expectations & (according to HCAHPS) we have to satisfy them unconditionally... whether they are overt racists, subtle bigots, misogynists or just ignorant/nasty people.

I'm in the most diverse (according to 2010 census) city in the US - which gives rise to much higher levels of acceptance & adaptation to cultural & language differences. Heck, we have multi-lingual street signs in many areas of the city. Language barriers and difficulties are addressed in (hospital) policies only as a safety issue... measures to ensure clear communication, etc. I am aware of many resources for accent reduction that are popular for clinicians as well as workers in other multi-national companies in my area.

If OP has not found speech therapy to be effective in accent reduction, and the employers are not tolerant - it would seem that there are very limited options. Either OP finds a job in which verbal communication is not important, relocates to a more diverse location or moves into a different type of work. I'm at a loss when it comes to jobs that would meet the first option & it would be horrible if the third option happens.

[KatieMI, BSN, MSN, RN]

Nothing more horrible than me becoming a good MSN wouldn't happen. I'd seen quite a few of them working everywhere from QA to clinical sites, speaking with accents many times worse than mine. Doctors (half of whom are recent immigrants as well, and also speak less than perfect English) work with them as well. Apparently, MSN world has different standards than bedside nursing.

The truly horrible things are intolerance, bigotry, xenophobia and at least some degree of antiintellectualism, and even more horrible that all these are not always looked upon as being completely unacceptable for anyone having nursing degree.