Abstract: Many English-as-a-Second Language (ESL) nursing students struggle in nursing school for a multitude of reasons. The purpose of this critical review of the literature is to identify barriers and discover bridges to ESL nursing student success. Twenty-five articles were identified for the review. Language barriers were identified as the single most significant obstacle facing the ESL nursing student. Bridges to ESL nursing student success include enhancing language development and acculturation into the American mainstream culture. Abroad range of strategies to promote student success are outlined and the role of the nurse educator in ESL nursing student success is also addressed.
Key Words: English-as-a-Second Language (ESL), English Language Learner (ELL), Nursing Students, Academic Achievement, Retention
According to the Sullivan Commission (2004), minorities represent 25% of the United States population, yet they account for less than 9% of nurses, 6% of physicians, and 5% of dentists. Recommendations by the Sullivan Commission and the Institute of Medicine (2003) to increase the number of minority health professionals and ultimately decrease health disparities include examining the educational environment of healthcare workers, particularly nurses.
English-as-a-Second Language (ESL) nursing students are a subpopulation of minority students who often struggle in nursing school and on licensure examinations. Attrition rates for ESL nursing students have been reported as high as 85% (Gilchrist & Rector, 2007). Difficulty passing the National Council Licensure Examination (NCLEX) is problematic. In an eighteen year study by Sims-Giddens (2002), the pass rate on NCLEX ifor ESL nursing students was 21% lower than native speakers. Bosher and Bowles (2008) identified a 40% disparity in NCLEX pass rates between ESL and non-ESL students regardless of academic record.
The nursing profession also faces the challenge of increased numbers of linguistically and culturally diverse patients who speak little or no English. Twenty percent of Americans speak a language other than English at home (Sullivan Commission, 2004). With these dramatic changes in patient demographics, nurses must be prepared to provide culturally competent care and understand the importance culture plays in patients' perceptions of their health needs and how they respond to the care they receive. Speaking a second, language is of benefit: research has demonstrated better compliance rates and patient outcomes when care is delivered in the patient's own language (Moceri, 2006; Simpson, 2004; Sims-Giddens, 2002). Increasing ESL nursing student success will provide racially and ethnically diverse nurses who can improve patient outcomes by bridging the gap of language barriers and serve as resources for their peers to provide culturally competent nursing care.
The literature review was organized based on Voder's (1993) theoretical model. The processes by which nurse educators respond to the needs of ESL nursing students form the framework of this theory. There are four need areas for the ESL nursing student: language, culture, academic, and personal. How educators respond to the student needs varies and can include one of five patterns: generic, culturally non-tolerant, mainstrearrung, struggling, and bridging.
In the generic pattern, all students are seen as the "same" by the nurse educator. The educator exhibits a low level of cultural awareness and identifies no differences among students. Teaching methods are seen as universal models for all students regardless of ethnic background or ESL status. Consequently, student needs go unrecognized under this pattern of responding. The feneric pattern was the predominant style experienced y ethnic nursing students in Voder's (1993) research.
With a culturally non-tolerant pattern, educators create barriers for ESL students due to their unwillingness to accept cultural differences. …