English-as-a-Second Language (Esl) Nursing Students: Strategies for Building Verbal and Written Language Skills

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Abstract: With the growing number of foreign-born residents in the United States, nurse educators face the challenge of educating students who may have difficulty with the English language. There are an estimated 28 A million foreign-born residents in the United States, which is the largest number in the history of this country (U.S. Census Bureau, 2001). The U.S. census report (2001) shows that the Hispanic/Latino population has increased by 57.9% since 1990 and now accounts for 12.5% of the total population. Another fast growing group is the Asian population that has increased by 48.3% since 1990 and now accounts for 3.6% of the total population. The Annual Report of the American Association of Colleges of Nursing (AACN, 2001) shows that the minority representation in baccalaureate programs has also increased with the Hispanic/ Latino students at 4.8% and the Asian/Pacific Islander/Hawaiian students at 4.7% of the undergraduate nursing student population. Several authors (Abriam-Yago, Yoder, & Kataoka-Yahiro, 1999; Lester, 1998; Davidhizar, Dowd, & Geiger, 1998; Dowell, 1996; Andrews, 1992) have discussed the importance of increasing the number of ethnic minority nurses to insure the quality of healthcare to an increasingly diverse population. As the nursing shortage deepens, recruiting minorities into nursing is essential to meet the increasing demand. This change presents unique challenges and opportunities in nursing education. Colleges and universities will need to develop innovative programs to attract these nontraditional students, and support programs to help them complete the nursing curriculum.

Key Words: English-as-a-Second Language, Nursing Students, Language Skills

Malu and Figlear (1998) report that there is an increasing number of English as a Second Language (ESL) students enrolling in nursing programs. They define ESL students as a student whose primary language at home is not standard English, and therefore, may not be fluent in standard English. Many of these students have difficulty with the coursework and/or clinical work. Memmer and Worth (1991) found that ESL students have a higher attrition rate than their non-ESL peers due to failure or becoming discouraged. In another study that compares the academic characteristics of ESL and non-ESL students, it shows that ESL students are especially at risk during their first semester (Femea, Brathwaite, & AbdurRahman, 1995). Many times the academic problems are directly related to a language problem. Nursing is dependent on written communication in terms of translating doctor's orders and recording patient data. But more importantly, it is highly dependent on accurate verbal communication, since much of the information and many orders are passed on verbally. In a comparison between ESL and non-ESL students, ESL students report more difficulty in the clinical courses than non-ESL students. It has been suggested that this is due to the high level of interactive communication skills that are needed (Jalili-Grenier & Chase, 1997). ESL students also have difficulty passing the NCLEX-RN exam. Johnston (2001) reports that students whose first language was English had a pass rate between 67.77% and 95%. Students for whom English was a second language had a passage rate between 33.3% and 47%. Johnston concluded that language skills are a key factor in passing the NCLEX-RN exam.

To understand how a person learns a second language, the Cummins Model (Cummins, 1991) is useful. Cummins explains that language acquisition is divided into two types. The first is basic interpersonal communication (BICS) that comprises everyday social interactions. The second is cognitive academic language proficiency (CALP) that enables students to analyze, evaluate, and interpret abstract concepts. Although students may be proficient at the social level (BICS), they may not be able to communicate either verbally or in writing at these higher levels.

Phillips and Hartley (1990) divide language skills into four categories: reading, listening, speaking, and writing. …