Teaching English as a Second Language to Nursing Staff

Northern Sydney Central Coast Area Health Service

Abstract

In 2006, ten of the twenty new graduate nurses appointed by the NSW Nursing Consortium to Hornsby and Ku-Ring-Gai Hospital spoke English as their second language.

The nurses who were from four Asian countries self-identified during the first week as having inadequate English language and communication skills.  An experienced Teaching English as a Second Language (TESOL) teacher and practising registered nurse was contracted to undertake assessment of their English language ability and communication needs.

In response a specialised nursing based English language and communications curriculum was developed and implemented. Nine nurses completed the initial 30 hour program, with seven completing the 60 hour program.

Assessments at 30 and 60 hours showed significant improvements in confidence in listening, speaking and writing skills, therefore reducing potential clinical risks.

Aim

The aim of the program was to increase the nurse’s ability to communicate in the context of practice to ensure safe practice and professional nursing care.

Nature of the Problem

Ten of the twenty new graduate nurses appointed by the NSW Nursing Consortium to Hornsby and Ku-Ring-Gai Hospital spoke English as their second language with levels below the accepted standard. A further four nurses from the existing workforce requested to be involved in the program.

Extent of the Problem

The Australian National Competency Standards for Registered Nurses (ANMC, 2004-2005) state that an RN must be able to communicate effectively using a range of communication techniques, in verbal and written language appropriate to the context.

Initial assessment of these nurses, was by means of self assessment, based on the International English Language Testing System (IELTS) and Cambridge University ESOL standards. This included written tasks and pair and group activities, followed by a skills/functions needs analysis covering baseline listening and comprehension, speaking, reading and writing. This testing indicated particular difficulties in listening and speaking. The Nurses and Midwives Board (NMB) requirement is an IELTS level of 7. The participants self assessments were 4 – 9, but trainer testing indicated the results were 3.5 – 6.5, this figure being below the NMB requirement.

Senior management initially agreed to support the program for 30 hours this increased a further 30 hours following evaluation.

Figure 1. Baseline Listening Comprehension

Figure 2. Baseline Speaking

Strategic Importance

NSW Health is committed to offer high quality, safe treatment and care in all settings of health (NSW Health, 2007).  Communication is a key issue in safe and competent care. Without the appropriate level of English language, safe patient care could potentially be compromised.

EQuIP 4 (2006) Guide to mandatory criteria states; that the governing body should lead the organisation in improving performance and ensure that there is effective management of risks including clinical risks.  Poor command of English language could pose a significant clinical risk. This course was of significance in addressing and minimising risks.
Planning and implementing solutions
Following the initial assessments the group numbers unfortunately fell to seven, this was despite the assessments showing the participants required language skill development.

The curriculum was developed in line with the identified needs and the program commenced with 30 hours of language training and assessment. The initial findings were difficulties with listening, speaking, thus comprehension, giving and receiving instructions, telephone communication, interpretation and pronunciation of medication names and medical diagnosis.

Senior nursing staff and clinical educators were involved from conception with identification of needs, curriculum development, implementation, resource and support requirements, assessment and evaluation. Feedback from the course was given verbally by presentation to key stakeholders at 15, 30 and 60 hours. Written evaluations were compiled at 15, 30, 60 hours and augmented with a final report.

Outcomes and Evaluation

The initial outcomes were to develop class cohesion, extend vocabulary and further develop language and communication skills.

Subsequently, the outcomes were to develop critical self awareness of language needs; provide language training for effective understanding; increase confidence and encourage/enable self directed study and learning in the context of practice.

At 15 hours there was firm class cohesion, enthusiastic participation and a notable improvement in listening and writing, pace and pronunciation.  The previously identified three levels of competence had merged to two levels. It was noted however that the participants still had a limited nursing vocabulary and compromised language ability.

Evaluation was attended by self assessment and trainer assessment, course evaluation and outcome evaluation in collaboration with supervising nursing staff.

Evaluation at 30 hours concluded the need for a further 30 hours of training and at 60 hours, six of the students had improved by 1-2 points on the IELTS scale. Two of the group reached IELTS 7, one 6, one 5 and three remained on 4.  According to information from Adams & Austin (2008) an increase in 1 point would be expected from 12 – 16 weeks of intensive study i.e 5-6 hours per day, preferably in a language school.

The ESL nurses listening, speaking and writing skills improved with growing awareness of their limitations. The students who acknowledged being the weakest were those who applied themselves the most. 

While the results are positive only two participants reached the level acceptable to the NMB. Further training was recommended.

Figure 3. Overview of Results for Speaking

Figure 4. Overview of Results for Listening

Sustaining Change

According to the research nursing students for whom English is a second language make up a significant component of nursing programs today. Research suggests that second language learners acquire two types of language, Basic Interpersonal Communication Skills (BICS) and Cognitive Academic Language Proficiency (CALP). BICS is considered by experts to be easy to learn and does not require either formal study or an academic background; it can be learned through normal interactions. However CALP is formal academic language and is a requirement in academic circles. Thus students who may appear to have no difficulty in BICS may have a minimal command of CALP (Malu & Figlear, 1998).

Malu & Figlear (1998) state it takes five to seven years for an ESL student who has learned English as a teenager to reach a level of CALP sufficient to succeed in academic studies.

The development of long term language learning and support in the form of either face to face teaching or technological media could benefit the patient outcomes, ensure safe practice and reduce near misses or incidences.

Future Scope

A report of the course and evaluations with recommendations was collated and submitted for future action. The recommendations suggested that ongoing English language support up to 40 hours per year was required for this group to ensure safe practice.

As the proposed model was tried and tested with successful outcomes in ESL Registered Nurses, a similar program could be used as a tool to meet similar needs for other healthcare personnel.

This successful model is currently being utilised by another group within the Area Health Service.

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