Many foreign-born LTC nurses report language barrier, current English proficiency test may be inadequate, study suggests

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About 15% of U.S. long-term care nurses say their English language proficiency or accent creates communication problems with residents, family members, other nurses and/or medical providers, according to recently published findings.

Communication problems were reported at about the same rate by nurses born and educated in another country and by those born abroad but educated here, the investigators found. They describe this as “one of the most significant findings,” because it suggests that tests of English competency might be insufficient.

For example, international students often are required to take the Test of English as a Foreign Language in order to be admitted to degree programs. However, the test provides “a measure of basic English competency, fluency and comprehension, and may not adequately assess an individual's ability to communicate complex issues regarding patient care,” the study authors wrote. In addition, some nursing schools might waive this test for people who were born in another country but have been living in the United States for a certain period of time.

Nursing homes are not mandated to have programs to develop nurses' language skills, but “further discussion” about these initiatives is warranted, the investigators proposed. The issue is likely to become increasingly pressing, they argued, because nursing homes already are relying on immigrant workers to fill vacancies, and demand for LTC services is set to expand substantially. Poor communication can erode patient care, they emphasized.

Regional accents and other variations in speech contribute to communication issues even for nurses born and educated in the United States, the authors noted. There likely is no “easy solution” to this issue, but there is “work to be done,” they concluded.

The findings are based on surveys of more than 1,600 nurses in 98 nursing homes in five U.S. states. The study authors are affiliated with a variety of institutions, including the School of Nursing at the University of California, San Francisco, and the University of Michigan School of Nursing.

Full findings appear in Geriatric Nursing.