Bilingual Nurses’ Skills Begin to Matter

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Bilingual Nurses in High DemandAbility to speak a foreign language can help a nurse do a better job. That skill, however, is much less likely to help a nurse get a better job. But that may be changing.

Language barriers and cultural differences can be a matter of life and death in health care, as studies and postmortems alike have demonstrated. The Affordable Care Act has 62 provisions specifically addressing race, ethnicity and language barriers to health care.

They are needed because English is not the primary language of 48 million people living in the United States. The U.S. Census Bureau’s American Community Survey found 61.8 million do not speak English at home; of those, 25.1 million report speaking English less than very well. Their language needs are expanding faster than the supply of competent interpreters. That means those needs are not consistently served.

Although efforts to serve those needs better are finally increasing, the historical lack of priority accorded to bridging language gaps has meant nurses with bilingual skills have not been called upon much to specialize in that area. The common practice instead has been to hire “medical translators” who are often paid only half as much as nurses and are trained primarily in medical jargon, according to the Bureau of Labor Statistics.

As a result, a bilingual nurse may become ambivalent about putting language skills to use. “I don’t think it did anything for my compensation, and it has not come up in my annual review,” a Spanish-speaking nurse at an 800-bed hospital said in a chat room on Allnurses.com. “I am at the job to be a nurse, not an interpreter. We have interpreter services 24/7, and the nurses call them. It would be really hard for me to do my job in the ED if I had to run around to other units.”

Medical translators as a stopgap

Medical translators are better than nothing, and more of them are needed. Even in California, where nearly 7 million people are categorized as having limited English proficiency (LEP), and 1.7 have become eligible for health care under federal health care reform, the state has only 738 certified medical interpreters.

More than 600 of California’s certified interpreters speak Spanish, serving 4.7 million, but the rest are often spread too thin to help the 282,000 Vietnamese speakers and 228,000 Philippines-Tagalong speakers, not to mention the 35,000 Hmong speakers for whom there is only one interpreter.

Elsewhere, shortages often mean that minor children are the most proficient English speakers on behalf of their families’ needs, and their inexperience poses risks to the patient and the health care facility.

Requirements for certification as a medical translator vary nationwide. California has two certifying agencies, but noncertified interpreters are used routinely to bridge the shortage.

Nurses fill in as interpreters

Kaiser Permanente has a staff of independently certified interpreters for serious cases but counts on bilingual nurses and others who are not linguistically certified to act as interpreters at other times.

Some economists say it can be cheaper to invest in staff interpreters than outsiders. Boston City Hospital’s 70 full-time staff interpreters were able to provide assistance in 150 languages and were tapped 205,000 times in one fiscal year, according to an article from Yale University. “Language barriers cost money. At $17.77 per request [for an interpreter], this is a bargain,” a professor of medicine at the hospital noted.

Competent interpreters are vital, no matter how they’re provided, and nurses are familiar with the reasons. Studies have shown that patients with limited English proficiency have less access to care and poorer adherence to treatment regimens, which exacerbate health disparities.

Numerous studies have shown relationships between communication and quality of care. A 2015 San Francisco Chronicle article cited a 2010 report by the UC Berkeley School of Public Health and National Health Law Program, which examined 1,373 malpractice claims and blamed inadequate interpretation to be a factor in 35 cases of death and severe medical harm.

The language barriers are the most obvious barrier to communication. The 2003 National Assessment of Adult Literacy (NAAL) measured health literacy disparities in several culturally diverse populations of American adults. Successful treatment correlated with that literacy, which tended to be lower among foreign-born patients.

A U.S.-born patient would be more likely than someone who recently arrived to know how to deal with the health care system, converse with nurses and correctly follow directions at home. Patients are called upon to understand discharge instructions, insurance statements, pamphlets and other medical literature.

Numbers can pose problems in perception, too. Skill with calculations of measurements and doses, blood levels and other statistics may cause errors or misunderstandings. Cultural differences are more complicated.

Differences in social structure matter

In their 2009 treatise on overcoming language and cultural barriers in medicine available via a NursingWorld journal, Kate Singleton and Elizabeth M.S. Krause cited some of the following cultural factors that can enter in:

  • Attitudes toward gender and age: In familistic cultures, the patient may defer to the family unit’s attitudes toward illness and treatment that don’t necessarily give the patient’s treatment and recovery priority. There may be a preference for listening to a doctor over a nurse, or a male over a female.
  • Differences in attitudes toward authority: Efforts to be polite and defer to health care providers who are perceived as authority figures can affect treatment adversely.
  • Differences in spirituality: Many cultures believe God has inflicted illness that will not be affected by treatment. Members of several cultures believe evil spirits inflict illness and won’t buy into scientific treatment.
  • Citizenship status: Undocumented immigrants who don’t want to call attention to themselves or low-income patients daunted by navigating the health care safety net can be affected adversely.
  • Literacy: Those who speak English as a second language may not be literate in any language.
  • Unfamiliarity with bureaucracy: Many who understand health care systems in their native cultures don’t understand their own roles in navigating the U.S. system.

No matter how bilingual nurses are employed to bridge communications shortcomings, they provide an advantage that is gaining increasing recognition. Singleton and Krause wrote, Nurses are in an ideal position to facilitate the interconnections between patient culture, language, and health literacy in order to improve health outcomes for culturally diverse patients,” they wrote.

A study published by Cornell indicated health care employers increasingly offer higher wages to bilingual nurses. “Medical emergencies demand immediate discussion and rapid-fire decisions that can’t wait for a translator to disseminate medical information vital to the patient’s well-being,” the report said. “This represents a great opportunity for those medical professionals who speak two or more languages.”

Why a bilingual nurse is preferable to a translator

Even when the rewards are less tangible, working as a bilingual nurse can be a fulfilling profession. Health Providers Choice describes several values associated with bilingual nursing:

  • First-hand information: The patient may feel most comfortable providing information with his or her nurse, rather than a doctor or translator.
  • Gaining a patient’s trust: A non-English-speaking patient may feel more comfortable around medical personnel who speak the patient’s language.
  • Increasing patient wellness and recovery: A bilingual nurse can explain the treatment plan and medicine instructions, helping the patient avoid readmissions.
  • Averting legal entanglements: A full understanding of a patient’s medical history and medical issues helps a facility prevent malpractice claims.

Why bridging language gaps can be satisfying for a nurse

Registered nurse Jennifer Ward made a further case for the satisfaction a bilingual nurse can provide in an article from NurseTogether.com:

  • Making the patient comfortable
  • Understanding the patient’s medical and lifestyle conditions helps put the patient at ease.
  • Increasing accuracy of data
  • A nurse’s translation is less likely to cause mistakes than a non-medical interpreter’s
  • Improved admission and discharge information
  • Improved dialogue with the patient makes records and advice more accurate.

“Nurses should continually develop their ability to practice cultural self-awareness so as to better recognize their own cultural and linguistic assumptions and biases,” concluded Singleton and Krause. “The ability of nurses to recognize likely interactions between language, cultural, and health literacy barriers; solicit additional information; and adapt communication approaches and care plans accordingly is important for effectively meeting the individual needs of patients.”

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