Tomato Tomahto—Precepting Pearls on an Unanticipated Language Barrier

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Globalization is a trend among healthcare professionals, many of whom move from their countries of origin to seek further education, experience, and travel opportunities abroad. As the product of an international recruitment effort to curb the nursing shortage in the United States, I journeyed from the far-away shores of South Africa, certain that I would acclimatize well and find myself right at home speaking English in America.
Of the many insecurities I brought with me, having a language barrier was something I did not anticipate. The day I received a nursing hand-off report for the very first time, my excitement waned and all the insecurities I had experienced as a new graduate nurse 8 years prior overwhelmed me. Everything sounded foreign, and I was panic stricken! I had been a registered nurse for 8 years, so surely my preceptor would expect me to understand a hand-off report. But the foreignness of American English deafened my ears; I was shaken to my very core at the thought of exposing my vulnerabilities. Receiving a report was challenging enough for me, but the thought of providing a hand-off report was even more unsettling.
Speaking with an accent defines ones cultural heritage; however, the anxiety of having a nonnative accent is ever present among foreign nurses and one that preceptors must be attentive to. The tendency of the listener to “correct” pronunciation can be perceived by the speaker as judgmental. Rather the listener should embrace the opportunity to hear a familiar word as if for the very first time. Capturing the attention of the listener amplifies the beauty and not the barrier of speaking with an accent. To the foreign-born speaker, pronunciation that is not of native tongue feels fraudulent and may even translate into an identity struggle or imposter syndrome.
One of the unanticipated challenges to consider as a foreign-born nurse is the distraction of an accent. Providing a detailed handoff report, taking care to include the most salient points critical to the continued care of a vulnerable and fragile patient, is a skill developed over time and with much practice. I recall an overwhelming frustration after successfully communicating complex patient information in professional terms to a receiving nurse in a hand-off report. I asked if she had any questions—only to be met with the response: “Where are you from?” In an effort to keep the hand-off report patient-focused and productive, I would redirect the question in a manner that implied I had not been clear, because I was more concerned about the diversion of attention from patient care to my accent and was truly worried about patient safety. Questions raced through my mind! Had the receiving nurse grasped the detailed and sophisticated complexities about the plan for care? Had she listened attentively so as to anticipate the pending and potentially critical laboratory values? Would she remember to speak into the patient’s left ear because their right ear is deaf? This is an example of the unanticipated language barrier that evoked anxiety long after my shift had ended.
Another consideration is the patient’s perception of nursing skill, which may be influenced by an accent. Patients may determine the clinical and technical skill level of a nurse based on language. In a descriptive qualitative study by Wysong and Driver (2009, p. 29), a patient identified the language skills of the nurse as a determinant of clinical skill, listing the inability to understand nurses because of their accent as an attribute of nurses who are not skilled. “Language barriers are cited by nurses and employers as the most significant challenge for foreign nurses working in the United States.
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