It would be difficult to overstate the importance of nurses. They provide about 90 percent of all health care services worldwide.
As important as nurses are, many countries are experiencing a shortage. The World Health Organization has noted the huge need for health care workers worldwide, especially nurses and midwives. Even the United States and other English-speaking nations have massive shortages.
But no matter what country nurses work in, at some point in their careers, they may be required to communicate in English. The reason is simple: The use of English in medical settings worldwide continues to grow.
When you think of nurses, you might imagine hospitals. But nurses work in countless other places, such as health clinics, schools, private homes and assisted living centers. They work on military bases, in refugee camps and in disaster situations around the world.
There are also many specializations within nursing. Surgery, cardiac care, oncology, midwifery and anesthesia are just a few examples. Throughout their career, nurses may work in one or many specialized areas.
Charlotte Nwogwugwu knows all about nursing, having worked in a number of specializations and settings.
During her 13 years in health care, she has served as a surgical nurse, orthopedic nurse, psychiatric nurse and global health nurse. She has also taken students overseas for their field experience in global health. A native of Nigeria, Nwogwugwu studied nursing in the U.S. and holds a doctorate degree in public health. She is now Assistant Professor-Global Health at the University of Maryland School of Nursing.
She joins us by phone to talk about nursing and some of the language challenges and victories that come with the job.
AB: Thanks again for being with us today.
CHARLOTTE NWOGWUGWU: You’re very welcome.
AB: Could you tell us a little bit about what you enjoy most about your work as a nursing professional?
CHARLOTTE NWOGWUGWU: One of the major things that I truly enjoy about nursing is the diversity in the role.
The core of what truly drives me is the ability to connect with people because, at the end of the day, I am a carer at heart. And, it’s still people that make my work valuable.
So, when I talk about the diversity in the role, it really is centered around connecting with people and how that inspires me to keep going to do what it is I do.
So, I always look at it from that perspective – whereby what it is I am doing with this individual patient is going to impact the lives of other people, not just that patient but their family members.
AB: OK great. In a typical day on the job, maybe in an interaction between nurse and patient, are there common expressions and terms that they might use?
CHARLOTTE NWOGWUGWU: Absolutely. One of the things that we are doing as nurses is that we are assessing this patient the moment we walk in. And by that, I mean we really are assessing their level of consciousness. We are assessing their pain. So, to do that, to be able to assess…how alert the patient is, I would ask the patient questions like, “Can you tell me your name?” and “What is your date of birth?”
And, of course, I’ve had patients – many, very many – who may be a bit confused. Maybe they may not be able to tell me their date of birth, so I would further probe and ask questions like, “Can you tell me what today is?” or what day of the week it is, or who the president is.
AB: So, could you give me an example of how a language barrier may impact a nurse’s interaction with a patient? Or you can talk about with a doctor, other health professionals.
CHARLOTTE NWOGWUGWU: Some nurses – maybe for those from Nigeria, for example, which is where I’m from…when we are speaking to individuals in positions of authority or even to patients that are elderly, we -
A. don’t call them by name and B. would use expressions or phrases such as, “Yes, ma.” And, for some individuals, they may find that offensive, because they don’t know what that means. But, from a cultural perspective, that is actually a sign of respect.
I think that when we have nurses who speak a different language, there are also different terminologies that kind of make it challenging. For example, it wasn’t until I came to the United States that I understood that “pants” [in Nigeria] were actually underwear [in the U.S.].
But then there are some biases between the nurse as well as the patient, in terms of 'the nurse does not have a quote American accent so perhaps they may not be able to provide the quality of the care that I expect.'
AB: So, how can – or do – nurses overcome such challenges?
CHARLOTTE NWOGWUGWU: I think that nurses, at least in my experience, have truly done an amazing job with overcoming this. And by this, I mean becoming lifelong learners.
I was really open about my own deficits in terms of what I didn’t know, what I needed to learn because that truly is one of the first steps to really be able to make the change or improve your own quality as a nurse and your own ability to speak the English language fluently. And for me, also, it is important that I practice. And, a lot of nurses will tell you that they do do that.
I’m a firm believer that it takes a village. So…administrators in hospitals also need to take an interest in the nurse workforce and also identify this [strengthening English skills] as an area of improvement.
AB: That’s a great, very thorough answer and it partially answers my next question. So, if someone were interested in the nursing field, what path of study do you suggest for a foreigner who wants to become a nurse in an English-speaking country?
CHARLOTTE NWOGWUGWU: I truly believe that the individual has to make that personal decision whether they would want to study in their own country or here.
Now, with that said, if an individual studies, say, in Spain, for example, or in Nigeria…or whatever country it is, for them to become a nurse – a licensed nurse – here, they still have to take the board exams. So, ya know, my response is really – they have to make that personal decision as to where they would want to get their degree from.
AB: OK great. Well, thank you so much.
CHARLOTTE NWOGWUGWU: Thank you. You’re very welcome.
And, in addition to her job as a global health professor, Nwogwugwu continues to practice nursing. She works part-time at the Perry Point VA Medical Center in Maryland.
I’m Alice Bryant.
Alice Bryant wrote this story for VOA Learning English. George Grow was the editor.
Helpful Words and Terms
midwife – n. a person (usually a woman) who helps a woman when she is giving birth to a child (plural: midwives)
clinic – n. a place where people get medical help
assisted living facility – n. housing for people with disabilities or adults who cannot live independently
surgery – n. medical treatment in which a doctor cuts into someone's body in order to repair or remove damaged or diseased parts
cardiac – adj. relating to the heart
oncology – n. the study and treatment of cancer and tumors
anesthesia – n. a medical treatment that prevents patients from feeling pain during surgery
orthopedic – adj. relating to the treatment of illnesses and injuries that affect bones and muscles
psychiatric – adj. relating to a branch of medicine that deals with mental or emotional disorders
global health – n. an area for study, research and practice that places priority on improving health and achieving equity in health for people worldwide
interaction – n. to talk or do things with other people
consciousness – n. the normal state of being awake and able to understand what is happening around you
elderly – adj. old or rather old
bias – n. a tendency to believe that some people or idea are better than others that usually results in unfair treatment
accent – n. a way of pronouncing words that occurs among the people in a particular region or country
license – n. an official document that gives you permission to do, use or have something
board exam – n. a set of tests you take to be allowed to work in a particular area as a doctor, nurse or other healthcare professional
VA – n. Veterans Affairs
English Programs for Nurses
A good Medical English program for nurses will:
- Teach medical and healthcare terminology
- Teach practical language and expressions
- Demonstrate nurse-patient interactions and offer role-plays to practice these interactions
- Use authentic written materials, such as forms and hospital charts
- Offer practice tests in listening, speaking, reading and writing
Sources: OET and other sources
After meeting their educational obligations, some foreign-educated nurses must take one of these English proficiency exams:
- Test of English as a Foreign Language (TOEFL)
- Test of English for International Communication (TOEIC)
- International English Language Testing System (IELTS)
Which test they must take will depend on their home countries.
Some countries, including Australia, Namibia, Dubai and New Zealand, require something called the Occupational English Test (OET) for healthcare workers.
However, those who attend nursing school in the U.S., Canada (except Quebec), the U.K., Ireland, Australia or New Zealand are exempt from the tests. For other countries, if the nursing school taught in English and the textbooks were in English, they are also typically exempt.