What you want? Communication challenges at work

Foreign graduate nurses working in the U.S. must demonstrate proficiency in written and spoken English before they receive their license to practice. Language and communication have been cited as the most critical skills that foreign nurses need especially during their first year in the U.S.

A foreign nurse was reported to the nurse manager by an angry patient. He said that the nurse was rude. "She just walked in here and said, ‘What you want?’"

Apparently, in the nurse's native language, there is not much distinction between wants and needs, and she was just translating words from one language to another.

Communication requires more than knowing the language. Beliefs, values, and unwritten rules for behavior are embedded in culture and expressed in verbal or non-verbal ways. Culturally competent communication builds credibility and helps establish relationships.

Rules for taking turns in conversations, interrupting, appropriateness of topics, laughter, speech volume, directness or indirectness, etc. are culturally determined.

In the U.S., directness in speech is highly valued. People usually express their opinions and feelings freely. People from other cultures may value group harmony more than individual expression, and may not want to challenge ideas or positions so publicly.

Eye contact may be a cause of misunderstanding. A nurse coming from a culture where it is considered respectful not to look at a person directly during a conversation, may be construed as dishonest or disrespectful in certain contexts.

There have been situations where nurses were seen as less skilled or even incompetent due to language and cultural differences.

Miscommunication can not only lead to unfair misinterpretations, painful misunderstandings and unintended insults, and in the health care setting, miscommunication can even be dangerous. Both the incoming foreign staff and the host country staff need to be prepared and educated culturally in order to ensure effective multicultural teams that respect and value diversity not only in their members but also in their clients.

It is a federal mandate that health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in cultural and linguistic competency. (CLAS standard #3)

"The most important thing in communication is to hear what is not being said." Peter Drucker.