NURS 618 Week 4 Discussion Board Forum 2 on Teaching Learners for Whom English Is an Additional Language Example

Discussion Board Forum 2: Supporting Nursing Students Who Learn in an Additional Language

NURS 618 Nurse Educator II: Teaching Strategies, Discussion Board Forum 2

Thread by [Student Name]

The students and classmates replied to are composites written for a model discussion.

Last term, a student in my preceptor's medical-surgical course was one of the strongest in clinical: quick to notice changes, careful with medications, kind with frightened patients. On unit exams, the same student scored in the low 70s. When we reviewed missed items together, the student understood every nursing concept once the question was explained in plain words. What had been tested was not nursing knowledge but the speed of reading complex English under time pressure. A question about fluid restriction, for example, had used the phrase "the client voices understanding but continues to sneak drinks," and the student had never encountered "sneak" used that way. My argument in this forum is that nurse educators must separate language from nursing knowledge when we teach and test students who learn in an additional language, so that our evaluations measure what we intend.

Billings and Halstead (2016) emphasize that educators should recognize the diverse backgrounds learners bring and adapt teaching and evaluation so that all learners can demonstrate what they know, and Halstead (2007) lists facilitating the development of diverse learners among the core competencies of the nurse educator. Recent research shows what that requires. Thompson and Hawkins (2026) surveyed 41 graduate nursing students in an online program who spoke 27 different native languages. Confidence in completing the program was high, but three challenges stood out: the time burden of learning in a second language, the effect of language on testing, and vulnerability in communication, such as speaking in synchronous sessions. The authors called for linguistically responsive teaching grounded in equity-mindedness.

Each challenge suggests a practical change. For the time burden, I would post lecture slides and key vocabulary lists before class, so students can preview terms. For testing, I would revise items to remove idioms, double negatives and unnecessarily long stems, and I would ask a colleague to read new items specifically for language that tests reading rather than nursing; the standard stays the same, but the noise is reduced. For communication, I would allow students to contribute to discussions in writing as well as aloud, and give feedback that names specific phrases to improve rather than general comments about grammar. In clinical settings, I would pair students with a peer for handoff practice before they give report to staff, since report is one of the most language-heavy tasks a student performs and one where mistakes carry real risk. I would also check my own speech, slowing down, avoiding slang, and writing key instructions on the whiteboard, because educators often contribute to the language burden without noticing. None of these changes lowers expectations; they remove obstacles that have nothing to do with being a safe nurse.

The apostle Paul wrote that unless the church speaks "speech that is intelligible," hearers cannot know what is said (English Standard Version Bible, 2001/2016, 1 Corinthians 14:9). That principle applies to nurse educators as well: a test or lecture that learners cannot understand fails as communication, regardless of how accurate its content is. Clear language is not a concession; it is good teaching for every student in the room.

Reply to Hannah

Hannah, I agree with your point that students from different cultural backgrounds may respond differently when they witness an error in clinical practice, and that we cannot assume every student will speak up in the same way. A recent qualitative study supports your observation. In interviews with 25 international undergraduate nursing students from Middle Eastern, African and European backgrounds studying in Türkiye, researchers found that culture shaped how students framed patient safety morally, how they attributed errors and how they responded to safety violations, even though all groups shared a basic ethical commitment to safety (Aktaş & Güneş, 2026). That suggests your idea of explicitly teaching how and when to speak up, rather than expecting it, could help many students, not only international students. Practicing short scripts in simulation, such as "I need to stop and check this dose," might make speaking up feel less like a cultural risk. Proverbs 28:1 says that "the righteous are bold as a lion" (English Standard Version Bible, 2001/2016), and part of forming righteous nurses is helping them find that boldness on behalf of a patient at risk. Have you found, in your own clinical groups, that students are more willing to speak up with peers than with staff nurses? If so, simulation with peers might be a good place to start building the habit before students face it on a busy unit. Pairing the script practice with a short debriefing about what made speaking up hard could also surface cultural expectations students rarely put into words.

Reply to Marcus

Marcus, your reflection on how one clinical instructor's patience helped you through your first semester as a career-changer from accounting made me think about how much instructors influence students who already feel like outsiders. A recent scoping review speaks to this. Gilmer et al. (2026) found only a handful of studies on instructors and student resilience, but the themes were consistent: instructors equip students with ways to cope, their own teaching qualities matter, they can stretch what students are capable of, and they set the tone of the clinical setting. The evidence base is small, but it matches your experience: an instructor who notices a struggling student and responds with patience can change that student's whole trajectory. For students learning in an additional language, the same is likely true, because they often carry extra stress in clinical settings where conversation moves quickly. Isaiah 50:4 speaks of being given "the tongue of those who are taught, that I may know how to sustain with a word him who is weary" (English Standard Version Bible, 2001/2016), and that is a good description of what your instructor did for you. What specific things did that instructor do, in those first weeks, that you plan to repeat with your own students next year, when you begin teaching on your own? Sometimes the small habits, like checking in privately before a hard shift, are the easiest to forget once we are the busy ones. Writing them down as part of your practicum goals might keep them visible.

References

Aktaş, Y. N. K., & Güneş, Ü. (2026). Cultural influences on patient safety error responses among nursing students: A qualitative study. Nurse Education Today, 166, Article 107291. https://doi.org/10.1016/j.nedt.2026.107291

Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). Elsevier.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Gilmer, C., Woods, P., & Murdoch, N. H. (2026). How clinical instructors affect resilience in undergraduate nursing students during clinical education: A scoping review. The Journal of Nursing Education. Advance online publication. https://doi.org/10.3928/01484834-20260708-02

Halstead, J. A. (Ed.). (2007). Nurse educator competencies: Creating an evidence-based practice for nurse educators. National League for Nursing.

Thompson, C. N., & Hawkins, D. E. (2026). Operationalizing equity-mindedness for graduate English as a second language students in online nursing programs. Journal of Professional Nursing, 66, 170-177. https://doi.org/10.1016/j.profnurs.2026.07.001