Imagine being ill and hospitalized without the ability to communicate with those providing care. An estimated 14% of people living in Illinois from 2010- 2014 were foreign-born. According to the United States Census report from 2010-2014, among people at least five years old living in Illinois during this time period, 22% spoke a language other than English at home. 41% of those reported that they did not speak English, “very well.” 1,2
This poses major challenges and safety risks when navigating the American healthcare system. The Joint Commission studied 6 accredited hospitals, comparing adverse events of patients with limited English Proficiency (LEP) to those with English as a primary language. They found that 49% of patients with LEPs were involved in an adverse event that resulted in physical harm compared with 29.5% of English proficient patients.2 The significantly different findings clearly demonstrate the serious need for culturally and linguistically competent services especially by care providers who are bilingual and bicultural.
Imagine having studied to become a registered nurse (or any other profession) and being unable to work in your profession. Immigrants in the U.S. face this reality, especially those nurses who live in Illinois. Internationally Educated Nurses (IEN) are underutilized in healthcare. According to data from the American Community Survey, In Illinois, 10% are underemployed and 2 % are unemployed. 1
Barriers to Nursing Practice
Internationally educated nurses are presented with several barriers in obtaining licensure in the U.S. The barriers in Illinois, as identified by the Chicago Bilingual Nurse Consortium, include lack of English proficiency, lack of clear information about the licensing system, difficulties in obtaining credentials from home countries, educational requirements that do not necessarily reflect the nurse practice act, a test format that is often very different from the format used in home countries, testing deadlines requiring passing the NCLEX within 3 years of application, and financial constraints. The licensure process could take several years for many IENs given the barriers.
To assist IENs in addressing these challenges, the Chicago Bilingual Nurse Consortium, (CBNC), a 501(c)(3) was founded in 2002. CBNC’s mission is to increase the number of internationally educated nurses for practice as bilingual bicultural nurses in metropolitan Chicago and surrounding communities through advocacy, education and supportive services. The focus is to prepare IENs to achieve licensure in Illinois. The consortium began with a special focus on Hispanic nurses, but as it developed nurses from other countries sought out the services. Since its founding, CBNC has served more than 700 IENs from over 60 different countries. It is the only centralized resource for immigrant IENs in Illinois and only one of a few in the United States that offers programs and services to enable IENs to adapt to U.S. health care systems and culture. The Chicago Bilingual Nurse Consortium is funded totally on grants and donations.
Using a case management approach, CBNC provides counseling to IENs about the path to licensure and assists them in planning and navigating the Illinois licensure process in a meaningful way. Since its inception, 92% of the reported CBNC candidates who took the NCLEX passed and attained licensure, compared to the 31.67% reported by NCSBN for IENs in 2015.
CBNC staff provides support and encouragement for the candidates in many ways including being a phone call away to answer questions and soothe nerves. Some of the educational programs that are provided by CBNC include: English Conversations in Nursing, Mentoring and English for International Nurses-Seminar, Writing Workshop for IENs, TOEFL Workshops, NCLEX Preparation course, NCLEX Peer Seminar, Therapeutic Communication Workshop, Resume Writing and Interview Skills Workshop and the CPR Course.
Each of our IEN’s present with a unique set of circumstances based on their country of origin and their individual struggles. At times the candidate may have graduated from their basic nursing program at least 5-10 years prior to coming to the United States. Not unlike nurses going back to school in America, this experienced nurse needs to develop the discipline to become a student again, along with learning the language, seeking employment and avoiding the pitfalls of programs that would like to exploit them. This laborious process can lead to feelings of disappointment and a sense of hopelessness to follow the calling of nursing.
SEE ALSO: Cultivating Diversity
Graduates Speak Out
As one of our graduates Heleine Kaha, RN, from Cameroon, West Africa states:
“Being born in a village in Cameroon, as the sixth of seven children, I was fortunate to graduate from high school. I was blessed with a loving and hardworking mother who valued education. I remember my mother holding my hands, saying “My Daughter, I feel your passion for nursing, but I cannot afford nursing school. I pray that God grants your wish someday.”
I moved to America in 2001, after our mother passed away. By 2005, I was working as a CNA and taking English classes at College of DuPage. Encourage by my patients I enrolled to nursing school in 2009. Nursing school was a rough journey but with the support of my instructors I graduated in 2012. I took the board exam a couple of times and was disappointed and discouraged that I had not passed. I was confused and depressed.
One day a friend introduced me to a former student of Chicago Bilingual Nursing Consortium (CBNC). I learned so much in a short time. The NCLEX-RN Preparation Course taught me about the fundamentals of nursing and other areas that I was struggling with. Through CBNC I learned how to use critical thinking and problem solving to answer questions. The instructor gave me the support and encouragement I needed to be successful and pursue my BSN.” I have been working as a RN for over 18 months and am pursuing BSN at Benedictine University. I will graduate in spring 2016. I thank God every day for making my dream come true. Thank you, America.”
Yet another story from Valentina Figueroa, RN, from Chile tells us:
“Moving to a new country is never easy. You leave behind your family, your job and even your language. You need to start all over again, even if you have already spent lots of years earning your diploma.
When I first arrived to the US, 3 years ago, I had to start from the basics. After taking some classes to improve my English, I found myself lost and alone in a very long a bureaucratic path to validate my degree.
The whole process is far from being easy. You need to take a couple of very difficult exams on top of doing all the paperwork.
I consider myself very lucky to have found CBNC on my way. They helped me in so many ways that any statement I could make would not be enough. At CBNC I got all the information and support needed to navigate through the whole process. I had the opportunity to take classes to prepare for the NCLEX-RN which were fundamental for me to finally pass the exam. Finally, but not least, I met a very nice group of people that convinced me that it was possible for me to get my goals. I’m very thankful to have found them. My story would be very different without them.”
Lucia Pelayo-Robles, RN, from Mexico, also describes her experience:
“I had forgotten that I was a nurse, I thought it was impossible to become a registered nurse in the US because of all the requirements and the paper work. The Consortium made it easier and possible to become a nurse again. It opened hospital doors to me not as a patient but as a nurse-offering me the opportunity to practice nursing again. Through the consortium I met others in similar situations and made new friends. The consortium provided the support and courses that met each individual’s need at their level-whether it was English, Nursing or both.”
Meeting Immigrants’ Medical Needs
In the future, CBNC plans to provide continuing education programs for nurses and hospitals on cultural awareness issues in healthcare. English Conversations in Nursing is being expanded to include other licensed RNs. Nursing peers from all cultures have rich experiences to share that contribute to everyone’s learning.
Bilingual and bicultural nurses are essential for meeting the healthcare needs of a growing immigrant population. As baby boomers age, the nursing population in the U.S. will also decrease. It is projected that we will be facing a significant Nursing shortage. It is projected by the Bureau of Labor Statistics there will be more than a million job openings for nurses. (4) A natural resource to address these challenges is the Internationally Educated Nurse. The path for licensure needs to be made easier so that IEN’s contributions to the U.S. Healthcare system can be made and immigrant patients’ care is safer.
Imagine how comforting it is if you are in a foreign country and your nurse communicates in your language and understands your needs. How safe does that make you feel?
1. Lebold, Mary; Lopez, Fanny; Hernandez, Elsie; Salinas, Graciela; and Smith, Virginia; August 2014; Barriers to Licensure and workplace Integration for Internationally Educated Nurses in Illinois (White Paper)
2. United States Census: American Community Survey Geography: Illinois, U.S. Department of Commerce; access date 1/29/2016, http://thedataweb.rm.census.gov
3. Divi, C ; Koss, R., Schmaltz, S., and Loeb, J. February 2007; Language proficiency and adverse events in US hospitals: a pilot study. International Journal for Quality in Health Care. Volume 19, Number 2; pages 60-67
4. Grant, R., February 3, 2016 , The U.S. Is Running Out of Nurses, access date 2/8/2016, http://www.theatlantic.com/health/archive/2016/nursing shortage/459741
Paula Schipiour is director of marketing and development and an instructor at the Chicago Bilingual Nurses Consortium, Fran LaMonica is the executive director of the Chicago Bilingual Nurses Consortium. Maria Cervera is the administrative assistant at the Chicago Bilingual Nurses Consortium.