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Enhancing communication skills with additional language acquisition

Lundgren, Laura, BS, RN

doi: 10.1097/01.NURSE.0000546457.40875.d1
Feature: New Horizons

Abstract: Miscommunication in a healthcare setting can be deadly, and language barriers between nurses and their patients can be a major factor. Having the ability to communicate with non-English-speaking patients strengthens communication and trust between a patient and nurse and helps prevent medical errors. This article discusses why nurses should pursue this valuable skill and how to start.

Communicating with non-English-speaking patients can strengthen nurse-patient relationships and prevent errors. This article explores why nurses should pursue additional language skills and discusses how to get started.

Laura Lundgren is an RN at Blank Children's Hospital in Des Moines, Iowa.

The author has disclosed no financial relationships related to this article.



AS A YOUNG NURSE, I worked with a patient who did not understand a word I said. Recalling 2 years of high school Spanish and a third in college, I attempted to introduce myself. Her eyes lit up and she spoke a string of words that I almost understood but could not quite catch. Despite my Spanish-language education, I felt woefully underprepared to communicate with my patient in a clinical setting. I could imagine how she must have felt to escape to the US as a refugee only to find herself sick in the hospital, unable to understand the basics of care without using an awkward, impersonal telephone or third-party translator service.

Inspired by this frustrating encounter, I reviewed my Spanish with a focus on healthcare and aimed to become fluent. As I connected with other people, I was surprised by how few healthcare professionals were interested in learning another language. Yet doing so can have many benefits for healthcare professionals.

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The benefits

Learning languages improves communication, enhances patient safety, and helps prevent medication errors and a lack of informed consent, which are among the leading causes of adverse events in patients with language barriers.1 In a recent lawsuit in Hawaii, the plaintiff claimed that a lack of translation services led to the death of an infant whose pneumonia went undiagnosed.1 In another case, a hospitalized Spanish-speaking man spent 2 days in the hospital without anyone discussing his care plan or diagnosis with him until just before his death.2 Clearly, patient safety and well-being can be severely compromised when nurses do not understand their patients' language or culture.3

When I was able to communicate directly with my patients, I learned quickly that due to modesty or cultural issues, patients do not always give medical translators correct information. For example, we almost kept a patient in the hospital for an extra day when she insisted to the male translator that she was not passing gas after an abdominal surgery, but when I spoke to her in Spanish, she told me she'd been passing gas perfectly fine. This saved her and the hospital money and time in additional diagnostic studies.

In terms of professional advancement, learning another language separates a nurse from the pack while applying for jobs. It's a valuable skill that most healthcare workers do not have, so all things being equal, the person who can speak a language common in the area has a significant advantage over those who do not.

For some established nurses, additional language skills may lead to a raise. Some hospitals pay bilingual employees a higher salary.4 Be sure to go through a formal qualification/certification process should you desire to translate for peers or plan to ask for a higher salary to do so.

A word of caution: Being a language novice is fine for conversation and meeting basic needs. If, however, you're translating complex medical ideas, consider becoming certified as a medical interpreter. Translating information inaccurately can lead to the very errors we seek to prevent. It's also more legally defensible in a negligence or malpractice lawsuit (see What are the legal implications of language learning?).

If you do become certified, make sure you have a clear understanding about translating expectations with your unit manager; remember, your first responsibility is to your patients as their nurse, not as a translator. You can find more information on certification from the National Board of Certification for Medical Interpreters at

Finally, it's fun to connect with people from different cultures, especially when they do not expect it. Learning a new language is the first step in learning about a new culture. Because I'm a white woman in the Midwest, most of my patients do not expect me to say more than “hola.” Seeing the surprised, happy looks on their faces when I attempted to speak to them, however poorly, brightened my day and theirs.

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Dispelling myths

Learning a language can be intimidating, but it's not as scary as it seems. Let's do some language-learning myth busting.

  • It's too late to learn. Perhaps the most pervasive myth out there is that babies and children are better language learners, and that once you reach a certain age, it's too late. While there is truth to the notion that you must develop some language skills before a certain age, adults are often better language learners than children because they can think more analytically and memorize faster.5 With larger vocabularies, adults also have more words to translate exact meanings.
  • Language learning is for people whose interests and skills are more arts-related. Healthcare workers tend to avoid learning languages because they think they may not be good at it. Sure, English majors and people with a natural affinity for language can learn second, third, and fourth languages, the thinking goes, but science-minded people like facts and concrete ideas.

One initiative I took to improve my skills was attending a Spanish conversations group session at the local library. Surprisingly, I was the only healthcare professional in the room. Perhaps even more surprising to me was that not a single person with a liberal arts degree attended. The most common professional field in the group by far? Engineering.

This might be surprising on the surface, but think about it. Language learning is highly analytical. Figuring out the structure to a language is half the battle. Healthcare professionals have even greater need to learn languages than engineers, and if another math- and science-based profession can find a way to make it work, so can healthcare professionals.

  • I do not have time and/or I do not know where to begin. Perhaps the toughest obstacle for potential language learners is not knowing where to begin or how to fit it into an already crowded schedule. If this is your worry, keep reading to learn how to begin.
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How to get started

First, set a goal. Are you aiming for fluency, or do you want to know just enough to converse informally with your patients? If you want to become fluent, I recommend reading Fluent in Three Months by Benny Lewis (2014).6 Whether or not you can actually become fluent in 3 months is debatable and depends on time and effort. It is, however, an excellent resource for those learning any language from scratch. Various online apps and courses are also available. Apps are not adequate for achieving fluency or translating for your patients, but they are great for beginners and for building conversational skills (see Web language-learning resources for nurses).

To find books and online courses for healthcare professionals, simply search for your target language and add “for healthcare professionals.” Books can provide a good overview for beginners, and may come with a CD for practicing pronunciation and conversations with patients. Online, you can find shared card decks already assembled for healthcare professionals wishing to learn another language. These will not teach pronunciation or context, but they can help build your vocabulary. You can also make your own cards. If you're short on time, review no more than 10 cards per day. This rarely takes more than 10 minutes.

Communicating with patients in the language they are most comfortable with will ensure the patient receives a higher quality of care. Enhancing nursing skills with language acquisition can be personally, professionally, and financially rewarding.

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What are the legal implications of language learning?

While further language acquisition is commendable, nurses should ensure they are in a legally defensible position should something go wrong. Ensure certified medical interpreters are the ones translating complex medical information or become certified yourself.2 Federal laws such as the Civil Rights Act require hospitals to provide adequate language services for patients.7 The Affordable Care Act also requires providers to offer qualified translation services to patients.7 According to the National Council on Interpreting in Healthcare, bilingual individuals may converse with patients but must ensure they are not providing interpretation services without becoming formally qualified. Interested nurses should check their facility policy on interpretation services to ensure they're following facility procedures as well as federal and state laws.8

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Web language-learning resources for nurses

Think Cultural Health—Sponsored by the Office of Minority Health, part of the US Department of Health & Human Services, this website includes information, guidelines, continuing-education opportunities, and other services for healthcare professionals interested in learning about culturally and linguistically appropriate services. It also offers recorded presentations on topics related to cultural competency and learning a new language, and an online library of resources. Access this site at

National Council on Interpreting in Health Care (NCIHC)—A nonprofit organization that aims to promote and enhance language access in the US healthcare system, the NCIHC offers webinars for healthcare interpreter trainers. Each webinar includes practical guidelines and approaches, as well as an array of reference materials. NCIHC also provides the National Code of Ethics and National Standards of Practice guidelines for interpreters in healthcare. Find this site at

American Translators Association (ATA)—This nonprofit organization offers a wide range of information on translation services and information on becoming an ATA-certified translator. The site also features online directories to help users locate an appropriate freelance translator or a language services company. This website can be found at

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1. Friedheim N. Baby death lawsuit cites a hospital language barrier. 2016.
2. Rice S. Language liabilities. To avoid errors, hospitals urged to use qualified interpreters for patients with limited English. Mod Healthc. 2014;44(35):16–18, 20.
3. Timmins CL. The impact of language barriers on the health care of Latinos in the United States: a review of the literature and guidelines for practice. J Midwifery Womens Health. 2002;47(2):80–96.
4. Huang J, Jones K, Regenstein M, Ramos C. Talking with Patients: How Hospitals Use Bilingual Clinicians and Staff to Care for Patients with Language Needs. Washington, DC: Department of Health Policy, School of Public Health and Health Services, The George Washington University; 2009.
5. Rubin J. What the “good language learner” can teach us. TESOL Q. 1975;9(1):41–51.
6. Lewis B. Fluent in 3 Months: How Anyone at Any Age Can Learn to Speak Any Language from Anywhere in the World. 1st ed. San Francisco, CA: HarperOne; 2014.
7. National Council for Interpreting in Health Care. FAQs—healthcare professionals. Information about providing language access services. 2017.
8. Hunt DB. New 2016 ACA rules significantly affect the law of language access. CM Elearning. 2016.

languages; language learning; bilingual; Spanish

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