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Are you a
competent preceptor?
Here’s a practical guide for helping an international nurse adapt to the culture and
practices of nursing in North America. BY MARLENE V. OBERMEYER, RN, MA

IF YOU’RE A PRECEPTOR for tional nurses undergo a rigorous Try to speak clearly (not loudly),
new nurses, chances are that you’ll process of educational approval and enunciate. If English is her
be mentoring a foreign-educated and certification. Most state boards second language, give her time to
nurse in the very near future—if of nursing require them to earn the mentally translate your spoken
you haven’t already. With projec- Commission on Graduates of words into her native language,
tions showing a nursing shortfall Foreign Nursing Schools (CGFNS) formulate an answer, and then
in the United States of almost 1 certification with a test of nursing translate it back into English.
million nurses by 2020, the trend knowledge, written and oral exams Avoid using expressions that
toward hiring international nurses of English proficiency, and a cre- have a meaning different from their
is likely to continue. dentials review. Then they must literal meaning, such as “He was a
What challenges do these nurses pass the NCLEX exam to get their wreck.” Instead, rephrase your
face in their new environment— U.S. nursing license. statement. For instance, say, “He
and how can you, as a culturally Most nurses coming here have was very upset about his mother’s
competent preceptor, help them had several years of relevant illness.”
succeed? In this article, I’ll answer nursing experience. Ask the An international nurse might pre-
these questions with practical nurse you’re mentoring about fer to demonstrate a procedure in-
advice and examples. hers. How long has she worked stead of describing it to you. Always
in nursing? What’s her specialty? let her ask questions.
Reassurance and respect This will give you a baseline for
American nurses worry about the assessing her performance. A matter of style
quality of international nurses’ In the United States and Canada,
education and experience and may Communicate with care we have a direct communication
assume that their knowledge and Although international nurses have style with straightforward talk.
skills are inferior. to pass English exams, cultural dif- People from non-Western cultures
“I felt like I was under a micro- ferences can alter the meanings of are more likely to have an indirect
scope for over a year. Everything I verbal and even nonverbal commu- communication style. When some-
did was triple-checked. I wasn’t nication. Using idioms, nonstan- one who communicates with an
allowed to make any nursing judg- dard English, and slang, or speak- indirect style says yes, don’t assume
ments on my own.” ing too fast, can cause misunder- she’s agreeing; she might simply
What you can do. First of all, be standings. mean, “I hear what you’re saying.”
reassured that most international “I was afraid to answer the She might favor ambiguities and
nurses have gotten a good educa- phone. It was hard enough under- generalizations to avoid offending
tion. Nursing students in the standing people face-to-face.” you. People from direct cultures
Philippines, for example, use What you can do. Use standard may misinterpret indirect responses
American textbooks. After they grammar when you’re talking with as dishonesty or hedging.
come to the United States, interna- a nurse who’s new to this country. People from different cultures

54 Nursing2006, Volume 36, Number 6

A snapshot of our international nurses position, and sex. In this cultural
These data were gathered from 1978 to 2000:
context, nurses may accept pater-
• 69% are between ages 23 and 32. nalistic attitudes from physicians.
• Most (73%) come from the Philippines. Fewer nurses hail from the United An international nurse may need
Kingdom (4%), India (3%), Nigeria (3%), and Ireland (3%). support as she adjusts to the
• 15% are men—a greater proportion than found in American nursing (6%). physician-nurse relationships in
• Most (over 80%) have a bachelor’s degree. About 18% have a the United States. For example, she
diploma or other nondegree education. needs to become comfortable clari-
• More than 60% received their nursing education in English, but more than fying and questioning orders,
80% speak another language as their first language. explaining situations, and being
Source: Foreign-educated nurses and the changing U.S. nursing workforce, Nursing Administration
Quarterly, CR Davis and BL Nichols, Winter 2002. assertive with other colleagues and
advocating for patients.
“When I was in Thailand, I
interpret body language in different tivist society, group harmony in learned how to shut up. When I
ways. For example, in the United relationships takes precedence over came to the United States, I
States, eye contact is a sign of most other matters. People from learned to speak up.”
respect and honesty; in other cul- these societies tend to blur the line What you can do. Be a good role
tures, looking down and avoiding between friendship and business. model. For example, have her ob-
direct eye contact is a sign of Nurses from some cultures may serve while you talk with a physi-
respect, and direct eye contact may speak their native language when cian on the phone, read back the
even be considered hostile. they’re together to express their order verbatim, and ask for clarifi-
“When I spoke to Maria about a group solidarity. This can seem cation, then discuss what you did
medication error, she couldn’t even rude to an outsider, but they don’t with the nurse. Let her practice or
look me in the eye. I felt like she necessarily mean to exclude you. role-play; be available to provide
wasn’t being truthful.” “If an American goes to Japan support when she feels ready to
What you can do. If you com- and meets an old neighbor from handle calls or discussions on her
municate directly, an international home, would they speak in own. Make sure you give appropri-
nurse may think you’re aggressive Japanese?” ate feedback and reinforcement.
and insensitive. So instead of say- What you can do. To build trust,
ing, “You should have introduced first establish a personal relation- Reap the benefits
yourself to your patient,” you ship with one nurse from a group- Foreign-educated nurses not only
might say, “Next time we go to a oriented culture. Express genuine add cultural spice to your work
patient’s room, let’s make sure we interest, not only in who she is but environment, but they can also be
introduce ourselves.” also in her family. Understand that a valuable resource when you’re
group-oriented cultures may not caring for patients from other cul-
Groups vs. individuals value privacy in the same way tures. Ask international nurses for
Some cultures—Asian, Latin American culture does. their input and show that you
American, and Middle Eastern Cover the concepts of liability value their contribution.
ones in particular—are collectivist and malpractice during general ori- By helping international nurses
or group-oriented. In contrast, cul- entation and reinforce them during succeed, you help your patients
tures in North America and West- clinical orientation. Be familiar come out ahead too. ‹›
ern Europe tend to be individualis- with and review the nurse practice SELECTED REFERENCES
tic. This too can lead to misunder- act with her as you encounter spe- AcademyHealth. Migration and the global short-
standings. cific situations. age of health care professionals. http://www.
The values of someone from an Accessed October 24, 2005.
individualistic culture include per- Speaking up Davis CR, Nichols BL. Foreign-educated nurses
and the changing U.S. nursing workforce. Nursing
sonal responsibility, accountability, Some cultures value hierarchy in Administration Quarterly. 26(2):43-51, Winter 2002.
privacy, and competition. Business relationships. This can conflict Hofstede G. Culture’s Consequences: Comparing
is business, even if you’re friends with the Western cultural values Values, Behaviors, Institutions, and Organizations
across Nations, 2nd edition. Thousand Oaks,
with a colleague. In an individual- of equality and opportunity for Calif., Sage Publications, 2001.
istic society, people may also be everyone. In some cultures, such Marlene V. Obermeyer, originally from the Philippines,
more legalistic and litigious. as those of the Philippines and is an independent continuing-education provider in
cultural competency, offering online and on-site cours-
In a group-oriented or collec- India, respect is based on age, es in Wichita, Kan. Nursing2006, June 55