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Yu-Jhen Wang
Professor Carlisi
ESL 033B
Project 3 final draft
13 Dcember, 2016
InternationallyEducatedNursesBeingDiscriminatedintheUnitedStates

Introduction
There are many nurses who come from all over the world to the United States
to work due to the shortage of nurses in the U.S. Thesenursesarecalledinternationally
educated nurses or IENs and they received the basic nursing education in their own
countriesbeforetheycametotheUnitedStates.IENshaveplayedessentialrolesandhave
highpercentageinhospitalintheUnitesStates(Wheeler,397).AlthoughIENsareimportant
forthehealthcaresystem,theyhavesomedifficultiesworkinginthehospitals.Firstofall,
accordingtoWheeler,Foster,andHepburnsresearch,IENsarediscriminatedbypatientsand
patientsfamiliesbecauseofthecountriestheycomefrom,culturaldifferences,andtheway
theyspeak.TheypointoutthatIENsdonotreceiveequaltreatmentbyhospitalandcolleague
aswell(Wheeler,355).InthearticleWorkplaceDiscrimination:AnAdditionalStressorfor
InternationallyEducatedNurses,theauthorMariaBaptistealsomentionsthatthesepatients
donottrusttheseIENs.SomeevenrejectbeingtreatedbyIENs.ThesebehaviorscauseIENs
toexperiencephysicaleffectsandemotionalproblems(Baptiste par.1).Secondly,theseIENs
feel overwhelmed when they have to provide healthcare. Some IENs complain that it is

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challengingforthemtotakecareofcertainnumberofpatientsintheirshiftanditmightbe
hardtoprovidethebestcareiftherearenotenoughnurses.IENswhointerviewedbythe
researcherssaidthatthelanguagebarriersarethemajorreasonscausingdiscrimination.Some
U.S.educatednursesandpatientshavedifficultiesunderstandingwhatIENsaretryingto
express(Wheeler,400).IfIENswanttodecreasetheamountofdiscrimination,theyshould
improvetheirlanguageskillsespeciallyoralproficiencyeventhoughtheirracesandskin
colors cannot change due to their nationality. Moreover, IENs who come from different
countriesandhavedifferentskincolorshouldadjusttheirattitudetowardsdiscrimination.
AdeniransuggeststhattheU.S.governmentshouldassistIENstointegrateintothehealthcare
systembyopeningtheprograms(Adeniran).
Improvingtheinterpersonalskillstogainpatientsandcolleaguesrespectis
significant forIENs workingin theUnited States. Gettingeducation fromoutside ofthe
UnitedStates,IENsarehavingenoughknowledgeofclinicalskill.However,theirlimited
languageskillcausesthemtoexperiencediscriminationinthehealthcaresystemintheUnited
States.Ontheother hand,it is difficultforIENs touseEnglishwhen theyare working
surroundedbyallEnglishspeakingcolleaguesandpatientssinceEnglishisnottheirfirst
language.Ingeneral,duetolackofconfidencefromtheirimperfectlanguageskill,IENs
experiencesomestressandphysicaleffectswhentheyarecommunicatingwithothers.
There are several types of discrimination by different people in IENs
workplace.Firstofall,IENsarediscriminatedbypatientsandtheirfamiliesduetoIENs
languagebarriers.Forinstance,patientshavedifficultyunderstandingwhatIENsaretryingto
say.AccordingtoWheel,Foster,andHepburnsresearch,someIENsreflectedthatpatients

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rejecttoreceivetheircareandrefusedtolistentothembecausetheyhaveaccent.Inthe
research The experiences of internationally educated nurses in the southeastern United
States, the author mentioned that patients commented negatively and sometimes even
rejectedIENswhenunabletounderstandtheiraccentedEnglish(Wheeler,400).Itisavery
seriousproblemthatpatientscannotclearlyunderstandtheirhealthconditionexplainedby
IENs.Itisevenmoreseriouswhenpatientsareconfusedaboutthetreatments.AlthoughIENs
havemanyclinicalexperiences,theystillfacechallengestousetheirlimitedlanguageskills
toworkintheirworkplace.IENspointedoutthattheyaretreatedwithdisrespectbypatients
andtheirfamiliesthatpatientssometimesdiscriminatedthemwithquestionsandbadattitude.
IENsreportedbeingquestionedaboutwheretheyarefrom,wheretheyattendednursing
school,howlongtheyhavebeennursesandhowlongtheyhavebeenintheUnitedStates
(Wheeler,354).
LanguagebarrierimpactsIENsinmanyotherways.Forexample,IENsarenot
familiarwithhealthcaresystemsmedicaljargonsuchasidiomsandabbreviationsbecause
they learned Nursing knowledge in other language. Some technical words have different
meaningsandare usedindifferentsituationthatIENsarenotfamiliarwith.Overall,these
problemsmadeIENsintegrationintonewworkplaceespeciallydifficult.Forthesefactors
above,IENscannotgiveasenseofsecuritytopatients.Adeniranmentionsthatpatientsmight
think that IENs communicating skills would affect their professionality and healthcare
qualities.(Adeniranpar.4).
Additionally, IENs are not treated equally as other employees. Supervisors
favorcertainethnicgroupsbecauseoftheraceandlanguageissue.Internationallyeducated

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nurses work longer and have heavier workload than other nurses (Wheeler, 400). IENs
usually work longer hours but get paid with the same salary as U.S. educated nurses.
Sometimes, they are even given more work to do. In some cases, IENs are threated by
supervisors and hospitals that they would work without pay from hospital. IENs might
experiencesomeunreasonabletreatments.Theirpassports,workvisa,andpermitsareoften
heldbyemployerswhentheyfirstcametotheUnitedStates.Thesesufferingsarenotfairfor
themjustbecausetheyaskforajob.
Furthermore, IENs experience discrimination when it comes to advanced
position. Most of the IENs felt difficult being raise their salary and promote to higher
position.OneoftheresearchesshowsthatsomeIENshavehardtimepromotedandhaveless
opportunitiestohavebetterchance.OneIENssaidthatU.S.educatednursesalwayshave
morechancetogetinwheneveryonecompetesforthesameposition.
Accordingtoresearches,IENsareasktoworkinlowerpositionwhentheyare
hiredbyhospitalduetotheiridentityandlanguagebarriers.TheauthorWheelersaidWhen
theyhiredme,Iwasmuchlowerthanothernurses(Wheeler,354).Stayinginlowerposition
isacommonsituationformanyofnewIENs.Languagebarrieristhemajorfactorthatcauses
IENs to be doubted by employers because hospitals have to make sure that patients are
satisfied while staying in hospital. It is important for them to get proper care by every
healthcareprovider.Hospitalstrytomaintainhighqualityservicetoallpatients.
Lastly, IENs are discriminated by other colleagues because their
communication ability is very limited. Some colleagues might see IENs differently just
becauseoftheskincolor.Raceandskincolordifferencesaretwocommonstereotypesrelated

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tohowgoodpeoplesEnglishability.However,havingthesameskincolordoesnotmean
IENs are accepted by either white of African American nurses (Wheeler, 355). First
expressioniswhatpeopledetermineotherswhentheyfirstmeetevenwithoutcommunicating
andknowingwitheachother.IENsarealsodiscriminatedbycolleaguebecausetheyhave
languagebarriersincommunicating.Languagebarrieristheprimaryproblemcausinggap
amongIENsandothercoworker.SomeUSeducatednursesdescribedthattheyhavehard
timetounderstandwhatIENsaretryingtosay.Somealsoclaimthatitisdifficulttocontinue
aconversationduetoIENslimitedEnglish.Asthesametime,someIENscomplainedthat
othercolleaguesthoughtthattheydontknowhowtodoanythingjustbecausetheyhavebad
accentinEnglish.Obviously,thesegapscauseunnecessarymisunderstandingbetweenthem.
Infact,IENscannotexpressthemselvesclearlybyusingEnglish.Inaddition
to experiencing difficulty on expressing themselves, IENs are also afraid to ask other
colleaguesquestionsorstandstandupforthemselvesduetotheirlackoffluencyinEnglish.
Inthissituation,itishardforthemtoarguewithstrongpointsorevidenceeventheyhave
moreclinicalexperiencesormoreknowledge.Thelackofcommunicationskillwouldaffect
teamwork.Forexample,asagroupofprofessionalconference,IENsmightbetheonewho
cannotactuallyparticipatewillandothergroupmembersneedtohelpthemtounderstand
howtheconferenceisoperating.Everystaffhastheirresponsibilityontheirposition.Itwould
beaburdeniftheyneedtoassistIENstointegrateintothehealthcaresystembesidestheir
ownjob.
IENspalyasignificantroleinhealthcaresystemduetotheshortageofnurses
intheUnitesStates.MostoftheIENscomefromothercountrieswhereEnglishisnotthe

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officiallanguage.Becauseofthelanguagebarriers,IENsmightexperiencedifferenttypesof
discriminationandsufferfromsomeunequaltreatmentsintheirworkplaces.Patientsandtheir
families doubt IENs professional skills and clinic experiences because of IENs limited
Englishcommunicatingabilityandheavyaccent.EventhoughIENspass thelicensetest
beforegettinghiredbyhospital,theyarestilltreatedbydisrespect.Moreover,supervisors
also prefer certain racial groups depends on IENs communication skills and working
capabilities.DiscriminationisalsoverycommonamongcolleaguesbecauseIENsEnglishis
notasgoodasothercolleagueswhosefirstlanguageisEnglish;therefore,IENshaveahard
timetointegrateintootherscircle.
ThesetypesofdiscriminationthathappenedtoIENsmightaffectthem,but
alsohealthcareorganizationsuchas hospital.Discriminationfromothers notonlyaffects
IENs physical and psychological wellbeings, but also affects their performances in
workplaces.InadditiontohavingeffectsonIENs,healthcareorganizationalsohastospend
extracostsonoperationwhenIENsprobablyperformbadly.Forexample,IENsmightbeing
lateorevenintendtoleavebecausetheydontwanttowork.Hospitalthenhavetopayextra
tohireothernurses.unitsareoftenleftshortstaffed,sometimeswithlessskillednursesina
givenspeciallyare(Baptistepar.13).IENsdiscriminatedintheirworkplacescausinghigh
turnoverratesthatbecomesthemaincoststohealthcareorganization.
TheprimaryreasonofIENsexperiencingdiscriminationbypatients,hospital,
and colleagues is language barriers. These IENs completed their nursing professional
educationbyotherlanguages.TheyarenotusedtospeakEnglishintheirdailylives.Inorder
tointegrateintohealthcaresystemeasilyintheUnitedStates,besidestoimproveEnglish

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communicationskillbythemselves,healthcareorganizationshouldalsoassistthemtowork
with confident. IENs need assistance in understanding and managing these cultural
differencestoreducetheirstressandhelpprovideappropriatepatientcare(Wheeler,Foster,
Hepburn402).
Although IENs language barriers and communicating skills are actually a
problemforthemtoworkintheUnitedStates,theirprofessionalskill,nursingknowledge,
andclinicalexperiencesareundeniableandapproved.PeoplecannotjudgeIENsprofessional
skillsbytheirlanguageproficiency.Patientsshouldrespectwhoevertakingcareofthemand
trustallthehealthcareprovidersinhospitalbecausetheyallreceivednursingeducationand
passedlicenseteststobelegalnurses.BesidespatientsshouldrespectIENs,supervisorsand
colleaguesshouldalsotreatIENswellbecausepeoplewhoallworkinhospitalaresupposed
tobeateamthattakescareofpatientsandmakeshospitalsoperatingwell.

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WorksCited
Adeniran, Rita K., et al. "Transitioning Internationally Educated Nurses for Success: A Model
Program." Online Journal of Issues in Nursing 13.2 (2008): 12. Health Source:
Nursing/Academic Edition. Web. 4 Nov. 2016.
Baptiste, Maria M. "Workplace Discrimination: An Additional Stressor for Internationally
Educated Nurses." Online Journal of Issues in Nursing 20.3 (2015): 1. Health Source:
Nursing/Academic Edition. Web. 3 Nov. 2016.
Jose, M. M. "Lived Experiences of Internationally Educated Nurses in Hospitals In The
United States Of America." International Nursing Review 58.1 (2011): 123-129.
Academic Search Premier. Web. 11 Nov. 2016.

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Wheeler, Rebecca M., Jennifer W. Foster, and Kenneth W. Hepburn. "The Experience of
Discrimination by US and Internationally Educated Nurses in Hospital Practice in The
USA: A Qualitative Study." Journal of Advanced Nursing 70.2 (2014): 350-359.
Health Source: Nursing/Academic Edition. Web. 3 Nov. 2016.
Wheeler, R.M., J.W. Foster, and K.W. Hepburn. "The Experiences of Internationally Educated
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60.3 (2013): 397-404. Academic Search Premier. Web. 11 Nov. 2016.