Introduction
Different issues may directly and indirectly influence staff performance and the quality of patient outcomes. In the course of nursing practicums, student nurses have an opportunity to experience and reveal such issues, as well as measure their effect on the staff and the outcomes of care and treatment. The nursing workplace environment can be seriously affected by language issues. In particular, the practice of using native languages by the nursing staff instead of the English language creates a sense of discomfort in nurses who do not understand the languages being used by their colleagues. Consequently, the usage of native languages may lead to misunderstanding and workplace hostility. In order to mitigate the aforementioned issue, it is advisable to introduce policies that oblige the staff to communicate only in English. However, there is a presumption that communicative training interventions for motivating the staff toward communication in English would allow achieving positive outcomes more effectively. Therefore, the PICO statement is the following: In intercultural nursing staff, how does the introduction of communicative and motivating training compared to the obligatory policy to speak English during clinical interventions and teamwork reduce the risk of miscommunication and staff hostility?
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Problem
The problem identified during the mentored practicum was that nurses spoke their native languages, which stressed their colleagues, led to misunderstanding, and created a hostile workplace environment. The leadership style of the nurse manager was democratic, meaning that she was considerate, intended to maintain good working relationships, and consulted the staff before introducing changes (Giltinane, 2013). According to scholars, democratic leaders believe that workers are well-motivated, and that they seek autonomy and opportunity to demonstrate their proficiency (Giltinane, 2013). However, the focus on the autonomy of the nurses and the introduction of additional policies did not have the desired effect.
The leaders recognized the revealed problem and attempted to mitigate it by issuing a workplace protocol that obliged the staff to communicate in English during the performance of clinical duties or caring for patients. The protocol was put into practice using Lewin’s change model, which consists of three stages, namely unfreezing, moving, and refreezing (Bartunek & Woodman, 2015). Disregarding the fact that the change model is effective in the introduction and maintenance of workplace changes (Bartunek & Woodman, 2015), it failed to achieve the desired effect. The main reason for the failure was the ignorance of some nurses in terms of the cultural identities of other nurses. In addition, some nurses did not treat the workplace policy update seriously. Thus, the staff required internal stimuli to accept change, whereas only external pressure was applied, which is why the manager failed to complete the stages of moving and refreezing.
The problem under discussion arose in the bariatric surgery unit, which employed 15 nurses who typically united in groups according to their ethnic backgrounds and native languages. The chief model of care delivery in the unit was patient safety and the quality of care, which required the use of English during group conversations or interactions with patients. However, in the unit, the majority of nurses spoke Spanish, Portuguese, French, and Irish, whereas only two individuals regularly used English in their daily workplace communication. As a result, some members of the staff were distressed by the fact that they occasionally lost verbal connection with their colleagues who switched to their native languages during group discussions. Moreover, certain nurses characterized such behavior as psychological pressure or even a form of bullying, which is why the workplace environment became hostile.
Intervention
In order to mitigate the problem, the manager proposed to introduce a workplace protocol that obliged the nursing staff to communicate in English when caring for patients and participating in group discussions. In addition, the manager proposed to introduce a disciplinary action for those members of the staff who fail to adhere to the updated workplace communication requirements. Although the manager used the democratic leadership style, the decision to update the workplace communication policy was her impulsive reaction to workplace conflicts. Overall, the intervention did not produce positive patient outcomes because some of the nurses ignored the requirement and continued to use their native languages. As a result, some members of the staff remained distressed and were forced to continue their work under constant pressure, whereas others made different mistakes due to miscommunication.
Furthermore, the effect of the policy on the staff was negative since few nurses treated the initiative positively and had a desire to support it and adhere to the newly introduced regulations. For instance, the Irish-speaking members of the staff were irritated by the fact that their colleagues ignored the policy and spoke Spanish, which is why they refused from adhering to the policy and continued speaking Irish. As a result, observing the ignorance of their colleagues, some members of the staff refused to follow the guidelines of the protocol even though they initially accepted it. Thus, the increased level of workplace autonomy provided by the manager did not have a beneficial effect in the case of the intercultural nursing staff.
The literature review related to the analyzed problem revealed that some scholars propose to introduce appropriate training sessions, which may increase the language competency of workers. In particular, Burke, Mohn-Brown, and Eby (2016) suggest that international nurses may have underdeveloped components of the language skillset, which negatively affects their clinical practice. For instance, they may have underdeveloped English listening or speaking skills, which is why it is more convenient for them to use their native languages (Burke, Mohn-Brown, & Eby, 2016). This issue becomes stressful for their colleagues and patients because of the failure of those nurses to conduct productive communication, even in the case they effectively care for a patient. In addition, patients of such nurses may face a perspective of failing to maintain life-saving treatment instructions in the case nurses communicate them inadequately (Meuter, Gallois, Segalowitz, Ryder, & Hocking, 2015). Therefore, using their native languages, nurses might try to avoid the miscommunication of clinical instructions to their patients, which potentially violats the newly established requirements.
In the cases similar to the one under analysis, experts propose to introduce a course of English for medical purposes in order to increase the language proficiency of immigrant workers. These proposals are based on the analysis of actual clinical evidence and the positive effect of the improvement of the workplace communication of immigrant nurses who had problems with communicating their ideas in English (Salager-Meyer, 2014). The purpose of such a course is not only to assist nurses to learn English but also to instill sociolinguistic competence, which would motivate workers to use English as a communicative tool for resolving issues in a professional setting (Salager-Meyer, 2014). Thus, experts characterize language as an empowering tool for a professional setting that should be obtained during workplace training sessions. Therefore, the staff of the bariatric surgery unit should undergo a series of training sessions in order to improve proficiency in English for medical purposes. This intervention would empower nurses with the possibility to improve the level of care and positively change the workplace environment by transforming several groups of nurses into a team of international practitioners.
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Comparison
Currently, the manager of the bariatric surgery unit attempts to mitigate the existing problem by pressuring the workers to adhere to the workplace policy update. In the case under analysis, the leadership style of the manager was irrelevant because she failed to create a productive workplace environment. Experts claim that democratic leaders share their responsibility with their followers, and that they may poorly control the workplace environment (Giltinane, 2013). The reason for this is that such managers and leaders tend to provide guidance instead of controlling workers (Giltinane, 2013). Thus, for the staff in the case, the leadership style of the manager was irrelevant because the healthcare workers abused their freedoms and ignored the workplace regulations. Moreover, the decision to create and introduce the policy was taken manually, which was different from the typical practice of discussing changes in the unit. As a result, the nurses tended to adopt an increased hostility to the manager due to the fact that she seemed to refuse from the practice of democratic staff-management.
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Unfortunately, the manager’s policy did not improve patient outcomes. Instead, the policy had a negative impact on the staff. The reason for failing to improve patient outcomes was that nurses often failed to communicate their ideas in English in a comprehensible manner, which is why they often switched to their native languages. According to the nursing staff, the introduced policy forced them to search for the words for exampling typical procedures, which caused them stress. Moreover, the staff was often irritated by the fact that when they attempted to communicate in English, discussions were too long and often caused confusion. Consequently, some of the nurses claimed that even if they wanted to switch to English during workplace practice, they did not have the required level of sociolinguistic competency.
Desired Outcome
The desired outcome of the proposed intervention is to improve the workplace environment and allow different groups of nurses to unite in a productive team. In particular, the intervention is expected to improve the level of understanding among the healthcare workers and enhance staff cohesion. Consequently, the intervention is expected to positively influence both employees and patients.
Time Frame
The desired change is expected to be achieved within a six-month period. The reason for such length is the need for designing the training course of English for medical purposes, scheduling, and staff training. In addition, the aforementioned timeframe is sufficient for sustaining the stage of refreezing according to Lewin’s model of change.
Conclusion
The practicum project analyzes the workplace problem that arose in the bariatric surgery unit. Nurses who work in that unit tend to communicate in native languages, which leads to workplace hostility and misunderstanding. A PICO statement of the project is the following: In intercultural nursing staff, how does the introduction of communicative and motivating training compared to the obligatory policy to speak English during clinical interventions and teamwork reduce the risk of miscommunication and staff hostility? The analysis demonstrates that the intervention adopted by the manager, namely the introduction of the policy that obligated the staff to speak English during working hours, was not successful because nurses often ignored the requirement. As a result, the staff and the patients of the unit experienced such negative outcomes as emotional discomfort and decreased quality of care. For this reason, the project proposes to introduce a staff training course of English language for medical purposes since it was revealed that the nursing staff refuses to speak English due to the lack of the required sociocultural competencies. Therefore, it is expected that the proposed initiative will positively change the workplace environment, allow the staff to cooperate more affectively, and improve patient outcomes.
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