Impact of Cultural and Linguistic Diversity on Success of the First Attempt of the NCLEX-RN®

Saturday, 29 July 2017

Ernestine Cuellar, PhD
Peavy School of Nursing, University of St. Thomas Houston, Texas, Houston, TX, USA

Schools of nursing and nursing faculty are struggling with high attrition rates and low NCLEX-RN first time pass rates. Many of the students identified among those with high attrition rates and low NCLEX-RN pass rates are culturally and linguistically diverse (CLD). Census data has identified a significant change in the cultural and linguistically diverse composition of the United States. Languages currently spoken in homes among CLD students in the United States include Spanish (73%), Vietnamese (2.7%), Chinese (2%), French/Haitian (2%), Hindu (2%), Korean (1.5%), Arabic (1.2%), and Russian (1%). The proportion of births among those who are from non-English speaking backgrounds is increasing; therefore our student population is representative of this growing demographic. Currently in some classrooms there are as many as 5 to 10 culturally and linguistically diverse students, representing different cultures, in one class. Students often find themselves in situations where they have difficulty understanding the accents of their peers (Rogan, Miguel, Brown & Kilstoff, 2006). There is also an increase in male nursing students that may also impact cultural diversity in the classroom. Many culturally and linguistically diverse students as well as those who are not challenged by culture and language (males, Native Americans, blacks) describe the need for emotional and moral support.

Most often CLD is used to define students whose linguistic interactions are different in comparison to other individuals in a given environment (Barrera & Cosco, 2003). Even though some blacks, Asian Americans, Pacific Islanders, Hispanic Americans, and Native Americans, may fall into this category, faculty must thoroughly investigate before automatically assuming by skin color or family history that a student is CLD. Even though there are studies that support the idea that black students speak English as a second language (Goff, Martin & Thomas, 2007); that assumption is not representative of all black students. In 1996, the Reverend Jesse Jackson stated, “Black youths around the nation need to be challenged to speak proper English,” so they may be accepted into colleges and universities (Lewis, 1996). Each student must be assessed individually to determine that student’s proficiency with English. Many students from diverse backgrounds are culturally acclimated; therefore we need to ensure that we address the needs of those individual students who are experiencing difficulty in the realm of CLD.

The most significant factor that impacts student success is the personal and academic relationship developed between faculty and students (Burnette, 1999). It is strongly recommended that faculty focus on how students learn so that didactic activities are focused on the skills that best address the student’s needs (1999). Unfortunately incivility among students and faculty hinders the learning process. Often students are marginalized because they are identified as CLD (Altmiller, 2012; Clark, 2009; Jenkins, Kerber & Woith, 2013). There is a strong need to increase awareness of incivility among nursing students and faculty in order to adapt appropriate skills that accommodate teamwork within both clinical nursing and academic settings. Since the 1960’s studies have been conducted that focused primarily on identifying and defining bad behaviors, but these studies fell short of providing meaningful evidenced-based intervention solutions. A new educational modality grounded on evidence-based research is vital to intentionally increase awareness of incivility, change negative behaviors, and influence teamwork within the clinical setting and the nursing curriculum.

Students identified as CLD may speak English but have difficulty with reading and remediation. Those students may not understand idioms or jargon in books or audiovisual aids, in addition to test questions. Some students from other cultures were educated in systems that taught students to memorize and regurgitate information rather than to think critically. Therefore it is the responsibility of faculty to assist students in developing critical thinking skills as well as to learn the new language. In nursing the most important component of learning is the need to learn to use information in the real world rather than to memorize” (Cohen & Rotem, 1983). NCLEX-RN is an assessment of the graduate nurse’s ability to think critically so that patients receive safe care.

Nurse scholars have addressed multiple strategies to address retention that are focused on one or two elements. However, retention, graduation, and NCLEX-RN success encompass multiple entities. Faculty-student relationships, family support, student population (diverse CLD population) civility in the classroom and clinical setting, remediation, and student self-confidence are all components of student success. Very little literature addresses the intersection of these dynamics and the role of the intersection of these entities.