Pulled away: the experience of bilingual nurses as ad hoc interpreters in the emergency department

ABSTRACT

This study aimed to understand the experiences of bilingual nurses asked to interpret in the Emergency Department (ED), and the subsequent impact on safety climate. Australian ED clinicians assess and treat high numbers of linguistically diverse patients, many with limited English proficiency. New South Wales Health policy mandates the use of accredited interpreters when collecting personal and health information, and when obtaining consent for medical procedures. Semi-structured interviews with 12 nurses (representing 12 languages) from two metropolitan EDs were audio-recorded and analysed using qualitative content analysis, guided by Glendon & Stanton’s model of organisational climate and culture. Analysis revealed widespread underlying assumptions that engaging interpreters is difficult, time-consuming and costly. Bilingual ED nurses with variable language fluency were used across organisations as the first choice due to clinical urgency, task urgency, and hospital workflow pressures. While the use of nurse interpreters facilitated timely assessment for the benefit of patients, it equally led to increased nurse workload, missed or misinterpreted information and subsequent perceived clinical risk. These practices were supported and facilitated by unit level managerial and multidisciplinary team practices, physician pressure and the nurses’ own values and beliefs. While some, (but not all) participants were aware of the interpreter policy, they were torn between their acknowledgement of risky translation practices and their desire to support their colleagues to provide timely, culturally-competent assessment and care. Findings suggests a ‘top-down’ approach to translation policy has failed to influence the local safety culture and practices and does not address a climate created by clinical urgency and workflow. Formal training and accreditation of bilingual nurses, and/or embedded interpreters for common language groups may reduce risks for non-English speaking patients.

KEYWORDS:

• Limited English proficiency
• culturally and linguistic diversity
• communication barriers
• interpreter services
• translating
• emergency department

Acknowledgements

The authors acknowledge the in-kind support (release for research training) by the Sydney Local Health District under the SCHoLAR Program (Sydney Community for Health Leaders And Researchers). We also acknowledge the valuable insights provided by our Emergency Nurse participants. HC & JG conceived and designed the study; JG provided training; HC & JG developed the study protocol and interview guide; HC, CH & JG collected interview data; HC, CH & JG analysed the data; HC, CH & prepared and approved the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.