As increasing numbers of patients don’t speak English as their first language—or at all—the health care field is taking action. Here’s what’s happening and how you can become involved.
Imagine if you were in a hospital in a country where no one spoke English. Being in a strange hospital or other health care facility can be scary enough, but if you had no idea what was going on, it would make you more stressed—possibly making your health worse. You would feel incredibly vulnerable, as not knowing what was happening to you or if the workers could help you would be terrifying.
There was a time in the United States when that
could happen. Although it shouldn’t happen, legally, anymore, as Allison Squires, PhD, RN, FAAN, explains, there is still a need for more bilingual nurses. “All health care facilities are required by law—including the Civil Rights Act and updated regulations in the Affordable Care Act—to provide patients who do not speak English with an interpreter,” says Squires, an associate professor at the New York University Rory Meyers College of Nursing. “The interpreter can be an in-person interpreter or a telephone or video interpreter to meet the requirements of the law.”
According to Squires, the increase in patients who haven’t developed English skills comes from two situations: the post-WWII legacy in which U.S. citizens came here as immigrants, and the most recent wave of immigration, which has matched or surpassed the immigration numbers of the early 20th century. “According to the Pew Research Center, one in five households in the U.S. speaks a language other than English at home. More communities are also becoming refugee resettlement cities across the U.S., which means increasing linguistic diversity in places that have historically only had English speakers,” says Squires. “The demand for nurses who speak another language is at an all-time high.”
Location, Location, Location
While all the sources whom we interviewed agree that Spanish is the most prevalent second language needed for patients, they also say that other languages are vital as well, depending on your region of the country. “Spanish is the priority language nationally. Other languages depend on where you live and who is migrating there,” says Squires. “For example, in the New York City and New England regions, there are now large numbers of Russian speakers. These individuals often come from former Soviet Union states where Russian was the official language. Other parts of the country, like Texas and Louisiana, have large numbers of Vietnamese speakers who came to the U.S. as refugees or immigrants. Other than Spanish, language demand is often specific to a local health care service area.”
“Spanish is the language in highest demand, particularly in Texas, California, Florida, and Illinois. In California, bilingual skills are needed for Spanish, Chinese, Vietnamese, and Russian,” says Terry Mort, who is manager of talent acquisition for VITAS Healthcare, the nation’s leading provider of end-of-life care. In the 14 states and the District of Columbia in which they provide care, VITAS Healthcare has also found the need for Mandarin, Cantonese, Tagalog, Hmong, Korean, and Creole.
“We constantly have to look at demographics of the communities we serve and pay attention to how they’re changing over time,” explains Mort. “Take California as an example. At one time, South Central Los Angeles was primarily an African American community, whereas today it’s predominately Hispanic. And as our services move into outlying areas of Los Angeles County, our needs change again because we encounter more families that are Filipino, Asian American, or Hispanic American.”
Currently, in South Florida, several VITAS hospice teams are solely Spanish speaking to appropriately serve their patients’ and community’s needs. “In California, a trilingual nurse—someone who speaks English, Spanish, and other language—would be in high demand,” says Mort.
Although particular languages may be needed to serve certain populations, there are also instances in which unexpected languages may also be required. For example, when there was a recent influx of patients from Puerto Rico at the University of Maryland Baltimore Washington Medical Center who needed health care after Hurricane Maria, there were more Spanish-speaking patients, says Edith Lopez Dobbins, RN. Dobbins is a JET Nurse, which stands for Just Excellent Timing and means that she is a full-time nurse who serves as supplemental staff for different nursing units throughout the hospital. As a result, she has noticed an overall increase in patients who speak Hindi and Korean as their first language.
“In the hospice profession particularly, we also have the challenge of end-stage dementia patients, who may revert to their language of origin as their disease progresses. We had a Russian patient who reverted to speaking Russian, but the family indicated he had not conversed in that language for more than 20 years. If that happens, it requires us to update our care plan so that our nurses and staff members can communicate effectively with these patients in a language they understand,” explains Karen Peterson, senior vice president and chief nursing officer for VITAS Healthcare. “The more languages our staff members can speak, the easier our job is.”
Benefits to Being Bilingual
Bilingual nurses on staff help open everyone up to another world as well as another set of patients to care for, says Vivian Carta Sanchez, DNP, ARNP, from Tenet Florida Physician Services. “Nurses who are bilingual can also serve as translators to communicate very important information from physicians who do not speak the language,” says Sanchez.
Squires says that if you work in a hospital, home care, long-term care, or rehabilitation, there are four key times when interpreters are needed—admission, patient education, consent, and discharge. “Using an interpreter during these times can help reduce your patient’s risk for readmission and complications,” explains Squires.
Having a nurse who is bilingual, rather than using a family member to translate, can be crucial. “Let’s say that I take five minutes to explain something in detail to a patient, and the family member who translates what I said to the patient takes about 30 seconds. I can tell that my patient isn’t hearing the same thing that I said—and that’s a risk to the patient, because they’re not getting complete information,” says Peterson. “It’s one of the reasons we prefer not to use family members as translators because they are part of the unit of care and also dealing with psychosocial issues associated with end of life.”
Another advantage to staffing or being a bilingual nurse is that when you are speaking the same language as a patient, the work you are doing will take the same amount of time that it does as when you are talking with an English-speaking patient, says Squires. There’s no need to be concerned about waiting for an interpreter to arrive or to have to deal with any issues that can occur when using an interpreter by phone. In addition, communicating with family members may also be easier. “That being said, as a bilingual nurse, if you are the first language nurse to work with the patient when they access health services—be they in the hospital, home care, or primary care—sometimes you spend more time with them initially because the patient is so happy to have someone who speaks their own language,” states Squires. “You find out all this other stuff that the patient held back because of the language barrier or issues with interpreter services. Another advantage of being a bilingual nurse is that you can quality check video or phone interpretation.”
Culture Comfort
Speaking to patients in their native language isn’t only about the words; it’s also about their culture. Dobbins says that while they use “language phone-lines” to keep at patients’ bedsides so that they, their families, and the health care workers can communicate—which is certainly helpful—the phones can also make talking more impersonal. “It makes patients and their families uncomfortable—possibly because it’s not just about language, it’s about culture. Most of the time, we use peers in the health care team who speak the same language as the patient for better communication and overall quality of care,” says Dobbins.
“Bilingualism is even more imperative in the hospice profession because there’s a lot of emotion and psychosocial aspects of language surrounding the dying process. Each person might have a different opinion or thought process around the issues related to dying. It’s unique in that people may have difficulty conveying their thoughts and feelings, even in the same language, simply because it’s about death,” explains Peterson. “Some patients or family members can’t even say the word ‘hospice,’ so they find a way not to say it. But when our nurses, families and patients understand each other’s language and cultural nuances, we’re more confident that patients are making the right decisions and receiving the best possible care because everyone understands each other.”
Knowing about patients’ culture has become so important that the Chamberlain University College of Nursing began offering a Hispanic concentration on its Phoenix, AZ campus in May 2016. Pam Fuller, EdD, MN, RN, the Phoenix campus president, states that this concentration doesn’t aim to attract Hispanic nurses, but rather to appeal to nurses who want to care specifically for this culturally diverse group. This concentration is offered to anyone who is enrolled in the university’s pre-licensure BSN program. Because of its ability to logistically provide clinical experiences for students who are enrolled in the Hispanic concentration, the Phoenix campus volunteered to pilot it. “The local hospitals and health care centers currently serve Hispanic patients and families every day, and Chamberlain helps provide nurses and care to these local communities,” says Fuller.
“Providing nursing care requires not just an appropriate educational degree and a license, but also crosses boundaries of human dignity and respect. Many, if not all, hospitals and care centers are challenged to communicate more effectively with their patients, regardless of cultural background. Chamberlain specifically launched the Hispanic concentration based on information from hospitals in our local markets,” explains Fuller. “When a patient is in pain or in need of health care, they tend to revert to what is comfortable to them, culturally. If you are culturally more comfortable with your own language and traditions, if there is someone who can speak—at least a little bit—the language you speak, it makes the care that much more effective and personal.”
“Chamberlain’s Hispanic concentration is not a language program. This concentration exposes students to the Hispanic language and culture and allows for 25% of their clinical experience to be placed with a Hispanic patient. This gives them real-time experience in serving the Hispanic population,” says Fuller. “Any student—regardless of their personal cultural background—may enter this concentration…The goal of the Hispanic concentration is to educate students and expose them to the culture and language of the Hispanic community to provide an improved level of care to this population.”
Attracting Appropriate Personnel
How can facilities go about recruiting bilingual nurses? Squires believes that a combination of actions could help. Nursing schools need to recognize local demand for bilingual services and restructure curricula to help ensure the success of English as a Foreign Language (EFL) students, says Squires. “Even now, EFL students have lower pass rates on the NCLEX-RN exam, and that’s not helping to meet our need for more bilingual nurses. Schools need to change how they teach and support EFL students so they have the same success rates as English speakers,” Squires says.
“Organizations should give bonuses to people who are bilingual to encourage better communication,” says Sanchez.
As for becoming bilingual, Squires says that to achieve the level of fluency to be able to effectively and safely communicate with patients about health issues, nurses would be required to undergo years of study or at least a six-month immersion in a country where the language that they want to learn is spoken. “Having just a few words or phrases can be helpful for recognizing when a patient is in pain or [has] toileting needs, but when it comes to the complex communication needs that go with admission for services, patient education, consent, and discharge, you really need to have what’s called sociolinguistic competence in a language. That’s something that your employer should help you certify or do it on your own to make yourself more marketable,” says Squires.
At the end of the day, being bilingual or having bilingual nurses on staff is all about patients’ safety and comfort. “As a nurse, many of my most rewarding moments have to do with going the extra mile to help a Spanish-speaking family during their hospital stay,” says Dobbins.
Hospitals For Humanity (HFH) is a registered nonprofit organization with 501(C) 3 status in the United States. The organization provides health care for people living in the least developed countries of the world. Their goals include providing health assessments and treatment for local citizens; updating existing medical facilities, assisting in the construction of modern hospitals, and providing training to local physicians; improving regional health and sustaining the quality of care through partnerships with local government; and responding to special cases of chronic illness and diseases through evaluation, diagnosis, and patient referral.
Efforts are currently focused on communities in Haiti, Nigeria, and the Philippines. HFH’s total patient population is over 65,000 and includes general surgeries, ophthalmic surgeries, dentistry, emergency medical services, and more.
HFH is looking for compassionate volunteers who desire to enroll in the organization, including CRNAs, NPs, PAs, RNs, optometrists, pharmacists, MLTs, EMTs, surgical techs, and physicians of all specialties. Currently, two Medical Mission Initiatives (MMIs) remain for 2012: one in Okija, Anambra State, Nigeria, from October 12–19, and one in Ijumu Land, Kogi State, Nigeria, from December 1–12.
If you are interested in learning more or applying for a Medical Mission Initiative, visit www.hospitalsforhumanity.org. You can view an informational video, look at pictures from past MMIs, and submit an application. Questions not answered on the website can be directed to Adrian Johnson, Director of Recruitment, at [email protected] or 224-577-5479.
The end of the year was dreamlike. Not only was I accepted into an accelerated nursing program, the school also selected me as a recipient for a prestigious scholarship award. The honor of being among an elite group chosen to represent the ideal future “face” of nursing leadership was an incredible sensation. But those exciting days quickly spiraled into a nightmare.
Many of us belonging to ethnic and racial groups experience disturbingly disparate health, educational, and economic outcomes, and we have committed ourselves passionately to improving the well-being and quality of life of individuals from populations from which we ourselves are drawn.
My faculty advisor for the scholarship program was so impressed with my curriculum vitae and scholarship application essay that she strongly encouraged me to pursue scheduling a meeting with the director of the Ph.D. program to discuss a seamless progression from a B.S. to an M.S.N. to a Ph.D. One week later, I met with my faculty advisor again to discuss some initial temporary feelings of anxiety I had about the program. I sought to proactively inquire about accessing resources and strategies to succeed in the program, with my diagnosis of depression and anxiety disorder. The next day, in a meeting with my advisor and one of the school’s deans, I was urged to voluntarily withdraw my admission and cancel my acceptance.
The experience was unfathomable; literally within a week, I went from being encouraged to complete all levels of nursing education at the school to being told “this is a very intense program,” “we want you to be well,” “there are other seconddegree programs,” and “when one opportunity closes another opens.” A week after the scholarship orientation and on the fourth day of classes, they concluded that I lacked the emotional fortitude to handle the rigors of the intense, accelerated program. Additionally, when I called several weeks later to honor my end of the scholarship contract with the organization, I was informed that the school had already contacted the organization the day after my withdrawal and requested that the scholarship funds be given to another fi nalist. Along with the frustration inherent in the situation, I was very disappointed with the enduring stigma of mental illness, so pervasive that my health condition superseded the accomplishments that resulted in my selection as a prestigious scholar.
About a month after the experience, I traveled overseas for a service mission trip. An uncanny experience served to maintain my resolute desire to be a nurse, in spite of the indignant and vilifying event.
As the service team of approximately 60 volunteers waited to begin our five-day service mission, the warm community residents greeted us individually. One young girl caught my attention, as she was wearing a bright pink shirt, decorated with the word “princess” (printed in English) and a rhinestone-studded tiara. It reminded me of something I would have worn at her age. Speaking in Spanish, I said, “I really like your shirt.” She tilted her head, her eyes downcast. Her facial expression indicated that she heard me, but she didn’t respond to my compliment. I then proceeded to tell her how pretty it was and called her Princess. Again, I received no response and little eye contact. I finally asked her if she understood me, as I didn’t rule out the possibility that my Spanish was rustier than I realized, but she answered “yes.”
When I walked off I watched the young girl and noticed she was aloof from the other girls and women who were waiting to enter the clinic area. I had two initial thoughts: first, this young girl needs to see a provider and feels shame or embarrassment, or she is extremely shy. Several hours into the afternoon, I saw her again and asked her age. She clearly responded with her head lifted, making eye contact: “16.” Then she became reticent to speak again, and I watched her from a distance and noticed that she remained aloof.
I asked one of the missionaries of a partnering organization about the average age of parity and the familial structure. He said couples are usually partnered anywhere from 12 years to adulthood. I asked our pharmacy manager if we had pregnancy tests. We didn’t.
I saw the Princess again for the third time in the late afternoon but didn’t find an appropriate opportunity to speak with her in an inconspicuous manner. The next day, I spoke with the pediatrician about my assumption, and when I spotted the young lady, I discreetly pointed her out. My hope was that she could be examined and referred to the permanent clinic, about a 30–40 minute walk, to receive the care I believed she needed. A few minutes prior to leaving for my service project worksite, I greeted her with a wave and a smile and it was reciprocated with a partial wave and smile. The next day, I discovered that a teenage girl was seen by one of our providers and that she indeed thought she might be pregnant but was afraid her mother was unaware of her potential pregnancy.
I shared my experience with my student mentor assigned to me at the time of my admission offer to the scholarship program. She expressed her concern about the information I revealed and reasoned that as a black female ostensibly entering a predominately white women’s profession, disclosing my mental health condition might not have been the action of my better judgment. I respectfully, wholeheartedly disagree.
Not only does concealment fuel stigma, but carrying this unnecessary burden hinders one’s ability to achieve a complete and whole state of wellness. Additionally, I candidly shared with her that my father was a physician, trained in the ’70s, who labored under the stigma and shame of his depression for 30 years, unbeknownst to most of his colleagues. Out of fear of losing his medical license and the respect of his colleagues, he concealed his illness and failed to receive the appropriate level of treatment he needed during a crisis episode. As a result, his lifelong battle with depression ended in suicide. His family, friends, colleagues, fellow community members, and former patients were absolutely devastated and angry that he never reached out for adequate help.
My very considerate and compassionate student mentor addressed a relevant and poignant concern, one I also believe has been inadequately examined in society: in a country that professes a desire for diversity, but where racial prejudice still exists and opportunities to render a racial/ ethnic minority as incompetent can be exploited, how does one handle a having a mental illness?
While this question should by no means be ignored, I’ve debated my decision to disclose my mental health history and the physical manifestations that I experienced. My conclusion? I unequivocally have no regrets. One of the main roles of a nurse is to be a patient advocate. I believe that if I can effectively advocate for myself, I’m well qualifi ed to be a uniquely effective advocate for a patient.
Finally, to my father, I’m so very proud of you for dedicating your life, service, and passions to helping others, even as you did your best to address your own struggles and challenges. Thank you for giving me the resiliency and courage to pursue my passions and dreams amidst obstacles and adversity. I love you.
If you are struggling with depression and/or anxiety, we encourage you visit the National Alliance on Mental Illness website at www.nami.org or the National Institute of Mental Health at www.nimh.nih.gov.
In 1909, Lillian Wald, founder of the Visiting Nurse Service of New York (VNSNY) and the “mother of public health nursing,” hosted the NAACP’s inaugural meeting at her agency’s early headquarters, at a time when integrated meetings were forbidden by local ordinance. Last year, the NAACP remembered Wald’s courage and work during its centennial anniversary celebration in New York City. On their website, they refer to Wald as one of the organization’s “first and oldest friends.”
Wald truly set a tone for the agency she established. From its founding in the late 19th century, the VNSNY has served a broad range of diverse communities, played pioneering roles in the civil and women’s rights movements, and blazed a trail for diversity in the workforce.
In the late 1800s, Manhattan’s Lower East Side neighborhood was deemed the world’s most densely populated slum. At that time, Wald was a young graduate of New York Hospital’s nursing program, studying medicine and teaching immigrant women about home health and hygiene. Galvanized by the public health needs she saw among immigrant communities in the area, she and a fellow volunteer launched VNSNY in 1893. Wald and her colleague became the first public health nurses in the country.
Wald championed women’s rights by hiring and promoting women. In fact, the National Women’s History Project included her among its 2009 honorees. She played a prominent role in the women’s suffrage movement and is enshrined with Susan B. Anthony, Elizabeth Cady Stanton, and others in the National Women’s Hall of Fame. From Wald’s 1933 retirement to present day, women have led the VNSNY, culminating in 1989 with the arrival of current President and CEO, Carol Raphael. Ten years ago, the VNSNY staff was composed of over 90% women. Today, that figure stands at about 80%. Because of the agency’s highly diverse clientele, VNSNY has been at the forefront of promoting cultural awareness, developing and retaining a diverse workforce, and creating an inclusive environment—all elements that are crucial to effective service delivery. According to U.S. Census data, nearly 37% of New York City’s population is foreign-born, and 48% of the city’s residents speak a language other than English at home. More than a quarter of VNSNY patients are non- English speaking, and its staff members speak more than 50 languages.
Following their founder’s example, the agency has a proud legacy in the hiring of minorities. In the 1920s, when mortality rates in the black community were 200% higher than elsewhere in New York City, African Americans comprised 15% of VNSNY’s patients. Wald and other agency leaders responded by increasing its African American nursing staff from one supervisor and four nurses to two supervisors and 18 nurses, a number commensurate with their patient load. In her 1933 book Windows on Henry Street, Wald noted that VNSNY was the first organization to hire black nurses on equal terms. Today, roughly a quarter of its patients and more than half of its employees are descendants of the African diaspora, including African Americans, Afro-Caribbeans, and colleagues from Nigeria, Sierra Leone, Togo, and other African nations. VNSNY has also been caring for Asian and Hispanic immigrant patients and hiring staff of the same descents.
For most of its history, VNSNY also has been caring for patients in a number of other ethnic communities, while employing clinicians who share their cultures and heritages. In recent years, VNSNY developed multicultural home care programs dedicated to serving New York’s Hispanic, Asian, and Russian communities. Patients often feel more comfortable and, in some cases, recover more quickly, when they receive care from nurses and other caregivers who speak their language and have in-depth knowledge of their culture.
Currently, VNSNY employs the largest pools of Asian and Hispanic caregivers in the New York area, offering home health care teams trained in providing culturally sensitive care to patients in their native languages, incorporating their customs and values. Staff tailor comprehensive home health care and community-based services to the more than two million Spanish-speaking residents of New York City, who trace their heritage to 35 nations worldwide. Patients from these communities make up approximately 20% of active cases, a fi gure that mirrors the 20% of VNSNY colleagues who self-identify as Hispanic/ Latino.
Features offered include a Spanish-language telephone hotline for referral and information; nutritional diet plans specifically designed for Hispanics; patient forms and educational materials in Spanish; partnership programs with key Hispanic community organizations and referrals to community resources; and a close alliance with Hispanic community agencies, doctors, hospitals, and managed-care organizations. In late 2008, VNSNY was honored with a special institutional award from the New York chapter of the National Association of Hispanic Nurses for extraordinary outreach in that community.
The composition of VNSNY’s workforce and patient populations also reflect a spike in Asian immigration to New York City over the past decade. The staff now includes more than 700 colleagues of Asian descent, including Chinese, Filipino, Indian, Korean, Pakistani, and other nationalities. These colleagues speak several dialects of Chinese, Tagalog (Philippines), Korean, Hindi, and other Asian languages. They provide home health care familiar with the cultures, values, and customs of many different Asian groups. VNSNY also administers the Chinatown Community Center, which has served more than 65,000 community residents since it opened in 1999. The facility administered hundreds of free fl u shots last year, and it regularly provides free cholesterol, diabetes, and blood pressure screenings; health classes; community outreach; and other services to residents, particularly seniors, of New York’s Chinatown. VNSNY also runs the Chinatown Neighborhood Naturally Occurring Retirement Community (NNORC) program, launched in 2006. In addition to the public health services offered at its Chinatown Community Center, the Chinatown NNORC nurses and social workers visit homebound seniors to assess their individual needs and provide culturally sensitive care.
To serve the more than one million émigrés from the former Soviet Union now residing in the New York area, VNSNY has hired more than 200 colleagues who immigrated from Russia and former Soviet republics, including Ukraine, Azerbaijan, and more. The agency also employs escort translators who speak other languages, ranging from Korean and Japanese to Haitian Creole. In addition to the VNSNY Multicultural Home Care Programs, the agency makes a number of smaller, less formal arrangements to coordinate caregivers and patients in New York’s many other diverse communities. VNSNY also regularly sponsors events tailored to recruit nurses and other staff members from various multicultural NYC communities.
In 2009, CATALYST, a global organization dedicated to promoting diversity in the workplace, added VNSNY to its roster of “case studies”—models of inclusive practices in the workplace.
Comfortable with their knowledge of other cultures, VNSNY staff often act as the organization’s ambassadors to various New York communities and teach coworkers about their cultural heritages. VNSNY has carried its 117-year-old inclusive, multicultural approach well into the 21st century, a philosophy suited to a highly diverse workforce and its patients.
At a time when stories about hospitals being ill-prepared to meet the needs of non-English-speaking patients have become front-page news in major national media like USA Today, I recently received a letter from a master’s-entry nursing student named Joy Caneda, who had been browsing our online “Featured Stories” article library on MinorityNurse.com. “I am responding to the article called ‘CLAS Action,’” Ms. Caneda writes. “It both excites and angers me to [learn] that there are federal standards [developed by the Office of Minority Health (OMH)] for Culturally and Linguistically Appropriate Services (CLAS) in health care.
“[The article discusses] the lack of awareness about CLAS among nurses. I believe one of the reasons for this is the lack of priority nursing schools have to teach these standards to students. Now that I am preparing to take my RN board exam, I am angered that I did not learn these standards in nursing school. Often during our clinical rotations, I was faced with situations where non-English-speaking patients would need interpretation and nurses would use ineffective strategies, such as using children to interpret for parents.
“I am hopeful that nursing schools can change their curriculum by prioritizing and teaching the CLAS standards,” Ms. Caneda concludes. “It was great to read how nurses helped create the CLAS standards. Now we must continue this leadership by incorporating CLAS as a core philosophy of the nursing profession.”
It’s one thing to not be fully up to speed on the newest still-emerging trends. But the “CLAS Action” article was first published in MN in Fall 2002! And in fact, everything nurses need to know about the CLAS standards has been readily available from the OMH, in both print and online formats, since 2001. So why, a full five years later, are so many nurses still unfamiliar with CLAS, so many nursing schools still not teaching it and so many hospitals still not providing CLAS training for their nursing staffs? Why do the CLAS standards still seem to be the best-kept secret in health care?
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Many cultural competency experts believe the answer is: The CLAS standards are not compulsory. While some of the 14 standards are mandatory under Title VI of the Civil Rights Act for health care facilities that receive federal funding, the others are voluntary. Fair housing laws, on the other hand, are just that—the law of the land. Realtors and rental property managers who discriminate against housing consumers on the basis of race, color, national origin, religion, gender, family status or disability can get slapped with hefty fines, often in the millions of dollars. As a result, the vast majority of realty and property management firms make sure their staffs receive mandatory fair housing training on an ongoing basis—often in conjunction with National Fair Housing Month, which is celebrated in April of each year.
OMH has stated that it is not a regulatory agency, and that if policymakers feel the CLAS standards should be mandatory, then they should work on incorporating them into the health care accreditation and credentialing process. But I can’t help wondering how many more nurses would be aware of CLAS—and how many minority health disparities could be reduced—if all of the standards were mandated under the Civil Rights Act for all medical facilities. What if there was a National CLAS Month, with free videos, posters and other training materials available to hospitals coast-to-coast? Perhaps the best month for celebrating CLAS would be September—the month when future nurses like Joy Caneda head back to nursing school.
