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 “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.

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