What Spanish do nurses actually need at work?

A needs analysis of 45 nurses and nursing students found that traditional language instruction is missing the mark, and identified what a better course would look like.

Language barriers in U.S. healthcare settings are not a minor inconvenience. Research has consistently linked them to unequal access to care, medical errors, and damaged provider-patient trust. As the number of Spanish-speaking, limited English proficiency patients continues to grow, the gap between what nurses can communicate and what their patients need to express has real clinical consequences.

The common institutional response is to route everything through interpreters and phone-based translation services. But nurses in this study described those systems failing in exactly the moments that matter most: emergencies, urgent assessments, patients who refused the phone, patients trying to communicate distress with no bridge between them and the person responsible for their care.

"Half of healthcare is trust and connecting with your patient."

So what Spanish do nurses actually need? That is the question Helms, Pitner, and Adams set out to answer.

How the study was conducted

The researchers used a Task-Based Language Teaching (TBLT) framework to conduct a needs analysis, a method that prioritizes the real-world tasks a learner needs to perform over abstract grammatical sequencing. Rather than designing a course first and assuming what nurses need, the study worked backward from actual practice.

Data was collected in two phases. First, all 45 participants completed an online survey covering their demographics, prior Spanish experience, learning goals, and skill priorities. Then, eight participants volunteered for a follow-up questionnaire and a 30-minute semi-structured interview. Interviews were transcribed and coded thematically by two researchers working collaboratively.

97% of participants expressed interest in a Spanish for Nursing course. 91% said speaking was the most important skill.

Participants were registered nurses, nurse practitioners, and advanced nursing students, primarily based in the southeastern U.S. Most had taken at least one Spanish course previously. Their consensus: those courses did not prepare them for the clinical environment.

What nurses said they need

Four themes emerged consistently across the survey, questionnaire, and interview data.

1. Oral communication above all else. Speaking and listening were selected as the most important skills by 91% and 82% of participants respectively. Nurses need to communicate in real time, often under pressure, and the ability to ask questions and give simple commands in Spanish was described as directly tied to patient safety.

2. Medical vocabulary grounded in tasks. Participants identified specific vocabulary as most pressing: body parts, symptoms, pain description, triage questions, and phrases for explaining procedures. The vocabulary nurses need is narrow, task-specific, and tied to the actual assessments they perform every day.

3. Role play and simulation as the learning format. Participants requested role play and scenario-based instruction. Since simulation is already standard in nursing education, they viewed it as a natural fit for language learning too.

4. Building rapport, not just conveying information. All eight interview participants raised rapport as a core concern. The inability to communicate in a patient's language was described as producing feelings of guilt, frustration, and a fundamental lack of connection.

What nurses are experiencing now

The interview data included specific accounts that illustrate why this matters. One nurse described a patient trying to communicate that she was bleeding while a phone interpreter repeatedly failed to connect. Another described a septic patient who refused interpreter services out of fear. A third recalled a patient who had an allergic reaction to morphine because a question about allergies could not be understood in time.

"Having the skills to speak with a Spanish-speaking client would be best, as it helps the client to be more comfortable and open up more, and therefore the best nursing care can be provided." — Participant 2, RN

These are not edge cases. They are the regular conditions under which nurses work. And the consistent finding was that existing Spanish instruction had not equipped them for any of it.

What a better course would look like

Content should center on oral communication: triage and health history questions, simple commands, body parts and symptoms, and phrases that help patients describe pain or understand a procedure. Grammar instruction alone is not what nurses are asking for and not what the clinical context demands.

The structure should mirror nursing training: role plays, simulations, and scenario-based practice. Intercultural competency should be woven throughout, because the ability to build trust across a language barrier is not separate from clinical competence. It is part of it.

This study provides a methodological and content foundation for Spanish language programs in healthcare settings. It is one of the few needs analyses in this area to report its methodology transparently, making it easier for future course designers to build on or replicate.

Helms, L., Pitner, H., & Adams, R. (2023). Spanish for nursing: A needs analysis for a Spanish for nursing course. Revista de Lenguas para Fines Específicos, 29, 74–93. https://doi.org/10.20420/rlfe.2023.617

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