Season 2: Episode 5: Yesenia Malave - Leveraging Nursing Language Skills & Education to Bridge the Gaps in Health Care Inequities for Non-English-Speaking Patients

Thank you for joining me for another episode of the Nursing Strategies for Success podcast with this week's guest, Yesenia Malave. Yesenia has been an ICU nurse for over 3 years and is only one class away from becoming a nurse practitioner. She has worked in medical surgical, inpatient, and observation units and is currently working in the ICU. She is a nurse who finished her BSN in Puerto Rico and has created a platform to raise awareness, to eliminate language barriers between patients and providers, to improve outcomes and quality of care. So let's welcome Yesenia to the show. Welcome to the Nursing Strategies for Success podcast, brought to you by The Nurse Speak, a show where we rally some of our nation's greatest nurse leaders, educators, experts, and advocates to tackle some of our greatest challenges that the nursing profession faces. My name is Damion Jenkins, and I'm your host for this show. So sit back, relax, and get ready to learn that nurses can do anything. Okay, thank you so much, Yesenia, for being on the Nursing Strategies for Success podcast. Why don't you just take a moment to introduce yourself to the listeners? Let them know a little bit about yourself, where you started in nursing, and where you are today.

Hi everyone, my name is Yesenia, just like he mentioned. I, uh, did my bachelor's in nursing in Puerto Rico, so I did my bachelor in Spanish. Then I transitioned to Florida. I live in Florida. I started in a medical surgical floor I had experience in medical surgical, then I decided to go further, and now I'm a critical care nurse here as well in Florida. I'm currently finishing up my master's degree in family nurse practitioner and looking forward to do that very soon.

Congrats!

I graduate in the month, March 16th.

That's awesome.

And, um, here I am.

Here we are. So, okay, so you went to school in Puerto Rico, you got your BSN, and then you came to Florida. Um, you know, I, I've spoken with and I work with a lot of international nurses who have gotten their nursing degree, um, from other countries and then had to come here. Now, Puerto Rico is not another country, right? This is still the United States. So they do NCLEX and everything there as well, or was that separate? Was that a different process for you?

It was a different process. Um, I made a video about this in my blog. Exactly. So, um, it's considered foreign because it's Spanish. Yeah. So we have to do the same process as any other country will do to come here and take the NCLEX in the States.

Gotcha. And because the NCLEX is an English exam written in English only, You have to make sure that you have the English competency and then you have to go through and submit all of the same documentation because Puerto Rico doesn't have a State Board of Nursing like each state here, right? Awesome. Okay, cool.

It has their own thing, but it's nothing related to the state.

And is it for the whole country, like their Board of Nursing? Is it, does it govern the whole country? Okay, awesome. Very good. So. You're here. You went through the medical surgical floors, you went through, um, outpatient, right? You did some outpatient stuff. Now you're in ICU for 3 years and you're finishing up your nurse practitioner degree. That's very exciting. Um, and I imagine that there's been some struggles along the way, right? We all have struggles. All of us. None of us can say in our nursing career that it's been perfectly easy, wonderful, smooth sailing, and that everything fell into our laps without much struggle, right? That just doesn't happen in nursing. Um, and so to, you know, fit the theme of this podcast, you know, developing strategies for nursing success, we have to first identify an issue or a challenge or a struggle. And so, you know, what is the one thing that you want to talk about today that was, uh, identified by you as a challenge?

Well, so like I mentioned, I— my bachelor was completely in Spanish. So when I came to the States and I applied to my boards, it was a long process because I have to went through a credit— the credential, uh, review, TOEFL exam, and all of that. So I literally have to reteach myself the whole bachelor with a book in English. So that's where the barriers, the language barrier started happening, and that's where I see, okay, language barrier is actually a challenge. Yeah. And I was able to overcome this by self-studying, but right now I want to be a resource for other nurses as well that come from Hispanic countries to actually be able to get their NCLEX in do the whole process.

Awesome. So in addition to helping people figure out that process, because that is a very lengthy process, and I've helped many people, um, get through that myself, help them navigate that, because each state board of nursing has a decent amount of resources on their website that can help walk you through what documentation you need to submit. And then, you know, they might have resource information for how to get these exams done or how to get the documents from where you went to school in your foreign country to submit them over to the State Board of Nursing. And then once they have everything that they want, which is a lot, they do want a lot.

It is a lot.

Um, then they have to review it and that takes a really long time. And not being familiar with the language very well, um, or learning in a different language and have to relearning, I bet you came into a lot of issues where there was no exact translation, right? Yes, some of the words just don't translate.

Yeah, especially when, um, my Spanish, you know, it's just normal Spanish, and I know my medical terminology in Spanish. So starting to translate medical Spanish to medical English, that's where the actual challenge comes to. Same thing when you're gonna try to serve as an interpreter or to a patient, you got to be very careful, careful how you do it, because words can be, like you said, non-translation at all, right?

And so you're almost creating your own translation to the best of your ability to make sure that you understand what that foreign word means to you, right? Um, so I know I've done that myself when I was interested in learning Spanish or learning Japanese, and some of the words that I wanted to learn, the foreign word didn't exist. And so instead of just being able to say, okay, well, this word exchanges equally for this word, instead I would have to then memorize phrases like several words that means this word. And even then, it's still a loose interpretation. It's very loose-fitting, and it could be changed easily depending on the context in which it's used. So yeah, language is very interesting, can be very complicated.

Yes.

And English in particular is a very difficult language because I think borrow from so many different languages and create— we created our own thing.

Exactly. It's like, I, I— every language is a challenge. But I specifically focus on Spanish because that's my first language. I have English as a second language, and I have seen patients, other nurses, doctors struggle with the language barrier as well. That's when it comes to play. You don't want to misinterpret something. You don't want to lose the loop of what exactly they want.

Right, exactly. Or, you know, if you're, if you're, you know, making sure that you're validating someone's understanding, because that's one of our responsibilities as healthcare professionals, as nurses specifically. We have to validate that our colleagues understand what needs to be done. We have to validate that our patients and family members know what needs to be done. Um, and if we're struggling with the language, that's a big problem, right?

So exactly.

All right. So this is real close to home for you. You know, this was a struggle for you. And congratulations on accomplishing that because it's difficult. You ask the average— you ask the average American to have to take on a whole new language to go work in another country. They're not going to be that successful. It's just we have a— we have a much lower conversion rate for Americans going to other countries. And of course everyone's capable, but still, it's quite the challenge. So, all right. So it started real close with you at home. And so you said you wanted to be a resource for individuals. So let's talk about some of the strategies that you've implemented, both in your own professional practice and then also to help others with the same issue.

Absolutely. So I want to start over on the transition from studying from Spanish to English. So you really have to have a book that has an easy English to understand and that it's a user-friendly book that has all the material you need to know. And it takes time, but you also have to have a resource where you can look up real quick something you need to know, like, okay, I don't understand this word. What does this mean? And look it up. I always look it up. Don't stay with the doubt. That's the first thing I started doing. My books, if you see it, it has sticky notes everywhere, everywhere, everywhere. I was studying. And that's how I was able to improve my English as well.

Right.

And also I have created a blog where I want to try to help other nurses. For an example, I work in the critical care unit and I have faced that One time I had a post-cardiac patient, post-cardiac arrest patient. So this patient wasn't reacting, he wasn't following any neuro commands, but you know what was the issue? That he didn't speak English. So the issue, once you started, once you realize, okay, this guy has a Spanish name, let's see. So once you try the Spanish with that patient, he started responding, you know. And in the ICU, neuro-wise, you ask them, okay, can you please open your eyes? Squeeze my hands, wiggle your toes, and stuff like that. So once I was able to ask him those questions in Spanish, she started seeing a response, right? So that's how important it is also to have either an interpreter in the— in your floor or in the hospital, someone that you have easy access to. Because just like we were talking, um, most of the time the phones It's, it's not going to work in this situation when a patient is intubated, right?

Of course, right. So the, the phones are only, um, appropriate if a patient is cognizant, right? They're, they're completely of sound mind, um, that they are familiar with the telephone, they know how to use a telephone, and that their hearing is okay, right? Like, we need to make sure that they have these capacities before the interpreter phones could even be utilized. And that's something that a nurse can do pretty easily, figure out, you know, if a patient can do that. You know, a lot of times we do our assessments through trial and error, right? We try it, and if it doesn't work, then we say that doesn't work for them. Now, you said having a medical interpreter is essential, and it is. And as many places as I've worked in my career, they've always had access to some form of medical interpreter. Have you experienced something different?

So we do have our facility, like an iPad, where you can go ahead and log into a program.

Mm-hmm.

And— but the steps into doing that, most of the doctors, most of the nurses don't want to do it. They just want to go the easy way.

Mm-hmm.

It takes a lot of time to log in to the computer, into the iPad, find an interpreter on the language you need, plus putting the patient's information there. And like I mentioned, um, the patients at the ICU are mostly intubated and, um, they are in an induced coma, so you're not going to be able to use that at all, right?

So it— so I'm very familiar with this program that you're talking about, and there's a variety of companies that offer this service. Um, I can attest to that being not the best option for interpretive services. For patients who don't speak English, because it does take a tremendous amount of time to log in. Sometimes you can have 10 or 15 minute wait time to even get an interpreter on there, especially if it's a language that is not common. And then again, if the patient has poor vision, poor hearing, if, you know, they're compromised in any other way where they are not going to be able to communicate with an iPad, then that's not appropriate. So, and in an ICU setting, I find it really difficult to believe that they don't have medical physical people who can come very quickly to interpret for you. So you don't have Spanish-speaking interpreters ready to come to you? Now let me ask you, do you have a high population of Spanish-speaking people in your area?

Yes, I live in Central Florida. And, you know, all Central Florida down, basically, of Hispanics.

Yeah. And so I just find that wild. And, you know, we're not going to call out any institutional names. We'll be professional here. But this just goes to show you that we're having— it's constant in so many different areas across the country. And I'm sure it's the same across the globe. That resources for direct patient care are always kind of falling on the shoulders of the nurses. And if you don't have nurses who speak those languages readily available to interpret, then we're not actually taking care of our patients appropriately. So part of the hiring— I mean, part of the hiring process should be to diversify our nurses to the point to where every shift is covered with several common languages that we get. And so if you have a high Hispanic population, then a lot of your nurses, if not most of the nurses, should be Hispanic or at least Spanish speaking, right? So that you could easily call on your colleague and say, hey, my Spanish is rusty, can you come and interpret for me? Right? And then someone who speaks the language would be able to pick up on the fact you mentioned the patient had a Hispanic last name. Someone who's not Spanish, they may not know that, right? They may not recognize that. And so that's something that could be missed. So having those services are great. So you also mentioned you have a blog that kind of outlines some of these strategies. And the one thing I want to go back to is you mentioned you have a video Yes, talks about the whole NCLEX process, right? Coming over from, I guess, Hispanic country or Spanish-speaking country to go through the NCLEX. And again, Spanish, because that's the language you speak. So tell me a little bit about that, because that's very interesting, and I'm sure a lot of people listening to this would also be interested in that.

So my blog is called Hispanic RN Life.

Okay.

And I have the blog and Instagram, and I also have a Facebook page, both with the same name. I actually pinned that video on the top of my Facebook page because I have received a lot of questions from previous colleagues, previous— from Puerto Rico that they want to come and do the process, but they don't know where to start or they're not familiar or they just have that fear of the English, you know? And even that Puerto Rico is part of United States and we are supposed to have English as a second language. That's not the truth.

Sure, of course.

If you're comfortable in Spanish, and most of our ancestors, they just keep repeating the Spanish, Spanish. So now, nowadays, they're implementing teaching more English to all the communities and all these kids are growing up, right? So In my blog, I also have that video, how I did the process of the NCLEX. I also have videos, like, I have videos where I say, like, for example, neuro ICU assessment. I say it in English, I say the phrase in English, I say the phrase in Spanish immediately after. I also upload a little table where I have Spanish on one side, English on one side, so you can have it visualized and you can hear it as well.

Nice.

And I also make sure that— make this disclaimer— Spanish, it also has different variants from country, from Mexican, from Cubans, from Puerto Ricans. We all have our own dialect, right? So my disclaimer is that I always try to use as a general word that it means the same in every country, right, and every Hispanic population, right.

You really try to weed out any slang words or any very regional words, right?

Exactly. I try to use the most general words about it. And how this blog came up, how this worked out, is because I had a couple patients that speaking Spanish patients and My coworkers went to look out for me so I will be able to help them interpret. And one of them says, "Oh, you should teach us Spanish. You should teach us the essential Spanish that we need in this work setting." So that opened my mind. I was like, "That's true." Like, if I know something, why not share it, you know?

Absolutely.

And if I'm seeing a lack of Spanish in a community where there's a lot of Spanish-speaking people, Why not use that resource, be used as a resource for this community when I can? Absolutely. So in looking up about the census, there's like 4% of RNs that are from Hispanic roots, not necessarily that speaks well Spanish.

Sure.

Nurses that are raised over here, most Hispanics that are raised over here, they have a broken Spanish instead of a broken English.

Correct.

So still, and 4% of Hispanic roots are in, it's not enough for the 60.5 million people according to the census of Hispanics in the United States. And this is just an 18% of the population of the United States. But this is expected to keep growing because, of course, migration, right?

Right. Migration, evolution. You know, our families are expanding. We're living longer, you know.

Yeah.

So it's just, again, it's wild to me that you are being asked to teach the nurses Spanish for like basic commands, basic assessments, you know, basic, you know, instructions so that their Spanish-speaking patients can understand. And I'm sure they'll sound like a third grader, right, a small child giving these commands, but whatever, something's better than nothing, right? But what's wild to me is your hospital, who services a large Hispanic population, has not offered Spanish-speaking classes to the nurses, that they don't have in-services that go over, you know, a particular assessment or a particular set of commands or anything like that. And I'm sure your hospital has where you can print discharge instructions in Spanish or any language. That's pretty common across all facilities that are in the 21st century, but it's still wild to me that if you're servicing a very large population that this should be one of the main resources that your hospital is focusing on for continuing education. So if you can't recruit the Hispanic nurses, which I know you can, there are plenty of nurses out there who speak Spanish. You should be specifically recruiting them, specifically saying Spanish-speaking preferred, right? It doesn't mean that that's the only thing that you can hire, but put it on there. They have no problem putting master's degree preferred, bachelor's degree preferred, right? They have no problem doing that. So why don't they list out, you know, Spanish-speaking preferred? Have you looked at any of your institution's job postings? Do they have any of that on there?

No, but I have looked at other, other institutions. And you know that because of COVID now telehealth, it's in.

Sure.

So I have seen plenty of job posts that says virtual educators Spanish preferred, virtual telehealth nurse Spanish preferred. So I have seen that grow a little bit more. And especially after the hurricane that hit Puerto Rico a couple years ago, a lot of Puerto Ricans moved to the States. And yeah, so there's— the community keeps growing. And it's a expected to keep growing, which means that institutions have to keep up with the evolution, like you mentioned.

Yeah, absolutely.

And how can they do that? They can hire Spanish-speaking nurses. They can train their staff. And not only because I know Spanish, like I mentioned, I learned— I teach myself the medical Spanish, medical English, you know. So if you have a Spanish-speaking Nurse provider give them the certification. They are official certifications where you can serve as the language interpreter from your, you know, your, your main language.

Absolutely.

That way you reduce the bias of, you know, of terminology.

Absolutely. So I think that's great. And so, you know, maybe you'll be on the forefront of creating those types of programs in the future. Um, and so, you know, as you get your nurse practitioner's, uh, degree and license, where are you going to be focusing most of your efforts when you come out with that? Where do you think you're going to be mostly?

So I— whenever I finish and I, you know, God willing, get this license done—

you're gonna get it done, it's okay, you'll get there.

Amen. I know it. Now I should be a little bit more comfortable because everything I went through with the NCLEX, that was a lot.

Look, you know, that's what I do for, you know, a living. I've been helping people pass the NCLEX for years. I know it's a very challenging exam. And then having to learn a whole new language in order to pass it adds just another layer of complexity. But once you, once you finish your FNP and you become a nurse practitioner, What area do you want to focus in?

I do want to focus to servicing Hispanic population in Central Florida, especially women. I like women's health, but I will take care of all population as a family nurse practitioner. My focus will be provide, um, health— provide that health services to those that aren't aren't able to afford insurance, you know.

Sure.

So yeah, that's my main focus for now.

Yeah, so servicing, you know, Hispanic underserved, you know, underrepresented, you know, low socioeconomic individuals— that's fantastic. And I think that's what a lot of us get into nursing for anyway, is so that we can help kind of extend our reach to the folks who don't have that care otherwise. Um, but this is a huge area that needs a lot of development And so I think you have a real potential here to grow nursing-related programming around the language and to make sure that there are services in place to help non-Spanish-speaking nurses learn the basics so that they can be more valuable. Just before we started recording, I mentioned to you, I wish I knew Spanish. It's something that I feel would have helped me tremendously in my career so far. And being here in New York City and working with a lot of Spanish-speaking individuals, I feel left out, right? I feel like I'm not as valuable as I could be because if I could communicate with them and meet them where they are instead of forcing them to try to understand what I'm saying, it would just make the learning so much easier. Um, yes, but so I think you have a real potential. So you said, you mentioned that you're on Instagram and you're on Facebook. One more time for all of the listeners, where can they find you?

In Instagram as Hispanic_RN_Life. Okay. And in Facebook just as Hispanic RN Life.

Perfect. Awesome. If you don't have a website yet, I recommend you get one together. You can get a free, easy WordPress website that you can start hosting these blogs, um, and then you can eventually build that out into something bigger. That way you can have not only your FNP services listed there, but you can also have any of the educational products or services that I know you're you're going to create. Um, because, you know, once you get a nice system in place that is easily implemented, people are going to want it. They're going to want your services, and you should be able to provide those services to them. So this is awesome. So I know, again, English-speaking, living in an English-speaking country, I deal with non-English-speaking people every single day. Um, I pretty much only worked in cities, like in urban areas. So that's common, right? It's very common for downtown Baltimore, Maryland to get a lot of international individuals. We get people from all over in, in Baltimore because of Johns Hopkins and University of Maryland, and people come all over the, the world for those institutions. And being in New York, it's the same thing. People come from all over the world to be here. So we should really beef up our educational skills. So I really appreciate you taking the time to share your story with us and let us know about the things that you're trying to do to raise awareness and improve the language barriers specifically for Spanish-speaking, um, health professionals and patients. And I look forward to, uh, following you as you develop your professional career as an MP, and Hispanic nurse educator, because I see that in the future for you.

Thank you so much. I appreciate you having me here too, as well.

My pleasure. Take care. We'll be in touch soon.

All right, bye.

And that concludes episode 5 of the Nursing Strategies for Success podcast with this week's guest, Yesenia Malave. We hope that you've enjoyed everything that we've shared in this podcast episode. And I will have all the ways that you can connect with Yesenia in the show notes of this episode. As always, if you have any questions about anything we covered, feel free to visit thenursespeak.com/contact and get in touch with me. I would love to have a conversation with you. So until next episode, take care, be well, And remember that nurses can do anything.