By day seven of a recent hospitalisation, I had identified four of the non-native speakers who worked on the nursing team. Apparently there are seven in total, but the ward is large and I may never get to meet the others. I know there are seven because I overheard a senior nurse commenting on it. And not positively. Communication, it seems is something of an issue on ward B5.
Of the four NNS nurses I’ve met, two are Italian and two are Portuguese. I would estimate that the Portugese are solid B2 level speakers – there are frequent mistakes but these don’t often impede communication and when they do, the speakers are able to correct. The Italians are lower level – one of the Italians is a solid B1 and the other, who is also older, is somewhere between A2 and B1; listening to her I can see how she might have passed Cambridge English Preliminary exam but her slips and errors are probably more common slightly below that.
And it was this lady, who I shall call Maria, that had to deal with this little burst of language the other day. If you can, imagine the nurse speaking with a broad south London accent, all run together and rapid with random glottal stops thrown in here and there:
NURSE: “Right. Maria, so bed 3’s jus come back from her colonoscopy so we know that means she can only have four things, black tea, water, apple juice and jelly. But not the red jelly cos it’s got that stuff in it she can have the orange jelly though so she’d better have a tea and an orange jelly but it don’t matter cos we ain’t got any jelly anyway and the kitchen’s sending some up so that’ll take a while so it’s probably best if you wayer first and that’ll give the kitchen time to send it up, alright?”
MARIA: Tea and jelly. Ok. I do this now?
NURSE: She’s going the wrong way. Maria luv? You’re going the wrong way! She’s over there. Go wayer. WAYer. Weigh her.
MARIA: ah! I weigh her and then tea and jelly.
NURSE: Yeah go on luv off you pop. (Exeunt Maria) it’s so difficult when they don’t understand English innit?
I’ve tried to reproduce this verbally in this recording – it’s the best approximation I can manage of the speed and speech patterns! Click the vocaroo link to listen.
Source: Vocaroo Voice Message
I later overheard a senior nurse tell the Italians they could leave an hour early the following day to attend English lessons being run elsewhere in the hospital.
Maria could probably use some English lessons, this is true – I wonder though, whether they will be the right kind of language lessons. Since being in hospital, the only people I have heard speaking in the UK prestige model of “received pronunciation” are some of the consultants and the surgeons. Everyone else in the hospital is from everywhere else. This being south London, there is a broad mix of Britain’s colonial and cultural heritage in the accents: West Indian, Jamaican, Indian, Pakistani, Nigerian, Ugandan. And of course the famous “estuary English” common to the South East of the UK.
Course book accents tend to be clearer, tinged slightly with regionalism here and there as a nod to the existence of other forms of speech and as a way of helping learners tell the speakers apart during the listening exercise. This is an understandable part of grading the materials to the level of the learner – listening materials need to be accessible after all, but I wonder if, in grading the language our learners hear, we could do more to include a greater variety of dialect and accent. That perhaps, is a topic for another blogpost though.
The big issue for Maria is the one that probably every teacher picked up on when reading or listening to the above conversation. It isn’t that Maria doesn’t understand, in fact if you consider the length and content of the initial utterance, Maria has done quite well to pull “tea and jelly” out of it and to use contextual knowledge to figure out that she has to go and get some for bed 3.
The problem isn’t just that the non-native speaker doesn’t understand, the problem is that the native speaker doesn’t have the best communication skills for speaking to a non-native speaker.
INSTRUCTIONS PEOPLE!!!! INSTRUCTIONS!
The nurse is delivering the utterance at relatively high speed and in an informal mode as is suitable between colleagues who don’t want to make an issue of any power relationships. She pre-justifies the instruction by giving background information that supports the instruction and then gets lost in her own thinking as she clarifies which kind of jelly and what the best sequence of activities is. The speed of speech, and in particular the south London speech patterns of catenation, elision and assimilation, make it very difficult to identify the word boundaries. Likewise, because this is delivered at speed, the stress patterns are not as obvious.
In short, it is a wonder that anybody understood anything.
It might be a bit too much to expect the nurse to grade her language appropriately as this is something that teachers get better at through repeated exposure to multiple levels of ability and understanding what language patterns and lexis are generally comprehensible at those levels. There are though, some simple things that our nurse could do to make life easier on the ward:
- Use fewer words. Don’t use three words where one will do.
- Separate out instructions into single imperative sentences. Don’t front them with polite phrases – keep it simple. So not “Please, if you wouldn’t mind, could you go and wash bed 8 and get them ready for X-ray?” But: “Wash bed 8. Get them ready for x-ray.”
- Enunciate more clearly and make sure key words are separated.
- Speak slower.
- Try and give stress to key words in the sentence, in particular actions to be taken and names or other key nouns.
I also have a theory, based on limited observation and not borne out by any reading or research (not that I found any research on this, so who knows?), that when native speakers try to simplify their language for non-native speakers, they do so in the same way that they might simplify their language for a child. This can be characterised by using more “informal” language, which includes more use of phrasal verbs. Phrasal verbs though, are notoriously tricky for non-native speakers to acquire and differentiate between. Certainly speakers of Latin based languages might have more luck with slightly more formal vocabulary where there are more cognates. So in the example instruction “Get them ready for x-ray”, a better instruction might be “prepare them for x-ray”. But this is only a personal theory…
So there is my free business idea for any teacher in the UK looking to drum up a bit more business – don’t only target the language learners, but look for opportunities in areas where the native and the non-native speaker work together or interact more regularly. Sell the courses in communication skills to Sharon and Tracy (or their boss in HR), and make sure it isn’t only Maria that gets the blame.