As a teacher of foreign languages, Helen frequently comes across opinions about English language testing for nurses that seem to be formed from very little information
Are we suffering from a nursing shortage?
The inbox of our small English Language training centre is full of requests from agents for nurses with the magic “four sevens” - a band score of seven or more on each part of the International English Language Testing System (IELTS) exam. Agents are regularly calling us offering us a tiny share of the huge fees they are being offered themselves by the NHS and Irish nursing homes.
There are once again vituperative internet posts about the iniquities of the IELTS exam and a recruitment company has asked us for the use one of our precious classrooms for six months to teach Indian nurses Finnish.
So yes, these are the signs and symptoms of a full-blown nursing shortage.
What to do?
We have been through this before and learnt to keep our distance.
The last time was just before the 2008 financial crisis so we learned long ago to keep a cool head and do what we do best: teach all our students to improve their English using the best methods, materials and research.
There seems to be a dearth of calm, well thought out comment on the subject of nurses and English Language testing and, reading the comment boards on nursing websites, people seem to have very little information but very strong opinions about this topic.
In 2003, when the Irish National Board introduced English Language testing for nurses, I was involved in helping a recruitment company and several Irish hospitals to recover from a disastrous recruitment trip where only 10% of the nurses recruited were able to achieve the score required.
There was much angry talk at the time about the shocking irrelevance of the IELTS exam for nurses and a good deal of ‘test blaming’.
“There was much angry talk at the time about the shocking irrelevance of the IELTS exam”
One of my colleagues called me to let me know that the Irish National Board had solved the problem. They were going to accept the Test of English as a Foreign Language [TOEFL] as well as the IELTS and then everyone would find out just how bad the IELTS was.
I explained that changing the test would make no difference as both tests are extremely well constructed and measure the same linguistic items, therefore those unable to achieve the required level on the IELTS would not be able to achieve this on the TOEFL.
A few months later, my colleague called and said she was surprised to discover that I had been correct in my analysis.
A couple of years later, the Irish National Board quietly dropped the TOEFL as an alternative to the IELTS.
Around the same time, our training centre was filled with nurses who were very excited about a new test that they could use to go to Australia and New Zealand: the Occupational English Test (OET).
“Our training centre was filled with nurses who were very excited about a new test”
This is a test designed for 12 types of healthcare professionals with listening and reading tests being the same for them all 12 and writing and speaking tests designed for the 12 individual professions.
I duly bought the very limited amount of material available to teach it from the Australian website and studied it carefully. Far from being a test of nursing knowledge, as the nurses wrongly thought, it seemed to me that it was a difficult test using health care vocabulary but testing the same linguistic items as the IELTS and the TOEFL.
One of my nurses, who had previously been studying for the IELTS, suddenly reappeared one day. She had not finished her IELTS course with us but she had taken the exam in India four times and, failing to achieve her score, she had given up with the IELTS exam as it was “too difficult” and she had switched to the OET, which she had already taken twice and believed she would definitely get next time if I helped her.
Her speaking score was the problem.
She had to perform in a role play with the examiner. The role plays involved situations like: you are a community health nurse and you have to give advice to a patient who has been newly diagnosed as a diabetic.
Now this requires understanding and making numerous questions and giving replies. These are difficult skills in English, made all the more difficult for my student as she had been working as a theatre nurse for several years.
Try as she might, she could not cope with answering modal verb questions, such as “should I buy special food?”
“On the whole, the IELTS speaking test was preferable as anyone could tell the examiner about their favourite teacher at school”
She took the exam twice more and then told me that, on the whole, the IELTS speaking test was preferable as anyone could tell the examiner about their favourite teacher at school. After a few months, no-one came for OET preparation: they couldn’t afford the re-sits.
The OET was four times the cost of the IELTS at the time and achieving the equivalent of IELTS Band 7 proved to be just as difficult and elusive as the IELTS itself.
By the way, Cambridge English Language Assessment have just bought a 70% share in the OET so expect it to be offered as an alternative for nurses to the IELTS just as soon as they resolve the problem of the lack of examiners worldwide.
So what have I learnt about English Language testing for nurses from all of this?
The regulatory body wants nurses to achieve the equivalent of C1 on the Common European Framework of Reference for languages, the level at which people are able to function in a wide range of settings.
All international language tests are now calibrated against this framework, not just English, and all tests are constructed to identify the achievement levels. If you are not C1 on the IELTS, you won’t be on the TOEFL or the OET and it doesn’t matter which test you use.
“As soon as they realized that they couldn’t get the score, they stopped paying through the nose for the OET”
The nurses really didn’t care that the OET vocabulary was in the health care domain. As soon as they realized that they couldn’t get the score, they stopped paying through the nose for the OET and went back to the IELTS.
If your English is at C1 level, then you should be able to cope with a wide variety of situations and quickly learn local expressions so it might be a good idea to keep the language requirements at that level. Test blaming is not productive, researching and identifying the precise levels of English required for nurses in practice probably would be.
Helen Macilwaine is Academic Manager International at Cochin International Language Academy in India