In my opinion, it is time to assure that nurses graduating in the United States be fluent in English and Spanish. It is estimated that in the first decade of the 21st century, the number of persons of Hispanic origin in the United States will reach 40 million; Spanish-speaking persons already constitute the largest minority group in the United States (Barkin, Balkrishnan, Manuel, & Hall, 2003). In the past decade, the ability to speak Spanish has become a critically important skill for nurses and other healthcare providers. It is particularly relevant for nurses who care for mothers and children, as many of the newly immigrated are young families who may first interact with the healthcare system during pregnancy and/or for well childcare.

Communication barriers can have serious consequences for health, including misdiagnosis, inappropriate medication, and mistrust (Flores, 2000). In one study, Spanish-speaking patients whose primary healthcare provider did not speak Spanish were less likely to take medication as directed, less likely to keep follow-up appointments, and more likely to use emergency departments for routine care (Baker, Parker, Williams, Coates, & Pitkin, 1996).

While interpreters exist in healthcare agencies, they are in short supply. At times, nurses rely on family members for interpreting, but this is less than desirable for privacy reasons (the patient might not want family members to know about abortions or other private health matters). Moreover, if the nurse doesn't understand Spanish, she can't verify the accuracy of the question or answer being communicated. Therefore, I believe that it is now necessary for nursing education programs to include Spanish language and culture in their curricula. Spanish language programs must transcend medical terminology, for working with the whole person, as well as with the family, requires a broader vocabulary than "[inverted question mark]Donde tiene el dolor?" (Where do you have pain?)

How can Spanish language and cultural skills be incorporated into nursing curricula that are already more than full? Formal courses are an option, but a second option is immersion courses either in a Spanish-speaking community in the United States or in a Spanish-speaking country. For example, since 1991 the School of Nursing at the University of Texas at Arlington has offered a 5-week summer elective in which students have the opportunity to spend 2 weeks at the Universidad Internacional in Cuernavaca, Mexico. They spend 60 hours in the classroom studying Spanish and also live with a Mexican family, speaking only Spanish. One advantage of immersion is the opportunity to more fully understand what it is like to live in a situation where communication is in a language other than your own, and to appreciate the difficulty in learning a second language as an adult. This helps to develop empathy for our patients.

Can 2 weeks immersed in another language and culture really make a difference? In one evaluation, five pediatricians were found to have increased language proficiency from 28% to 55% with a proficiency maintenance of 50% 12 months later. There was also a significant difference in Spanish-speaking parents' ratings of physician communication (Barkin et al., 2003). In the 21st century, critical knowledge for nursing continues to evolve. As the population of the United States becomes increasingly diverse, the ability to speak Spanish and to understand Latino culture are skills that must be strongly encouraged in both undergraduate education and continuing education for practicing nurses.

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