Code-switching is the practice of alternating between two or more languages, or varieties of language, during conversation.1 Social science research presents code-switching as a multifaceted custom often observed in members of diverse communities. Although it is common among diverse RNs, the efforts involved in code-switching and its impact on a nurse's morale, practice, and livelihood are often overlooked. Code-switching involves the spontaneous interchange of languages, accent, personality, vocabulary, and demeanors. Depending on the circumstances, those engaging in this practice present a dichotomous self to the world. Below, the reasons for code-switching are explored in nursing history, before earning a nursing degree, and during nursing practice.
Code-switching in nursing history. The origins of nursing's professional identity and the inherited standards of "what makes a nurse" are deeply rooted motivations for code-switching. The need for acceptance by the nursing community, or to fit into standards unrelated to one's identity, has a subconscious influence on what one presents to the world. Nursing leaders who built the foundation of this profession were clear on what makes a nurse. Historically, the nurse's identity was structured to suggest a particular race, gender, socioeconomic status, and even marital status.2 Although the term code-switching was yet to be used, the practice of adjusting oneself in order to belong within the nursing profession had been in effect for decades. Nurses unable to fulfill these idealistic expectations were able to assimilate either by mastering code-switching or by forging their own paths. The development of diverse nursing schools, organizations, and resources was a welcome respite to the constraints that limited diverse nurses' approval.
Learning the code. In nursing, the effort of code-switching is apparent during the formative years of training and education and persists into one's practice. The issue with code-switching is not necessarily the act itself, but the consequential mental constraints. When considering the developmental psychology of the diverse nurse, the act of code-switching may have been taught long before entering nursing school. Whether through family upbringing or church teachings to "act properly" in certain spaces, code-switching is a skill that's built over the years. Do you code-switch? Is your accent less pronounced around certain people? Do you adjust "how much space" you take up? Do you regulate the "versions" of yourself that you present? By the time of admission to nursing school, you may have acquired a level of mastery in this act. Code-switching examples range from contributions in class (especially if you are in the minority within the group), masking your identity to blend in with the institution's faculty and student body, and a hyperawareness of the characteristics you present.
Code-switch fatigue is a term I developed, though this concept has parallels in social science research. It occurs when one becomes cognizant of the efforts and energy exerted to alternate between one's genuine self and the "appropriate" persona presented to the world. It is a response to the constant attention you give to making others comfortable. Code-switch fatigue is heightened by your unrelenting awareness of the perceptions others have of you and by your deliberate alternating of tone, demeanor, and relatability with other qualities perceived as more acceptable. Code-switch fatigue culminates in double-consciousness and in a state where others no longer know where you stand. Recognition of code-switch fatigue is pivotal, as it impacts the morale of diverse nurses. In some instances, the failure to effectively code-switch may create a perception of lack of intelligence, lessening one's ability to be heard and damaging one's self-worth. As we move forward with a more diverse and inclusive climate in nursing, we need to discourage negative customs that pressure our peers into conformity. Rather, we must welcome our differences and collectively explore the advantageous nature of code-switching in the nursing profession.
Code-switching during nursing care. Diverse nurses advantageously utilize code-switching when encountering diverse patients. Below are examples of how I, as an Afro-Latina nurse, code-switch while providing care:
"Buenas, soy Ashley, la enfermera. Como estas? Tienes dolor?"
"Miss A., good evening, how yuh feelin'?"
"So, how about we try this? Imma give you the Dilaudid now, we'll see how you feel in 30 minutes. But you gotta let me know when the pain is creepin' back up. Don't wait for it to reach a 10."
With each patient I encounter, I adjust my dialect, tone, and demeanor to make them comfortable and meet their respective needs. Trust and familiarity are the bridges to quality patient care and positive rapport. Code-switching during patient care is a delicate, flexible, and skilled dance that requires much cognitive awareness. Recent studies have found that a common complaint of hospitalized patients involves communication. In a review of complaints relating to admissions on hospital internal medicine services, Elias and colleagues reported that 59% of complaints were in the "relationship" domain, and that 98% of these pertained to communication and humanness/caring.3 Code-switching provides a common ground and a sense of familiarity for patients who may feel vulnerable in the hospital setting.
The potential dangers of code-switching are offset by acknowledging its enigmatic influence on diverse nursing staff. It is essential to openly discuss what it means to code-switch, the mental constraints of the practice, and the power in being one's true authentic self. This acknowledgment and support builds on the self-care and resilience of nursing staff. Diversifying the nursing profession must include welcoming our differences and rejecting the expectation to dim the light on what makes us diverse.
REFERENCES