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Should nurses be able to speak in languages other than English in a clinical setting?
Well, apparently not, according to a memo to staff at Waikato and Christchurch hospitals.
And at Palmerston North Hospital, Indian nurses have been singled out and told they had to stop speaking Malayalam in public spaces.
Professor Ineke Crezee from Auckland University of Technology has been working in this field of healthcare translating for decades, and is a registered nurse. She told RNZ's Saturday Morning when she first heard the news, it felt like "a lurch back in time".
"I did my PhD research many years ago on Dutch migrants who came to New Zealand, and they were told to 'please not speak Dutch' within earshot or in the home, and as a result they actually lost their language. And now they're elderly and can't communicate in their first language with their children.
"So that was my first, you might call it maybe a knee-jerk reaction, but that was my first response."
The instructions to staff at the hospitals sparked accusations of racism and discrimination.
Health Minister Shane Reti said while English was the base language at Health New Zealand - Te Whatu Ora, there had been no directive from the government to healthcare staff not to speak other languages. Nurses who want to be able to speak their first language to each other or to patients where they feel it is clinically safe should be able to do so, he said.
Health New Zealand later clarified and put out another memo saying where it was clinically safe and appropriate, staff should exercise their professional judgement on what language to use.
Crezee said this was the right call, but noted the research had found there were times nurses should consider avoiding using languages their patients might not be familiar with.
"If two nurses are speaking over a patient in their own language, I would never have done that. I would never do that at all because it's very alienating, because you're sowing the seeds of distrust.
"People don't know what you're saying. They might think you're talking about them, which is a very natural thing to think, even if the nurses might just be saying, 'Did you watch the America's Cup last night?' or something like that … but the patient doesn't know that, and the patient's already stressed.
"So I think that's a no-no in my book. I think that professionals need to use their professional judgement as to when to use their first language."
On the whole, having nurses fluent in more than just English - and being able to talk to patients in their native tongues - was a big advantage, she said.
"I think that is very, very appropriate if you want to elicit accurate information, because the nurses on the ground are often the doctor's ears and eyes, so they're the first ones to know when something's not quite right, and they then sound the alarm and the doctors get told and action can be taken, so that's very, very important.
"Also, when nurses want to explain things like 'you're only allowed 500ml of water if you're on dialysis', why that is, Or maybe, 'Yes, I know in our country, if you're sick, you stay in bed. But actually we want to mobilise you because otherwise you might get pneumonia and you might get blood clots.'
"So those two things are very important for better health outcomes, shorter in-hospital, stays, less avoidable readmissions, and research has proven that."
Crezee said while English-speaking patients "already feeling stressed out" might find it unnerving to hear nurses speaking other languages, people who cannot speak English are "constantly surrounded by people who speak a language that they're not used to".
"So I think it's good to take a deep breath, look at it from different perspectives and look at it from both the English-speaking patient's perspective, maybe the English-speaking staff perspective and the non-English speaking patient's perspective."
One study in Australia, she said, found multilingual nurses were highly coveted because they could also act as translators.
"If I were an internationally qualified nurse and I got a directive [not to use languages other than English] I would feel discriminated against… It's almost like, okay, we have a diverse society, but diversity is not positively valued…
"It's actually going to increase confusion. It may, unfortunately, make people feel discriminated against and not valued. And that is not good for any professional doing their job in the workplace - especially not in a healthcare setting."
Health New Zealand chief executive Margie Apa appeared to walk back the directives after Reti's comments.
"It is important that everyone involved in a patient's care, including the patient and their whānau, can clearly understand what is being discussed and be able to participate in assessment, diagnosis and treatment planning … they are professionals, and we trust their judgement."
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