SAUDI UNDERGRADUATE NURSING STUDENTS’ EXPERIENCES LEARNING NURSING IN ENGLISH AS A NON-NATIVE LANGUAGE

Abstract

Nursing students for whom English is a non-native language often face substantial academic and clinical challenges when instruction is delivered in English, particularly when their proficiency is limited. Difficulties include comprehending nursing concepts, succeeding in examinations, communicating with faculty, patients, and healthcare providers, and documenting patient care in clinical settings where English predominates. These barriers can threaten academic success, increase attrition, and compromise readiness for safe practice. In Saudi Arabia, where all nursing programs are taught in English, such challenges are particularly pronounced given the discontinuity between Arabic-medium pre-university education and English-medium nursing education. The purposes of this study were to explore and describe the experiences and learning needs of Saudi undergraduate nursing students learning nursing in English as a non-native language. A qualitative descriptive design grounded in naturalistic inquiry guided the research, which sought to capture participants’ experiences in their own words within their authentic educational context. Participants were recruited through purposive snowball sampling. Data were collected through semi-structured interviews conducted via Zoom® with 12 native Arabic-speaking Saudi undergraduate nursing students enrolled in eight public nursing programs across Saudi Arabia, representing various academic years. Data were analyzed using a content analysis, generating 654 codes organized into five categories and 12 subcategories. Findings revealed that participants faced multifaceted challenges related to comprehension, examinations, communication, time management, and psychological well-being. Despite these difficulties, students demonstrated adaptability through translation, independent learning, and support from peers, faculty and academic programs. Over time, sustained exposure to English in academic and clinical settings led to progressive improvements in proficiency, confidence, communication, and performance. Participants emphasized the need for stronger English preparation before and during university study, nursing-specific curricula tailored to linguistic needs, bilingual instructional supports, equitable assessment practices, accessible resources, smaller class sizes, and increased opportunities for language practice. The implications of these findings are substantial for nursing education, research, and practice in Saudi Arabia and globally. They highlight the urgent need to integrate language development within nursing curricula to enhance comprehension, communication, and academic success. Strengthening English preparation and linguistic scaffolding can promote equity, improve outcomes, reduce attrition, and enhance readiness for licensure and clinical practice. The study findings advance nursing science by emphasizing language proficiency as a developmental process requiring sustained scaffolding, multimodal pedagogy, and bilingual strategies to support progression from conversational to academic and professional fluency. For practice, English proficiency emerges as a cornerstone of patient safety, documentation accuracy, and interprofessional collaboration, while bilingual competence remains essential in caring Arabic-speaking patients. Ultimately, the findings reframe English language proficiency as a professional competency and institutional responsibility, an essential investment in nursing education and workforce preparedness, and the long-term sustainability of global nursing and healthcare quality.