In one of the courses I teach, I am in the clinical setting (e.g., long-term care facility) with internationally educated registered nursing students. These students have received a nursing degree in another country and are now becoming acclimatized to our health care system in Canada. Some of these students adjust quickly as they may have worked elsewhere in the world, such as in Saudi whereby they spoke English in a health care environment. Other students seem to struggle to understand and sometimes even express themselves. I can see they know what they are doing but they might not be able to clearly express themselves. I have to take a step back and ask if what I am seeing is as was pointed out in this module, not fully grasping English.