Background: The U.S. government mandates nurses to deliver linguistically appropriate care to hospital patients. It is difficult for nurses to implement the language mandates because there are 6,912 active living languages spoken in the world. Language barriers appear to place limited English proficient (LEP) patients at increased risk for harm when compared to non-LEP patients. Hospitals, a primary nurse employer, are responsible for supplying language services to support accessible, quality care to linguistically diverse populations. This descriptive study explored relationships among the use of remote simultaneous medical interpretation (RSMI) in hospital settings, hospital size as an indicator of organizational resources for cultural care, and clinical practice area. Review of the literature: The literature supported the need for improving quality of care through managing the impact of language differences. Published comparative studies on language service use were limited in scope. Nurses had reported RSMI was the most available language service, however, they reported not using the service. Evidence emerged in support of RSMI as the interpreting method of choice by patients, nurses and other health care providers. The literature showed an association among language services availability, omission, and commission as factors important to reducing patient risk for harm and positive health outcomes. Methods and Design. Using two existing de-identified, retrospective databases with data collected over a 12-month period a sample size of 4,502 instances of RSMI use was obtained. RSMI use was compared using chi-square analyses to describe differences among hospital settings, hospital size as an indicator of organizational resources for cultural care, and clinical practice area. Results: RSMI use most frequently occurred during the day shift with the average call lasting less than nine minutes. Spanish was the most frequent RSMI language. Significant differences in RSMI use were found by clinical practice area and hospital size. RSMI use was significantly lower on the intensive care areas in all pairings. In contrast, the mother-baby areas were significantly higher in RSMI use in all pairings. Hospital size comparison revealed that small and medium hospitals had significantly lower RSMI use than large hospitals, while small hospitals had significantly higher RSMI use than medium sized hospitals. Described RSMI use differences may place patients at increased risk for harm. Implications: Nurses need to consider which clinical practice area and hospital size is less or more likely to support delivery of language appropriate care, and adjust practice accordingly to decrease patient risk for harm and improve health outcomes. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]