The purpose of the study was to understand the role of culture in English as a Second Language (ESL) nurses' clinical communication experiences in the United States, and how these experiences demonstrate the need for continuing education for ESL nurses. Five Taiwanese nurses who worked in U.S. health care contexts were recruited in the study. Data were collected through focus group and individual interviews, and data were analyzed using narrative and thematic analyses. Findings indicate that cultural differences in clinical settings complicated ESL nurses' communication experiences, including linguistic and cultural diversity, the independent role of nurses, patient-centered care, and choice of speech registers. Findings further show that comprehensive on-the-job, vocational training in English for Nursing Purposes (ENP) is essential in order to assist ESL nurses' transit between home and host country cultures. In other words, familiarising nurses with patient-centered care and different discourse patterns, developing critical thinking skills, and enhancing cultural competence should be emphasised in ESL nurses' continuing education.