I need help with insight RE: school

[Kevin L.]

Hi guys.

I am a student in nursing school (about halfway through), and I ran into a problem because I followed the rules when I was doing my clinical hours in the hospital (it's a common problem with me).

We had to sign off on a 20 page book of rules and regulations, with the understanding that any infraction may result in immediate dismissal from the program, and that there " . . . are no exceptions."

One rule is that we are only to use a professional translation service, or a hospital-certified in-house translator.

This is because mistranslation has led to severe medical errors, and even--on occasion--a patient's death.

I speak some Russian, and my fellow students and one of my instructors knew this because they overheard me speaking with a janitor at the college.

In any case, the translation service was down because of the recent tornadoes.

In any case, everybody (including one of the staff physicians) lost their temper with me because I refused to translate.

They said to me: "I promise you won't get into trouble. We realize that there are rules, but we need to know what's going on with the patient."

I alienated everyone because I refused to translate, as the rules clearly state that the phrase "I was following instructions" is not an excuse to break the rules.

Further, there is the policy that translating without being a certified translator is outside the scope of practice . . . which means that it's like a nurse doing surgery.

Further, my instructor had promised me something earlier in the semester, and broke her word to me.

So, everyone got pissed off at me when I reminded my instructor that she broke a promise to me, and that I can't trust her when she promises me that it will be OK if I translated.

I still got called into the office after the shift, and I put the rule book on their desk with certian things highlighted, like:
1) Following orders is not an excuse to exceed the scope of your practice.
2) Only certified translators or the translator service is acceptable for translation. There are no exceptions to this policy because of the risk for medical errors.
3) Any violation of the rules may result in immediate dismissal from the program.

I stayed in the program and was not written up, but I have the impression that my instructor really, really dislikes me.

I then hear them tell me the thing that I've heard my whole life, which made me need to walk away to avoid losing my temper:

"You're always right. You are an expert at being right. The whole rest of the world would do it one way, and you can produce the facts and figures to prove that you're right and the whole rest of the world is wrong. You make me sick."

Am I in the wrong for refusing to translate? They tell us that the rules are to be followed perfectly.

I had mentioned that maybe they could certify me on the spot, but this couldn't be done because there is a process to become a certified interpreter, so doing this would be against hospital rules.

 

[Kevin L.]

A few other points:

They keep hammering into us that "the ends don't justify the means" and that high ethical standards are the result of doing the right thing even when everybody is pressuring you to do otherwise.

As for my instructor, she promised me--in accordance with school policy--to give me off from school for Yom Kippur, and told me at the last minute that I had to attend class or fail.

I did write her up for this, and the dispute was resolved in my favor, but this was after I had spent hundreds of dollars on tickets for the occasion at the temple. I also had bad performance at school on that day because I was fasting and going without water (in accordance with Jewish custom)

 

[Thinx]

I don't think the issue is whether you are right or wrong. It's probably more about whether you have enough power in the situation, to defy and annoy your immediate boss/instructor and still pass the course? It seems like you may have, if theres quite a shortage of reliable trained staff?

Trainers may have a lot of power over who passes and qualifies, and especially in work with supervised practice components they may be able to fail candidates they don't like for whatever reason. This is because there are a range of subtle elements in practice based assessments that they can basically, manipulate, if you have a trainer who doesn't want a person to pass.

Another issue is how uncomfortable you are prepared to feel at work, short term at least. But once you are through and have passed it all, you are relatively free and clear. One possible idea would be to placate the person and pretend you like them. Tell them how sorry you are to have seemingly upset them and say you are learning a lot from their excellent input. You would have to really sound sincere.

The person is currently paid and qualified as a gatekeeper. If they don't like you it is likely to be uncomfortable there for you. The same will apply with future supervisors, but at least then you will be qualified. It's pretty hard for us not to rely on the rules as we are not neurotypical, so we can't easily intuit how else to navigate the situations. Good luck with this.

 

[Kevin L.]

I don't think the issue is whether you are right or wrong. It's probably more about whether you have enough power in the situation, to defy and annoy your immediate boss/instructor and still pass the course? It seems like you may have, if theres quite a shortage of reliable trained staff?

Trainers may have a lot of power over who passes and qualifies, and especially in work with supervised practice components they may be able to fail candidates they don't like for whatever reason. This is because there are a range of subtle elements in practice based assessments that they can basically, manipulate, if you have a trainer who doesn't want a person to pass.

Another issue is how uncomfortable you are prepared to feel at work, short term at least. But once you are through and have passed it all, you are relatively free and clear. One possible idea would be to placate the person and pretend you like them. Tell them how sorry you are to have seemingly upset them and say you are learning a lot from their excellent input. You would have to really sound sincere.

The person is currently paid and qualified as a gatekeeper. If they don't like you it is likely to be uncomfortable there for you. The same will apply with future supervisors, but at least then you will be qualified. It's pretty hard for us not to rely on the rules as we are not neurotypical, so we can't easily intuit how else to navigate the situations. Good luck with this.

Thank you very much.

 

[VictorR]

I just wanted to say that you have my sympathies - it was quite triggering for me for me to read that as it brought back memories of a very similar situation that I had been in, which lead to a soured relationship with my managers for several years that only ended after they left.

 

[Lysholm]

Technically you did everything correct and they did it to themselves. But...

So much time of a professional's day is engaging in CYA and the "rules" are there to ensure every student is constantly thinking about it. They don't want you to follow the rules one-hundred percent, but instead want you to always consider how every action could potentially be a liability to the institution.

With this in mind - plus the impetus to help the patient no matter what - we can forge a compromise so you and the hospital are covered and the patient can get help: tell them "I'm not a certified translator and therefore cannot translate in an official capacity. However, I will tell you what the patient says, and anything staff does with this information is on their individual judgement."

This way if anything bad happens to the patient the administering nurse or physician will be the one who didn't follow the rules by acting on an unofficial translation. You and the institution are covered. The official translator will still get paid because they will have to do the paperwork.

Likely, there won't be anything administered that is dangerous with just a casual translation. If you relay the patient says they are diabetic, no one is going to give them insulin based on that, but there are other things that can be done to help the patient before an official translator can be summoned. This is an example of the other person considering how their actions could potentially be a liability to the institution. Everyone works together to help people without putting themselves or the institution in an obvious actionable position.

Regardless, it is near impossible for a patient to win a malpractice suit. The law recognizes that professionals do the best they can in their area of practice and allows leeway for their personal judgement to determine best practices in most situations. Under this, ninety percent of success is the physician's intent...at least, their intent as stated on the deposition. If you ever get named on a law suit make sure you only comment through the hospital's attorneys and they'll take care of the rest.

 

[Kevin L.]

Technically you did everything correct and they did it to themselves. But...

So much time of a professional's day is engaging in CYA and the "rules" are there to ensure every student is constantly thinking about it. They don't want you to follow the rules one-hundred percent, but instead want you to always consider how every action could potentially be a liability to the institution.

With this in mind - plus the impetus to help the patient no matter what - we can forge a compromise so you and the hospital are covered and the patient can get help: tell them "I'm not a certified translator and therefore cannot translate in an official capacity. However, I will tell you what the patient says, and anything staff does with this information is on their individual judgement."

This way if anything bad happens to the patient the administering nurse or physician will be the one who didn't follow the rules by acting on an unofficial translation. You and the institution are covered. The official translator will still get paid because they will have to do the paperwork.

Likely, there won't be anything administered that is dangerous with just a casual translation. If you relay the patient says they are diabetic, no one is going to give them insulin based on that, but there are other things that can be done to help the patient before an official translator can be summoned. This is an example of the other person considering how their actions could potentially be a liability to the institution. Everyone works together to help people without putting themselves or the institution in an obvious actionable position.

Regardless, it is near impossible for a patient to win a malpractice suit. The law recognizes that professionals do the best they can in their area of practice and allows leeway for their personal judgement to determine best practices in most situations. Under this, ninety percent of success is the physician's intent...at least, their intent as stated on the deposition. If you ever get named on a law suit make sure you only comment through the hospital's attorneys and they'll take care of the rest.

Thank you very much.

I still have a problem with the idea of breaking the rules . . . even a little bit, as we're told things like "this is an absolute," "there are no grey areas", and my personal favorite: " It's better if something bad happens because you followed the rules than for something good to happen because you break the rules."

I have had problems with this my whole life (I recounted many examples in other threads).

Even so, your response contains a lot of constructive ideas, so thank you again.

 

[Aspychata]

I function the same way too. If the rule is clearly stated, and you would clearly not be following protocol which is extremely important for general purposes, l would state l am unable to translate at the risk of the possibility of losing my good standing at this institution. I applaud you for standing your ground. You may have complied, and been booted, so you did stand your ground. I use to explain the decision process to my daughter as sometimes you are required to make a decision that isn't the popular choice however it's the right choice at that time for you, and later you will be happy with yourself.

 

[Progster]

They really put you on the spot. They were wanting to put you in a position of great responsibility, in which medical decisions that could do harm to the patient if wrong would be made based on what you told them and which could also jeopardise your career. Given this, I think it was your call whether to translate or not, not theirs. I think that I would have made the same decision - not to act as translator. Though if the patient had said something like "I'm diabetic" or "I'm allergic to nuts and I think my last meal may have contained nuts" then maybe I would have said something.

 

[GypsyMoth]

I then hear them tell me the thing that I've heard my whole life, which made me need to walk away to avoid losing my temper:

"You're always right. You are an expert at being right. The whole rest of the world would do it one way, and you can produce the facts and figures to prove that you're right and the whole rest of the world is wrong. You make me sick."

WOW. Is that an autism thing? I get this A LOT. This might not help you but, boy, can I relate!

Am I in the wrong for refusing to translate? They tell us that the rules are to be followed perfectly.

Do you know if yours is a rule-based form of autism? I've heard the term recently & don't know much about it, except that it displays with a perfect adherence to rules. If you're not familiar with it, you might want to Google it. I have a young friend with it and if you tell him what the rules are, he is unwavering in their adherence--just as you were in this situation.

As to the 'were you wrong' question. I have another way of looking at this that might help. What you've raised is a very good ethical dilemma.

If you were brought before your hospital's ethics board, what standard would they use by which to measure your behavior? Would it be by the rule book? Or, would it be by some other standard?

Sure, such a review board might start with the rule book. Some ethics are based on the collective wisdom of your cultural narrative. If the culture emphasizes reliance on the rule book as the guiding ethical principle, then you have done no wrong. The fault--if any--can then fully rest on the shoulders of those who have emphasized the supremacy of the rules. But, if the culture emphasizes instead the idea that we should act only as we would will others to act (Kant), then you are on much shakier ground.

What is a rule? A rule is a guiding principle. In your case, it is a guiding principle backed by the authority of your university. Rules, as laws, are designed to regulate morality. They establish a code of conduct that conforms to the professional standards of a field of study, where such fields have their own authority systems in place. Such codes of conduct are then legally recognized so that (hypothetically speaking) if a patient dies in the normal course of receiving treatment for his condition, the courts can ascertain the behavior and compliance of the medical practitioner and determine whether all due diligence had been observed by the practitioner.

In your case, you want to know if you followed all due diligence, right?

If I may recap here, you made a solid defense for yourself that was based on the rule book. (The rule becomes the authority.) Additionally, you also made the defense that the teaching passed down to you reinforced that you follow the rule book. (The culture is the authority aspect.) So we've determined that you were operating not under one, but two separate authorities.

Very likely--though you have not said it--you may have also been accused of shifting the blame or not taking responsibility for your actions. (If that's not the case, then please disregard. That's what usually follows me after I get the 'you are always right' lecture.) And, if I'm looking at this right, then your teacher is probably seeing it from the 'he missed the point' perspective. They possibly want to distance him/herself from you because they feel responsible for the missed point, as they represent the professional cultural authority from which you learned about these rules. Therefore, your literal interpretation of the rules puts your instructor in an awkward position both with their peers and the people in authority over them.

There is a third authority I have not yet raised. If I may take some liberty here, the debate between Hillel and Shammai--two influential, first-century rabbis--seems to have been on the very matter that concerns you. The debate seems to be, Do you follow the letter of the law, or the meaning of the law? What is the guiding morality behind which the rules were written? Was it merely to provide a way of authorizing all professionals in your field to act, out of conformity or consistency -- or is there implied within their pages and within the larger society, a moral expectation that intends their rulings to appeal a higher good? In other words, what shapes the rules that were written? Joseph Telushkin writes that one of the answers to the debate between the two great rabbinical schools of thought may be found in Ecclesiastes, "the end of the matter, when all is said and done: revere God and observe His commandments, for that is all of man" (Eccles. 12:13; found in Hillel, If Not Now, When, p. 115). I noticed that you are a godly-minded person. You may want to ask yourself, did your actions please God?

I am reminded of the police officer who pulls over the speeding car that blew through the red stop light. When he gets to the window and sees two passengers inside, the driver, a man, shouts out, "sorry, officer, it's my wife! She's having a baby!" Does he issue a ticket? No, because there is a higher, unspoken rule in place: the sanctity of life. Which is the very thing the prohibition--don't speed and don't pass under a red light--are meant to protect. But in this case, obeying the rule to stop at a red could endanger the very life it is meant to protect. What does the officer do? He provides a police escort to the hospital, just to keep the panicking man and his wife safe along the way.

This concerns there being a values system in place that supersedes the rules. And I think for those of us with autism, sometimes we miss the things that everybody else thinks we are all agreeing on. I think you can still get there, though it might take you longer than others. It might help for you to approach it logically.

Take, for example, the Hippocratic Oath (do no harm). Where was the greater good in refusing to translate, because of the rule book? If the Oath is taken as the guiding, moral principle upon which the rule book was based, then if the rules lack moral depth in any given area, is it possible that the rules are not sufficient for giving guidance in that situation? Was it more harmful for the patient to endure his suffering than for the rule book to be upheld?

There is something else to consider.

General Custer was said to have been a lousy student. He graduated last in his class from West Point. Compared to General McClellan, who had graduated second in his class 15 years earlier, Custer was unproven and had no experience leading men. But when the Civil War broke out, Custer quickly proved himself to be a fine field commander--he understood the spirit of the law. Whereas McClellan, on the other hand, failed miserably on the battlefield but was a fine garrison commander. McClellan followed the letter of the law. They were, in many ways, polar opposites. this experience may benefit you in thinking of where your strengths and weaknesses lie. Are there things you can do to shore up your weaknesses, or are there strengths you may leverage, should this come up again?



When thinking about my own relationship to rules, I had an epiphany about the place of rules and law in my own life not too long ago when I realized that someday, this man who had bullied me for nearly ten years, would be judged for his actions, I realized that maybe I ought not to follow his rules so adamantly in my heart. I might have to obey his rules--but I didn't have to believe his rules were right or just.

What about the rules in your rule book. What do you believe those rules are trying to communicate? Do you believe they are always right or just? In every situation? Why? And, if you are faced with doing something the rule book deems unethical, what situations might you believe you would be in the right for doing, even though it might go against the rules? Would you be willing to stand up for what you believe is right, even if might cost your job--but save many lives?

If you have learned nothing else in school, I think the lesson of the rule book will stay with you for many years to come.

 

[Outdated]

I don't really have much to contribute here, except I found out the hard way that often with instructors you are dealing with their ego and their perception of their own public image.

During a lecture while studying Graphic Arts - Printing I put my hand up and said "Excuse me sir, but that's wrong.". The lecturer invited the whole class out to the press room so that I could prove to him how he was wrong, and when I did he became an extremely unpleasant individual to deal with. He didn't care about facts or about teaching correctly, all that he was concerned with was his own ego.

Those that can do, do do. Those that can't teach at TAFE.

And the being right thing, when I split up with the girl I almost married she said "All men always think they're right, the trouble with you is that you actually always are.". (I edited the expletives out of that comment)

 

[Mr. Stevens]

Sounds like they could have prepared better, too. Like have a translator onsite if tornadoes are in the forecast. Or have a serious talk with you ahead of time about being willing to translate, without liability to you, if bad weather cuts off the normal translation service.

 

[Forest Cat]

In any case, the translation service was down because of the recent tornadoes.

I wonder if this can be called "force majeure". If tornadoes have ripped through the community, the usual services are down and out of order, someone desperatly needs something to be translated and you know the language, it could actually be ok to translate. I understand why you didn't want to do it. The problem with the world is that it's often not black/white, either/or, sometimes we have to adapt and do things differently. But you had received clear instructions so it was a tough call. I think if one of your superiors say "I promise you won't get into trouble", then you can do it. Maybe get it in writing with a signature on it.

 

[Outdated]

I think if one of your superiors say "I promise you won't get into trouble", then you can do it.

I'd want that in writing, with witnesses.

 

[Forest Cat]

I'd want that in writing, with witnesses.

Yeah it's always best to have things in writing, on paper with a signature on it. Always. Doesn't take much for a verbal agreement to turn to crap.

 

[Outdated]

In my first job the owners were two brothers that gave me conflicting instructions. When I got them both together and asked them which one I should listen to they both ganged up on me. They didn't like being showed up by a 16 year old kid.

 

[Forest Cat]

In my first job the owners were two brothers that gave me conflicting instructions. When I got them both together and asked them which one I should listen to they both ganged up on me. They didn't like being showed up by a 16 year old kid.

That's one way to do it, gang up on the 16 year old. I have experienced the same thing, I worked for a guy who had a son. Unfortunately his son was a huge ass. He got involved in things and they told me different things.

 

[Kevin L.]

I want to thank everybody very much for weighing in.

I got a lot of constructive ideas, and I'll see where I can go with them.

My issue still remains how to decide when to break and/or bend the rules . . . and it's been this way since I was a child.

For example, my parents told me never to talk to strangers. Never.

They also told me that just because other kids do something that's wrong, that this isn't an excuse for me to do somethingvthat's wrong (like shoplifting or doing drugs).

Well . . . I get sent home from school because I refused to acknowledge or talk to a teacher. She was a substitute teacher and, therefore, a stranger (I had never seen her before).

The first thing out of my father's mouth when they were screaming at me was "You can see all the other kids talking to her!"

And I said that just because the other kids were doing something wrong by talking to a stranger doesn't mean that I can do something that's wrong.

I guess that part of my issue is that I sometimes believe in absolutes.

I am also (in addition to being autistic) a recovered alcoholic, and I haven't had a drink in almost 17 years. It isn't a higher power that keeps me from drinking, or meetings, or 12 steps.

It's against the rules for an alcoholic to drink.

Following this rule as an absolute--with no exceptions--has made the difference between a healthy life vs. being dead in the gutter, and/or perhaps killing other people while driving drunk.

When I heard about the translation rule and medical errors, I thought about it in the same way.

 

[Outdated]

It's also a common autistic trait to take things literally. It doesn't matter how well we can socialise or how much we practice, if we are caught off guard the literal is what we follow.

I have very poor facial recognition, and one morning a couple of years ago a man knocked on my front door. When I answered the door he asked me if I'd like some company for a little while. I didn't have time to think, the simple truth came out. "No.". This seemed to make him angry and he stormed off.

I was curious so I watched where he went, he was one of the full time carers for a couple of disabled people that live across the road, and then I realised that he must have needed to run an errand and wanted someone to sit in the house while he was gone. I felt bad about it but it was too late to correct the problem by then.

Such is life. It's not like I can practice and try better next time, he should have phrased his request better.

 

[Kevin L.]

I understand about the facial recognition thing. I have prosopagnosia, which is trouble recognizing faces.

I can work around this limitation 95% of the time and have no problems . . . except when the COVID epidemic hit.

I am a cardiac technician, and I normally work out of my home analyzing EKG material.

I felt a need to do my part when the hospitals were critically understaffed, so I began working in the hospital . . . and everyone wearing masks made my facial blindness much worse.

This led to people suggesting that I'm a racist when I confused my co-worker's names, because they would ask me: "All us black people look alike to you, huh?"

My explanation (and providing paperwork with my diagnosis) kept me from getting disciplined, but it strained my relationship with my co-workers.

All black people do look alike to me, but so do all white people, asian people, hispanic people, and mixed people. I once had trouble recognizing my own sister when she drastically changed her outfit and hairstyle.


https://www.google.com/url?sa=t&sou...EQFnoECCsQAQ&usg=AOvVaw1h0_7X3uzgYexUvh-Mga7R
So, having prosopagnosia meant that I had to also battle the idea that I'm a racist (I'm not).

Much of this isn't a problem anymore, as mask mandates have been relaxed, and my usual tools for compensating for my facial blindness are working again.