¿Hablas en Espanol?

[adventure_rn, MSN, NP]

To all of my Spanish-speaking compañeros out there: Do you ever speak to Spanish-speaking patients at work without an interpreter? Do you worry about liability?

I speak Spanish well, conversationally but not fluently. I've taken classes in medical Spanish and worked in clinics in Latin America, but I've never been a certified, formal hospital interpreter.

My hospital does not serve a large Hispanic population, so when we do get Spanish-speaking patients on my unit (Neonatal ICU), we're pretty poorly equipped to work with them (even though we have a Language Line system, which I frequently remind my coworkers of). Consequently, whenever my coworkers have a Spanish speaking patient, they tend to come and grab me.

I'm absolutely in favor of calling the translator whenever we need to discuss a major medical change, or specific discharge instructions that require close patient compliance. I'm not going to try to explain to a scared, distressed parent why we're switching a baby from CPAP over to a ventilator (although I frequently have coworkers ask me to, who get ticked off when I refuse since they're busy trying to rescue their unstable baby...)

My bigger concern is that the small stuff, like minor changes in status and where to find the cafeteria, never gets passed along because it isn't important enough to get out and set up the Language Line. For instance, I had a mom whose baby had been on the unit for nearly 3 weeks. We have private rooms with pull out beds so the parents can live in the room with the baby; our parent showers are on the other hall. This mom, having lived in the unit the whole stay, asked me where the showers were--she'd been bathing in the sink for over half a month since nobody ever used interpreter services to discuss things like unit layout with her.

So, I ask you: what are your thoughts about using your Spanish? Is it ever appropriate, even to discuss things like unit policies? What about minor changes in status, etc.? Does your unit or hospital have a policy? Have you ever had any disciplinary action taken against you?

[Okami_CCRN, BSN, RN]

I work in a mixed medical-surgical ICU that serves a large Spanish-speaking population, that being said I along with a few co-workers speak Spanish fluently and are often asked to translate certain things. I do not mind the least bit translating things like assessment questions, status updates, or things of that nature. I will never translate for consents, for that I tell the physician/NP that we have a dedicated language line and they can use that as they please.

Our facility just requires that we document each time the language line is used and the translators personal identification number so that it can be tracked.

As a nursing student I rotated through a facility that required staff to ALWAYS use a language line, even if they were fluent in that language.

[akulahawkRN, ADN, RN, EMT-P]

While I do speak some Spanish, I understand more than I am able to speak. What I do know at least allows me to get a general feel for what my Spanish-speaking patients are complaining of. I do tell them very early on that I speak very little Spanish so they keep their words simple, which helps quite a bit. Occasionally I'll use Google Translate to help with giving simple directions or to convey relatively simple things. I know and they know that GT is not 100% accurate so we use it only for minor things like restroom location, cafeteria location, and the like. We have a language line that I use for things that require their services, such as medication instructions, procedural consents, in-depth interviews, and pretty much anything else requiring high-accuracy translation.

Some of our staff speak Spanish natively, or nearly so, as do some of our Medical Providers. Unfortunately they're not certified medical interpreters that I know of so while I also make use of them for certain aspects of providing care, the language line is still heavily used for certain events (and documented) to help with liability problems.

What helps greatly with Language Line use is that our staff phones have built-in speaker phone capability. We also have (somewhere) a dedicated 2 handset hard-line phone, but with the transition to portable phones that have speaker-phone, we haven't used it in a very long time.

[klone, MSN, RN]

First, I need to share a pet peeve. A translator translates written documents. An interpreter works with verbal speech. So, the language line phones offer interpreting, not translating. :)

I am also conversational, but not fluent. Unlike most people, I speak it much better than I understand it (although my receptive language skills are improving quite a bit, compared to three years ago). So for basic patient instructions, I will often get by without an interpreter. However, if I know the patient is going to have questions, I will get the phone interpreter right off the bat, as I don't want the patient to be afraid to ask any questions they might have.

[Scrubs_n_sirens, MSN, RN]

We just had a demented and aggressive behavioral health patient who spoke Spanish but understood English. He wouldn't listen when we talked English to him, he wouldn't acknowledge the interpreter on our iPad, and really only responded if we used Spanish with him.

Really very difficult situation. I only know enough to say "sit down", "follow me" (he wandered the ER constantly), offering food, drink, or the bathroom. It was so emotionally taxing. Most of our staff have no Spanish speaking capabilities.

[brownbook]

I have never read our policy. What I've been told is that legal forms, consents, etc. that the patient signs must be done by a hospital certified interpreter, which I am not.

I have no problem explaining simple procedures, (not procedures they need to sign consent for), asking for information, etc. It isn't rocket science to know when my basic Spanish is sufficient and when I need to get an interpreter for more complex situations.

I may be misinterpreting your comment (misinterpreting....ha ha) about co workers annoyed you won't explain complex medical procedures to a scared parent. I hope you help out in some way? Even some poorly worded explanation while their baby is being rescued in an unstable situation can be of some solace? Ask someone to get a fluent interpreter STAT while you stay with the parents?

[NurseMegP, BSN, RN]

I don't speak Spanish, but I do ASL (American Sign Language) with patients who are deaf if it is in regards to small things. I will ask about pain, quality, location, if they're cold, hungry, thirst, if they need to go to the bathroom, etc. However, if it comes to discussing their medical diagnosis I will use the "deaf cart" where there is an interpreter on screen to communicate or if they're AOx3 and able to read/write back and forth with me I will print out medical information and ask them to explain it back to me in their own written words. It really depends on the patient for me. I don't worry about liability because I always make sure my patient is safe. If I have a single doubt they can't understand what I'm saying I will go straight to by-the-book policy on patient's who do not communicate in the same language as I do on a daily basis.

[adventure_rn, MSN, NP]

I may be misinterpreting your comment (misinterpreting....ha ha) about co workers annoyed you won't explain complex medical procedures to a scared parent. I hope you help out in some way? Even some poorly worded explanation while their baby is being rescued in an unstable situation can be of some solace? Ask someone to get a fluent interpreter STAT while you stay with the parents?

I hear you. Usually if a baby becomes unstable, I can definitely reiterate to the parents things like, "You're baby is making his own breaths and receiving oxygen to help him breathe, but if he becomes tired he may need more support," or "This machine is helping your baby breathe; this is completely normal for your baby's age, and as he becomes stronger we can use less support." In these cases, I always try to follow by saying, "We've got a Language Line interpreter who will be available soon, and the doctor/NNP will be able to explain everything that is happening and answer all of your questions."

What freaks me out is when we have parents who ask questions that I wouldn't know how to answer in English, where I'd defer to the provider. For instance, a coworker had a four month preterm kiddo a couple of weeks ago on the cusp of viability. While trying to explain to the parents that we were switching to a more invasive type of vent (which was already out of my comfort zone), the terrified mom asked me, "Are you going to save him?" I tried to explain that we were doing everything we could, and that he was doing exactly what we'd expect him to do at that age, but I worry that the mom misinterpreted my lack of confidence discussing such a delicate topic in Spanish as a lack of confidence in our ability to resuscitate your child. :speechless:I told the nurse that we needed to get the provider and the Language Line, and she got ticked off that I wouldn't just answer their questions. By our standards this baby was 'fine,' appropriately managed and acting as stable as any 23-weeker could, but of course you can't tell a family looking their 1-lb child with a vent, art-line, phototherapy, and central venous catheter that he's 'fine.'

I appreciate hearing all of these comments--while I'm still on the fence about moderate- to high-acuity interpreting, this makes me feel a lot better about discussing minor updates with families!!! Thanks, guys!

[traumaRUs, MSN, APRN]

I use the language line because they provide a written transcript for the medical record which is admissable in court.

[HeySis, BSN, RN]

but I worry that the mom misinterpreted my lack of confidence discussing such a delicate topic in Spanish as a lack of confidence in our ability to resuscitate your child.

Wow, that is a really difficult position to be in... I think I would tell the parents "While I do speak conversational Spanish, I am not confident in my Spanish medical vocabulary to give you the details you need. Can I stay with you until the provider and medical interpreter is available?"

[brownbook]

The mom misinterpreting your lack of confidence discussing the situation is unfortunate but I can understand the mother's fears, worry, lack of understanding, etc.

Your co-worker not understanding that you weren't comfortable explaining a serious change in their child's health, a complex change in treatment, to the parents is ridiculous.

I work with relatively healthy and knowledgeable English speaking patients. I know when to explain, educate, them about up coming surgery, but I know when to say, (sometimes I joke that is above my pay grade), ask the surgeon or anesthesiologists when he/she stops by.

[sjalv]

I speak Spanish very well but I wouldn't say fluently. I explain the situation and answer questions as best as I can but if I find myself unable to describe a medical procedure adequately, I will absolutely use the language line. I have a coworker who speaks Spanish natively but refuses to interpret because our hospital will not pay us extra for being bilingual "because there is a language line".