American Speech-Language-Hearing Association

2013 Student Ethics Essay Award — 1st Place

Scope of Practice Workplace Dilemma: Navigating Difficult Terrain Gracefully

by Karen Cuthbertson
Western Carolina University
Chapter Advisors: Traci Rice and Kristopher Cleary

At a meeting with the school principal, a mother is desperately trying to get the school services she believes her child deserves. The mother has a child with Cerebral Palsy. Her child has difficulty coordinating muscles involved in swallowing, resulting in food sometimes being left behind in his throat. Two years ago, a speech-language pathologist from a private practice diagnosed the dysphagia and informed the mother of the risk of aspiration. The child has received dysphagia treatments twice a week at home with the private practice speech-language pathologist. The mother has been insistent that the dysphagia services be provided at the school, so she does not have to deal with the scheduling problems surrounding at-home treatments. When the mother brought this suggestion up at the IEP meeting, the school speech-language pathologist declined, informing the parent and principal that she was not skilled in dysphagia treatments. The mother went home and looked online. She found that some school speech-language pathologists do perform dysphagia treatments. The mother pleads with the principal, "Why didn't she learn how to do this in school? Can't she take a workshop in dysphagia and then be qualified to treat my son?" The principal thinks the mother has a good point and he is also wary of any bad press or litigation that may result if this mother is not appeased. The principal meets with the school speech-language pathologist and informs her that he believes dysphagia treatments should be a part of her job description. The principal tells the speech-language pathologist that she is expected to do the dysphagia treatments, even if she needs to go to a workshop or seminar on her days off.

The speech-language pathologist clearly does not feel comfortable with providing dysphagia treatments. As ASHA's Code of Ethics states, "Individuals shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their level of education, training, and experience" (2010). According to ASHA the speech-language pathologist is acting ethically, even in the face of great pressure from her employer. The speech-language pathologist understands that due to the complexity and level of risk involved with dysphagia, a seminar or even a refresher class on dysphagia will not make her competent in this area. As the ASHA Code of Ethics highlights, competence is gained not only from education, but also through training and experience (2010, p.2). This means without the education, training, and clinical experience, the speech-language pathologist cannot ethically follow her employer's proposed plan. Instead she must find another way to deal with this workplace dilemma with her employer.

The speech-language pathologist would be wise to revisit methods for conflict resolution before speaking with her employer. An informative resource is Vinson's book Workplace Skills and Professional Issues in Speech-Language Pathology (2009). This book offers a chapter dedicated to conflict resolution, describing specific concepts and strategies for the successful negation of difficult issues. For example, the speech-language pathologist could take the advice of Vinson (2009) and seek to understand other's opinions and address the issue with a win-win approach. By first understanding the parent's and principal's concerns, the speech-language pathologist can be more effective in finding a solution. The speech-language pathologist could realize that the mother does indeed have a burden with the at-home private speech-language pathologist sessions. The speech-language pathologist could also realize the principal is trying to make the mother happy and is also concerned with litigation. With these perspectives and the concept of win-win in mind, the speech-language pathologist may create a win-win situation by suggesting the private practice speech-language pathologist perform the dysphagia treatments on campus, during the child's lunch time, or just before or after school. This way, the mother wins because the dysphagia treatments are not in her home and she does not have to schedule them. The principal wins because the mother is happier and he is not making the school speech-language pathologist uncomfortable by asking her to do a task that violates her professional ethics code. And the school speech-language pathologist wins because she is upholding her ethical duties to ASHA, herself, and her client by not performing unqualified services. In any case, taking the time to see other's points of view and practicing conflict resolution techniques would be the beginning steps of a healthy discussion.

Another aspect of her discussion with her employer would center on her obligation to ASHA's Code of Ethics. Huffman (2003) points out that many employers of speech-language pathologists are not obligated to ASHA's Code of Ethics, and therefore filing a complaint would be of no use. However, this does not mean that the Code of Ethics cannot be useful with employer workplace dilemmas. Huffman (2003) provides guidance on this issue, suggesting that the Code of Ethics be used as a tool. In addition to using ASHA's Code of Ethics to guide her own decisions, the speech-language pathologist can use the Code to educate her employer about her responsibilities and duties. By showing the employer the specific wording and spirit of the document, the speech-language pathologist can have a more meaningful and legitimate case to present to the employer. In addition, Huffman (2003) suggests that speech-language pathologists should be proactive in preventing conflicts by discussing their Code of Ethics periodically during every day work activities.

Vinson (2009, p.329) reminds us that "Conflict at...work is inevitable." With the understanding that conflict is a natural part of the work place, the speech-language pathologist can more objectively deal with the uncomfortable situations that predictably arise. Although extremely challenging, the speech-language pathologist can choose to look conflict the way Vinson (2009) suggests: as a beneficial aspect of problem-solving. By viewing conflict in this manner, greater communication and professional relationships can be established with the employer. To this end, ASHA's Code of Ethics can be used not only a guiding force, but also as an important tool when undertaking these types of professional challenges.

References

American Speech-Language-Hearing Association. (2010). Code of ethics [Ethics]. Available from www.asha.org/policy.

Huffman, N. (2003). Employers, Employees, and Ethics. Retrieved March 23, 2013, from http://www.asha.org/Practice/ethics/Employment/.

Vinson, B.P. (2009) Workplace Skills and Professional Issues in Speech-Language Pathology. San Diego: Plural Publishing.

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