Nurses demand concerns about care and safety be taken seriously
Nurses face a unique dilemma.
On the one hand they have a professional and ethical responsibility to protect
the interest of patients. On the other hand, they are expected to obey directives
from employers, even where such directives may compromise patient safety.
The only RN on night shift
in a small hospital may become overwhelmed by new admissions, or critically
ill patients who suddenly become unstable and need her full attention. She
knows she needs another RN to provide safe care to her patients. She phones
her supervisor to ask permission to call in a colleague to help. Her supervisor
says, "No, we're over budget, you will just have to
If she obeys her supervisor, thereby failing to maintain professional standards,
she risks discipline from her professional association as well as legal liability
for any harm arising to the patient. If she disobeys her supervisor, and calls
a colleague in to assist, she may be disciplined by her employer, including
suspension or dismissal.
Nurses who joined unions were seeking much more than protection against unjust
dismissal, unworkable schedules, or inadequate salaries or benefits. Nurses
also expect their unions to help solve this dilemma- responsibility without
In Alberta "professional responsibility" was
a major issue in contract negotiations
The right to exercise some control over the safe care of patients has, since
the time of Florence Nightingale, been a central concern of nurses. Nurses
have always acted as advocates for their patients, striving to get them the
care and resources they need to be well. This theme in the profession carried
directly over into their collective bargaining when nurses unionized.
Heather Smith: "That's
were I actually began, started to become active in the union, was through
professional responsibility. I didn't see myself as a union activist. A
patient advocate, yes. You were always very clear on that, but that's how
I came in was through wanting to advocate, wanting to get the staffing
for the patients on my medical unit."
In Alberta, the right to "professional responsibility" was one of the
major issues behind one of the few provincial strikes by United Nurses of Alberta
nurses. And it was one of the issues, right from the beginning for UNA.
As President Heather Smith points out, "The key issue, the primary issue
in initial bargaining was wages. They were atrociously poor. The other issue
that came up was the ability to advocate, to have a say and we called that
professional responsibility, the professional responsibility committee."
Helen Krizan: The
professional responsibility clause, is one of the only clauses in our contract
that lets us have access to the hospital board. In a hospital it's really
important to nursing. Maybe we're short staffed, maybe there's something
in the institution that's not safe. You keep working, but you can file a
form that says this is what happened, this is what we think should change.
So it's asking for action on things that you are concerned about.
Mike Mearns: The
Professional Responsibility Committee was very high on the agenda, because
nurses believed that they knew what was good nursing, and they wanted to
use their collective bargaining capital to ensure they had a say on how the
patients were nursed.
In negotiations in 1980 both the wages and the professional responsibility
came to a head.
Trudy Richardson who worked
as UNA's education officer for many years remembers it clearly. "So bad were the wages that UNA's ingoing proposal was for a wage
increase of 33.3% and the employer offered at 29% wage increase, but they refused
a professional responsibility committee. They said the question of professional
responsibility didn't lie with the nurses that was management's responsibility
and nurses should just do what they were told and not question the professional
judgment of the employer regarding nursing."
The stand off led to a strike. The nurses were quickly ordered back to work,
but despite the fact they had been offered a nearly 30% wage increase, the
nurses refused to drop their demands for professional authority.
Finally the courts were
about to become involved and at the last minute negotiations continued. Trudy Richardson remembers: "They just bargained right through
that weekend, hour after hour after hour. There were two huge impediments:
one was the question of wages and at some point early in that marathon the
employer agreed to I think it was 39.8% which was 10% higher than their last
offer and more than the nurses had initially asked for. So obviously
they knew these nurses were serious and it also indicated how badly paid they
had been. A 40% wage increase like that doesn't happen often. But what
held up the talks, the second huge thing was a professional responsibility
committee. They were more insulted by the nurses' demand for a say in
the quality of health care that was being delivered than they were about whatever
the money was and it was only into the very, very early morning of the Sunday
night Monday morning that they finally agreed to the professional responsibility
Margaret Brick : The
union has been the only way I've been able to see where I can fight for my
The nurses had successfully negotiated a mechanism to raise their professional
concerns about their patients' care and safety. The new contract laid out the
process for the professional responsibility committee or PRC. Nurses always
have the right to bring up concerns to the joint nurse-employer committee and
have it addressed. If the nurses are not satisfied with solutions that are
reached, they can take their concerns directly to the governing board of the
Health Region or employer. Over the years nurses have filed hundreds and hundreds
of PRC complaints and made many, many presentations to the Boards of Directors.
Lee McNiven: We
can do it successfully through our collective agreement, through our professional
responsibility committee, right within our worksite, within our nursing unit
where we work. The care can be upgraded and other issues related to patient
care can be talked about. Those things that we don't think we have any impact
onto, ie. that there is no linen cart that's going to arrive on the nursing
unit and midnight, and you're out of linen. What do you do about that?
Nurses use their contract rights to protect patients
Inadequate nurse staffing
is the safety concern that nurses raise far more frequently than any other. At
Alberta Hospital Edmonton, for example, nurses took the following complaint
right through the Capital Health Board of Directors
Nurses, when unavailable
due to vacation, illness or other reasons, are being replaced by psychiatric
aides, or in some cases, not being replaced at all, resulting in inadequate
nursing care. This is an ongoing problem. It
is happening for both predictable absences such as vacation leave, and for
unpredictable absences, such as illness. Levels of permanent nursing
staff are insufficient to provide accessible, sustainable, and consistent
quality nursing care.
Cynthia Perkins: And,
in fact, in our emergency department over the last six years, we have had
so many professional responsibility concerns there that they have increased
the staffing by probably eight FTEs because the manager there was very
receptive, and he used these PRCs as ammunition to his manager to increase
the staffing. So it really worked in some
cases, and so I really encourage people to do that. It's the only
way that we're ever going to get safe staffing levels.
Judith Russell: The
first PRC submitted at the Charles Camsell caused a hurricane at level five.
I wrote a PRC citing a Dopamine drip on a medical unit, down the hall, unmonitored,
as unsafe. Management classified this as high treason. Waiting for the axe
to fall, we stood our ground and came out with all our heads intact and the
patient included in the winnings.
After the tremendous cuts
in staffing during the 1990s, nurses also began raising concerns about excessive
overtime and being forced to work while they were too tired. Again, this came
through the "professional responsibility" process in