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 cope."
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
From SUN's inception, the union was expected to represent and defend nurses
who were desperately concerned about patient care. But, health care employers
vigorously resisted any collective agreement provisions which restricted, "management
With no provisions in the new collective agreements that required management
to treat nurses' concerns about patient safety seriously, nurses took direct
action, and SUN had to develop new strategies and processes (outside the collective
agreement) to support them.
In June, 1975, the six
general duty nurses at the Broadview Union Hospital resigned over concerns
of a, "steadily deteriorating working relationship with
one of the doctors on staff." This action by nurses lead to an investigation
resulting in the permanent suspension of the doctor's privileges. (SUNSPOTS,
Vol. 2, #1, March 1976, pp 6,7
On June 28, 1975, eight
general duty nurses (the entire RN staff) employed by the Birch Hills Memorial
Union Hospital submitted their resignations, in part because of a, "dispute
between the doctor and the hospital over the scheduling of certain major
surgery with the result the doctor took certain action which placed nurses
on duty on two shifts in an intolerable situation related to patient care." (SUNSPOTS,
Vol 1, No. 3, August 8, 1975, pp 4.)
The doctor was also charged
and found guilty of common assault against one of the nursing staff and agreed
to sign a statement retracting remarks he made at a town meeting where he
referred to nurses, "in slanderous terms", referring
to them as, "two year bohunks " and, " two year wonders " and
alleging that they were responsible for patient deaths. The Hospital was closed
from June to February of 1976. SUNSPOTS, Vol 2, No. 1, March, 1976, pp 7.
SUN decided to put pressure
on the Birch Hills Hospital to reinstate the nurses by, "Greylisting" the
hospital. "Greylisting" was
a process where SUN publicly advised nurses in Saskatchewan not to seek employment
with the hospital.
SUN employed the "Greylisting" strategy
again when sixteen nurses at the Watrous Union Hospital went on strike on
Wed, January 4 , 1978 over two staffing issues. The hospital failed to maintain
normal RN staffing when the Director of Nursing was absent and replaced by
a general duty nurse, removing one of the two nurses from the bedside.
The hospital also refused to continue a provision to provide orientation
for new nurses. The SUN Board of Directors voted to "Greylist" the
Watrous Union Hospital until the dispute was resolved. On January 20 th , an
agreement was reached and the Greylist lifted. SUNSPOTS, Vol 4, No. 1, January
20, 1978, pp 3..
While the drastic action
of mass resignations and the "Greylisting" policy
had some success, nurses pressed SUN to negotiate improved staffing and patient
safety provisions in their collective agreements.
On October 2 and 3, 1975,
SUN's bargaining conference reached a consensus about key items for the 1976
round of negotiations, including: " General
improvement in areas of working conditions with respect to staffing, hospital
ADC (average daily patient census) right to file complaint re workload, staff
development." (SUNSPOTS, Vol. 2, #1, March 1976, pp 1.
"Be it resolved that
SUN strongly encourages S.H.S.P. (Saskatchewan Hospital Services Plan)
to establish a compulsory, functional, patient workload index as the criteria
for allotting registered nursing positions in Saskathewan hospitals." Resolution
passed at March, 1976 SUN Annual meeting, (SUNSPOTS, Vol. 2, #1, March
1976, pp 3.
In 1977, SUN was well aware of the conflict between a Registered Nurse's responsibility
to the employer, and responsibility to the patients, and why nurses felt compelled
to resign where that conflict became intolerable.
SUNSPOTS, quoting an article
that first appeared in the March, 1977 issue of Dimensions in Health Science,
by Lorne E Rozovsky providing legal advice to nurses that, " If a registered
nurse forsees the possibility of patient injury as a result of the standards
of nursing practice of the employing agency...she
Hoping to provide nurses
with a powerful tool to help resolve this conflict, SUN members at the 1980 Annual
Meeting passed a resolution directing that " The
Union develop and implement a Documentation Program incorporating the use of
a, "Professional Accountability Form". (SUNSPOTS, Vol. 6, #2, June 20, 1980,
- Advise the agency in writing of her concerns and suggest changes.
- Within the employer's policies, abide by the standards of the average,
reasonable and prudent nurse in the circumstances. If the policies are
so incompatible with a reasonable professional standard, the nurse
should resign . [emphasis added] Failure to abide by these
standards may result in injury and liability of the nurse as well as the
employing agency." (SUNSPOTS, Vol. 3, #3, March 13, 1977, pp 8.)