Professional Accountability-Part I

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 authority.

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 rights."

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.

Dual Responsibility

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 should

  1. Advise the agency in writing of her concerns and suggest changes.
  2. 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.)
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, pp 12.
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