Treatment of nurses

Finding

The evidence suggests that because nursing occupied a subservient position within the HSC structure, issues raised by nurses were not always treated appropriately.

Throughout 1994, the experiences and observations of the nursing staff involved in this program led them to voice serious and legitimate concerns. The nurses, however, were never treated as full and equal members of the surgical program, despite the fact that this was the stated intent of the administrative changes that the program underwent in June 1994. Intensive care unit nurses, for example, were never properly involved in the review team that assessed the program during 1994, and nurses were not properly involved in the Williams and Roy Review. The concerns expressed by some of the cardiac surgical nurses were dismissed as stemming from an inability to deal emotionally with the deaths of some of the patients. As well, any concerns over medical issues that the nurses expressed were rejected as not having any proper basis, clearly stemming from the view that the nurses did not have the proper training and experience to hold or express such a view. In addition, while HSC doctors had a representative on the hospital's board of directors, nurses did not.

Historically, the role of nurses has been subordinate to that of doctors in our health-care system. While they are no long explicitly told to see and be silent, it is clear that legitimate warnings and concerns raised by nurses were not always treated with the same respect or seriousness as those raised by doctors. There are many reasons for this, but the attempted silencing of members of the nursing profession, and the failure to accept the legitimacy of their concerns, meant that serious problems in the pediatric cardiac surgery program were not recognized or addressed in a timely manner. As a result, patient care was compromised.

Finding

The evidence suggests that nurses were not allowed to play a role in planning the February 1994 restart of the Pediatric Cardiac Surgery program, even though they formed an essential element of that program.

The concerns expressed by the PICU and the NICU nurses over the types of procedures that were to be carried out in the intensive care units were not addressed in a timely manner. In a number of cases it appears that the concerns of the operating room nurses over the nature of the deaths that occurred and with the mortality rate were interpreted as an inability to cope with the unfortunate, unavoidable death of a child. There was an implication that the nurses lacked a vision of the larger picture.

When the hospital was reorganized in the summer of 1994, the position of Vice-President (Nursing) was eliminated, although a commitment was made by the President of the hospital that there would always be one vice-president with a nursing background. (While the medical vice-presidency was also eliminated, HSC doctors continued to have direct representation on the HSC board). The restructuring that took place in 1994 also led to the creation of the position of unit manager, to replace the previous position of head nurse. While there were a number of benefits to this structure, creation of the new position led to a situation where nurses could theoretically be reporting to non-nurses. (While head nurses had to be nurses, this is not the case with unit managers.)

Finally, the evidence suggests that despite its stated intent, the hospital reorganization of 1994 implicitly devalued nurses, since it appears to have been driven by a concern to cut costs primarily by reducing staff, the bulk of whom ended up being nursing staff.

Throughout 1994 the nurses made proper and appropriate use of existing channels to voice their concerns. For a variety of reasons-some personal, some institutional-their concerns were not attended to. Indeed, the reception they were given led some nurses to silence themselves. It also left them frustrated and distraught. Many paid a heavy emotional price. By the time the program ended, at least one nurse was on the verge of taking her concerns outside the hospital, at great risk to her position and career.

It is necessary to put in place structures that ensure that all staff can make their concerns known without fear of reprisal. It is also important to ensure that the structure of the HSC be adjusted to ensure that the position of nursing does not continue to be a subservient one.

Recommendations

It is recommended that: The HSC restructure its Nursing Council to allow nurses to select its membership and to give it responsibility for nursing issues within the hospital. The Nursing Council should have representation on the hospital's governing body and be responsible for monitoring, evaluating, and making recommendations pertaining to the nursing profession within the hospital and for nursing care. The Council should also serve as a vehicle through which nurses could report incidents, issues, and concerns without risk of professional reprisal.

It is recommended that: The HSC establish a clear policy on how staff is to report concerns about risks for patients. This policy must ensure that there is no risk to the person who is making the report. It should be clear to every staff member to whom they are to present such reports.

It is recommended that: The Province of Manitoba consider passing 'whistle blowing' legislation to protect nurses and other professionals from reprisals stemming from their disclosure of information arising from a legitimately and reasonably held concern over the medical treatment of patients.