Posts Tagged College of Nurses of Ontario

About Anonymity, Confidentiality, and Fear

I wrote a post a few days ago about the family member of a patient threatening to report a colleague at another hospital to the College of Nurses of Ontario. In response, I received an email from a nurse in British Columbia who deleted her entire blog when it became apparent she had readers from government domains, including the College of Registered Nurses of British Columbia. She writes (I quote with permission):

Even though I have nothing incriminating on my blog, because I was aware of the “small world” thing that is Canada…..I didn’t trust  what I was seeing.   Perhaps I am paranoid.  Perhaps all it was, was someone interested in what I blogged about (some of the references were papers drawn up by the government itself)…..but since I value my income….and know what the CRNBC is capable of – witch hunting…..and if they ever decided to haul me in or whatever……I decided I would leave nothing to chance and deleted everything.   Just wanted to let you know – be very wary of who is doing what out there……  I don’t trust anyone out there in the government – or any governing body……and in my 30 years plus of nursing……I have seen a lot of what they can do…..

It is sad and disheartening to see yet another nurse-blogger take a dive because of feared retribution from someone in authority. Even sadder when our professional regulatory bodies — with some justice, I’m afraid — are viewed by the frontline as The Enemy. Is it good public policy when nurses self-censor themselves because they fear losing their licences?

I also appreciate the concern expressed in the email. I am the Queen of Paranoia myself. Rest assured, I have been very diligent in applying the principles outlined in my disclaimer. I am resolutely anonymous. I can count on one hand and have fingers to spare the number of people who know my true identity. And, I figured out a little while ago — like, I think, most health care bloggers eventually do — that the stories I share with you about my experiences in the Emergency Department aren’t actually about working in a hospital: they concern human beings, the good, the bad, and the funny — especially the funny. (I’m looking at you, Dr. Weanus.)

The point being, the importance isn’t in the details but in the narrative, the exposition of the human condition. So a lot gets changed, which protects patients (and myself) — but the essence always remains. I want cover my butt, you see, and continue to regale you with tales from the Other Side of the Bed Pan.

So I’m going to carry onwards and upwards, more fool me. Where angel fear to tread, and so on.

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When The College of Nurses Comes Calling

A patient, or more accurately, the family member of a patient has threatened to report an emergency nurse I know at another hospital to the College of Nurses of Ontario.

This is serious business. The College of Nurses is the professional regulatory body of nurses. Its mission is to “protect the public’s right to quality nursing services by providing leadership to the nursing profession in self-regulation.” According to its website, the College “regulates nursing to protect the public interest and sets requirements to enter the profession, establishes and enforces standards of nursing practice, and assures the quality of practice of the profession and the continuing competence of nurses.” In other words, the College receives complaints not only from patients but employers*, disciplines nurses for breaches of the Standards of Practice, and has the power to fine nurses and suspend or revoke licences to practice.  The College’s complaints and disciplinary procedures are generally adversarial, punitive, Byzantine and laborious, and the most trivial complaint against a nurse will result in legal bills running in the multiple thousands of dollars, even if it never goes before a disciplinary hearing.

As a rule, the College of Nurses is generally feared, if not loathed, among Ontario’s nurses. To be fair, those coming before disciplinary hearings usually (but not always) deserve it: they’ve committed some violation the Standards so egregious, so gross, they deserve to be tossed out of the profession. These usually involve sexual or physical abuse, or some other violation of trust. Then there are the corner cases that often don’t make it to disciplinary hearings, and which I think generally have to do with clinical performance: a missed medication, not properly assessing a patient, not providing proper nursing care.  My friend’s case falls into the latter category. She misjudged and misassessed a patient’s condition, and the patient nearly died as a result. Awful enough, for both the patient and the nurse. But she was also besieged by patients, her department was hideously busy, and she was in a role in which she was inexperienced.

She will get spanked for this if the family member carries out his threat.

Unfortunately, the College of Nurses rarely, if ever, addresses underlying issues. The nurse is always and utterly to blame at all times. This is called accountability. In many hospitals, however, when a sentinel event occurs — an event in which a patient was harmed because of some sort of human or systemic error — an inquiry into the root causes of the event is done. What were the contributing factors?  So, to give a very common example, when a medication error occurs, it’s not as simple as the “nurse gave the wrong drug.” Sometimes procedure isn’t followed. Maybe the nurse didn’t do the Five Rights and the Three Checks.** But maybe the medication vial looked similar to another right beside it in the med room. Maybe the concentration of the medication changed. Maybe the names of two medications had similar sounding names. (This happens a lot.) Maybe the work environment was cluttered and noisy. Maybe the nurse had too many patients with similar-yet-different medication regimens. And so on. The point is not to assign blame, or even to dodge responsibility. The point is to prevent it ever happening again.

I hope my colleague makes out okay. She’s a good nurse with a long and spotless record. But she tells me that her finances are such she can’t afford $10,000 in legal expenses, and she may have to leave the profession if she gets the dreaded Registered Letter. I get the accountability thing. But I’m not clear that forcing good nurses out of the profession is in the public interest either.

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*Employers — hospitals, nursing home, whatnot — of course are never assumed to be acting in bad faith. Because employers, presumably, always treat their nurses with fairly, and with justice and respect.

**Five Rights: Right Drug, Right Dose, Right Time, Right Route, Right Patient.

Three Checks: Check the drug when taken from the shelf, when pouring it, and before putting it away again.

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