Dialogue with Your Executive Director

RNAO: With you every step of the Way!

The Registered Nurses Association of Ontario (RNAO) reacted with sadness and strength to the news that two registered nurses were charged October 25 with criminal negligence in the death of Lisa Shore. We are saddened for all the people involved in this case, which is now making its way through the courts, and concerned about the possible implications for nurses trying their best to do their jobs under difficult circumstances every day.

While we cannot comment on the specifics of this case, we must emphasize the importance of considering any case within a larger context that includes system-wide issues in the delivery of health care.

I would like to share with you RNAO's reaction to this unsettling news, and how, once again, the profession stepped in to speak out for health and speak out for nursing.

After reading Christie Blatchford's news-breaking story in the National Post the morning of October 24 ("Two nurses to face criminal charges"), it became clear that the profession was once again going to be subject to intense scrutiny. The issues embedded in this case required a strong, sensitive, and united response. Not a knee-jerk, circle-the-wagons kind of response, but one that respects the judicial process (including the presumption of innocence), the complexity of nursing in today's world, and the feelings of the two nurses as well as the Shore family.

Later that same morning, before official sources confirmed that charges would be laid, a media outlet called RNAO's home office for the association's reaction. But before agreeing to participate, we took time to consider several questions. Is it prudent to respond when charges had not yet been confirmed? What do registered nurses across Ontario need - and deserve - from their professional association at this critical juncture?

Once we had confirmed that charges were about to be laid, we prepared a statement highlighting nurses' daily commitment and steadfast intention to provide high-quality care for patients. While it is not the place of the professional nursing association to act as judge and jury of a case that has unfortunately landed in the courts, there is much to be said.

Through our statement, we shared with the media and the public the connections, complexities and consequences of health-care policy and practice. Nurses do not work in isolation. Multiple factors, including clinical competence of nurses, their work environments, their practice support systems, and their communication with other health-care providers, affect critical incidents in health care.

We reminded everyone that nurses come to work every day with the intention and commitment to give patients safe and high-quality care. To do that, nurses require support and a healthy work environment to fully use their knowledge, expertise and commitment to care.

We also assured the public that our commitment to safe and high-quality care was unwavering. And, while there is no doubt that Anagaile's and Ruth's experience affects us all and increases our stress, nurses are professionals, and will continue to provide the best care they can in their day-to-day practice.

Ontario's nursing community has a long-standing tradition of supporting nursing colleagues in times of crisis - a tradition we are committed to sustain for years to come.

Consider, for instance, the charges brought against registered nurse Susan Nelles in 1981. Nelles, accused of murder in a series of baby deaths at the Hospital for Sick Children, was of course cleared of any wrongdoing. But the toll that process took on her and the profession is legendary.

According to Gail Paech (RNAO president, 1983-1985), the hearings united nurses as never before. The RNAO applied for and received standing - the right to participate fully, cross-examine, call witnesses, and make submissions and recommendations - at the Royal Commission of Inquiry into Certain Deaths at the Hospital for Sick Children and Related Matters (also known as the Grange Inquiry). The RNAO Foundation established the Grange Inquiry Fund to offset legal expenses incurred representing the profession. And in 1986, the RNAO established the voluntary Legal Assistance Program (LAP) to assist nurses with legal problems that may arise in work-related circumstances.

Another case comes to mind. In 1998, registered nurse Gita Proudman was charged with second-degree murder in the death of two-day-old Mustafa Dehzad at Humber River Regional Hospital. The Crown later dropped the case, citing insufficient evidence. In an article Proudman wrote for the January/February 2000 issue of Registered Nurse Journal, she eloquently summed-up the support she received from Ontario's nursing community when she said, "To have both RNAO's and the Ontario Nurses' Association's leaders dancing in the street with my father [after the charges were dropped] says a lot about our profession."

Today, at the Hospital for Sick Children, the RN Council is engaged in a number of activities to support the nurses charged with criminal negligence and to communicate with all nurses during this difficult time. From unit debriefings, to cards of support for Anagaile and Ruth, to one-on-one meetings with nurses, the key is communication and ensuring that all RNs receive factual information in a timely fashion. I met with nurses at the Hospital for Sick Children, and will continue to do so as often as requested.

Nursing's rich history has demonstrated the profound good that comes when registered nurses come together. No one said it better than Proudman in 2000: "Nurses, true nurses, take care of each other. They stand by each other, no matter how difficult the situation. This was made poignantly clear throughout my ordeal. I hope no one ever again needs the kind of support I received. But if you do, know that nurses will be behind you and when you stumble, they will pick you up, dust you off, and help you keep walking."

The RNAO shares Proudman's hope that nurses will be free to practise without fear of criminal allegations. But if you do find yourself in need of support, we hope that you will take comfort in the fact that your colleagues and your professional association will be with you every step of the way.

Doris Grinspun, RN, MSN, PhD (cand.) is executive director of RNAO.