Losing our ‘self’ in self-regulation: Carolyn Strom, the SRNA, and some critical reflections about nursing identity

The ongoing saga created by the Saskatchewan Registered Nurses Association (SRNA), who more than two years ago took action against a fellow registered nurse for her social media critique of the healthcare provided to her dying grandfather, is leaving a wake of moral residue in its path.

When I first learned that the SRNA was going to subject Carolyn Strom to disciplinary proceedings for having shared her feelings about “subpar” end-of-life care online, I was perplexed. They accused her, among other things, of failing to direct her concerns through “appropriate channels”; of “tarnishing reputations” of the employees responsible for her family’s care, and of failing to obtain “all of the relevant facts” before expressing an opinion on her personal Facebook page. When I later learned that Ms. Strom was found guilty of supposedly violating the Canadian Nurses Association Code of Ethics (a document that I have studied, taught, and was consulted to help refresh in 2017), I was dismayed. But these feelings paled in comparison to what I would feel just a few days ago, when I saw a Facebook post by SRNA announcing the most recent judicial decision in this case. The day prior, on April 11th 2018, a Saskatchewan judge had ruled that the courts would not interfere with SRNA’s authority to make the disciplinary decision that it did, which had included a 26000$ penalty.

How could it be that SRNA would take to Facebook – a medium they themselves had deemed an inappropriate “channel” for conversations about controversial nursing topics  – to express vindication? I then noticed that some individuals had “liked” this status, themselves employees of SRNA.

And just like that, my previously familiar feelings of confusion and distress morphed into something darker. For the first time ever, rather than merely being upset by the actions of a nursing organization, I felt a twinge of shame in being a nurse.

Nursing has been my greatest love for most of my adult life. I cherish our profession’s values and I take its responsibilities seriously. Every day, I am amazed and inspired by the fierce intellect of the nurses that I am privileged to know. And I know a lot of nurses.

At the same time, I am painfully aware of the dystopian contexts that nurses in the 21st century are working within. Current contexts of nursing practice are simply not set up to facilitate good care. Mandatory overtime, enduring hierarchical relationships with medicine, misuse of healthcare resources, and continuous under-recognition of nurses’ agency are just some of the forces that conspire against our abilities to do right by our patients.

And yet, I have never once faltered in my hope for our profession. I take pride in a belief that while nurses occupy many different roles – direct care, leadership, education, research, professional associations, unions, and regulation – we all share a common commitment to a core set of values and corresponding responsibilities. These are what define our collective identity.

My understanding of nursing identity, however, assumes the following:

  1. Nurses value the subjective perspectives that patients and families have about their own experiences of health and of care. When a family member expresses concern about the care that a loved one is receiving, nurses engage with them to deepen understanding about what is at stake, and what might be done to help. Nurses do not respond by defensively demanding that families “obtain all of the relevant facts”.
  2. Nurses appreciate the obvious flaws and shortcomings of our health system, particularly regarding end-of-life care. When someone expresses dissatisfaction with the “subpar” end-of-life care being delivered in a particular circumstance, nurses recognize the plausibility of this interpretation. Nurses are aware that while great efforts have been made in recent decades to improve palliative care in this country, there is still so much that needs to change.
  3. Nurses value each other. They understand that their “professional” identities as registered nurses are so tightly wound together with their “personal” identities as human beings, that it is impossible to fully separate the two. When a colleague expresses distress – through social media or otherwise – nurses offer support, not punishment.

In his April 11th court decision, Justice Currie reminds us that when a nursing disciplinary committee exercises its power to examine the conduct of a fellow registered nurse, they do so by considering the rules that apply to all registered nurses, “including themselves”[1].

Carolyn Strom, as a grieving grand-daughter upset with the care being given to her family by a healthcare facility for which she did not work, was in every sense of the word a member of the public that the SRNA is mandated to protect. They did not protect her. Instead, they dismissed her perspective concerning her loved one’s care; they ignored the wider issues at stake about quality end-of-life care in Canadian healthcare; and they wielded their authority as a weapon.

Self-regulation is a privilege that is earned by keeping the public’s trust. It is also the primary mechanism by which we enjoy self-governance and professional autonomy. But if the nurses entrusted to work at SRNA have lost touch with the ethical spirit of our profession, then Saskatchewan nursing will have forgotten its self in self-regulation. This loss of identity harms our profession, in a way far more serious than any damage conceivably caused by the personal Facebook musings of Carolyn Strom.

David Kenneth Wright, RN, PhD, CHPCN(C) is an Assistant Professor of Nursing at the University of Ottawa, a specialist palliative care nurse, and a nursing ethics researcher and educator. He is also a collaborator of the Nursing Observatory, a group engaged in critical analysis of issues pertaining to the nursing profession in Canada.

[1] Strom v Saskatchewan Registered Nurses Association 2018 SKQB 110 at para 35

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