In a recent news story out of Prince Albert, Saskatchewan, Carolyn Strom, a nurse, was found guilty of professional misconduct for a post on her personal Facebook page, citing problems in her grandfather’s care at a local long term care centre. You can read the CBC story about the case here.
In her Facebook post, which you can read more about here in the redacted version of the disciplinary committee decision, she praised but mainly criticized the quality of care that her grandfather received. The excerpt of the posting that the CBC and other news media have presented cite her dissatisfaction with the care her grandfather received while he was in palliative care in the facility, in the last week(s) of his life. The more complete version of the posting, as appears in the redacted decision, goes on to state that the problems and dissatisfaction with her grandfather’s care were ongoing and she warned others whose loved ones were in the facility to “keep an eye on things and report back anything you Do Not Like!”. The post suggested that she had tried to take other steps to address what she calls “subpar” care for her grandfather, and that “not much else seems to be working”.
A disciplinary committee for her provincial regulatory body found her guilty of professional misconduct for posting what she did, and in the manner that she did so. Many argue that this is a “silencing” of discussion over inadequate and poor quality health care for seniors and those at the end of life. Others counter this argument by suggesting that her posting was unprofessional, and inappropriate.
Nurses – and all health care professionals – have a complicated relationship with social media. Is my “personal” Facebook page separate from my identity as a regulated health care professional, with particular obligations and responsibilities? Can I separate out the professional from the personal cleanly and easily? No, it’s not easy nor straightforward. In this case, the personal and professional are clearly enmeshed – Strom is making clear accusations of very poor quality of care, and stating that problems related to care were ongoing. As a nurse, she has particular knowledge of how to work within the system to have her voice heard and a clear idea of what “good quality” care might have looked like. As a family member, she obviously has an emotional reaction to what she viewed as poor care for her loved one, and her post reflects a deep entanglement of these perspectives – which can be, and was, seen as problematic, at least by the provincial regulatory body. Be clear: social media platforms very much want you to mix the personal and the professional. They have a strong desire for you to have a bigger social media reach, offering us more “suggested friends” and “connections” every day. But as health care professionals, with particular and unique obligations – such as maintaining confidentiality – that extend beyond formal working hours, we must use social media more judiciously than many others, and with awareness of those obligations that continue even when we walk out the hospital doors at the end of our shift.
The nurse in this case used her personal Facebook page to engage in a form of professional whistleblowing. One can pick up on her obvious frustration, sadness and anger at the care of her grandfather, in the posting. But was this the most appropriate and effective way to address the problem? Whistleblowing can be effective as it calls attention to what is usually a serious problem, but in most cases, it should only be used as a last ditch effort and with full knowledge of the potential fallout that can ensue for the person bringing light to a particular problem. When all other avenues of possibility have been exhausted, then whistleblowing may seem like a timely and often desperate plea for change or action. It requires moral courage and stoicism and sometimes, personal sacrifice. Whistleblowing was discussed in great public detail as the instigating force behind the investigation into the deaths of 12 children, (between the ages of 4 months and 2 years, who died while in hospital for cardiac surgery in Winnipeg) and the subsequent Manitoba Paediatric Cardiac Surgery Inquest led by Justice Murray Sinclair.
There’s a lot in Strom’s more complete posting when you read through it. There’s a list of accusations and claims beyond her grandfather’s palliative care. There are accusations of poor quality care, of ongoing and unresolved practice issues, of particular staff providing subpar care, of lack of education of staff, of efforts to address these problems without resolution, accusations of complete lack of compassion and care, of treating patients in a way that fails to respect their dignity and a charge to others to be vigilant about the care of their loved ones – inherently suggesting that the problems cited are systemic, rather than tied to individuals. It’s also not clear if she really did exhaust all possible avenues of seeking better quality care for her grandfather. Did she voice complaints to the staff, the manager, the institution, the Board or health region, the regulatory body, the Ministry? Did she report particular nurses, as is our professional obligation, if the situation demands such? Her complaints cite a specific need for education into palliative care, quality care and compassion for some of the nurses in that unit and a demand for them to “step back” – but don’t clearly state what particular professional problems or inappropriate practices she may have witnessed that would underpin that comment. And if these problems are as she has described, the provincial regulatory body should have been involved. There are clear avenues to bring practice problems to the attention of the regulatory body, who are required to take these types of claims very seriously.
As nurses, we often may not be in positions of “enough” power to have our voices heard in the way we would like, but that does not mean we should abandon the avenues that we do have. We must still persevere, in professional and ethically responsible ways, to be heard and to voice our valuable and needed perspectives in ways that can help enact change. As a family member and an RN, Strom had a clear and deeply emotional stake in the care of her grandfather and was able to see where his care could – and should – have been better. We can all imagine – and some may have well experienced – how it feels when you have knowledge about what constitutes high quality care and you see that the care of your loved one is not up to the standards you would expect. It would be, without a doubt, deeply morally distressing. But the question remains, should she have pressed the “post” button on her personal Facebook page to voice her professional views on her grandfather’s care? And if the answer is no, she should not have done so, the subsequent question for many is – does this then shut down discussion of quality health care and problems within our systems and institutions? No, I don’t think it does, and many might argue Strom may had other options to engage in such a discussion more professionally and effectively, even publicly.
There are ways to make whistleblowing ethically permissible as long as other avenues are explored first and you have reasonable evidence that whistleblowing might work. It’s a high risk avenue of action, and without being clear that it might effect change and ensuring that the message is crafted in a way to be most effective, some might claim it is then potentially ethically problematic. It’s not clear here if this posting has resulted in any kind of change or attention to the alleged problems in the named long term care facility – as was Strom’s intention – or if the case has simply just raised more discussion on how nurses should use social media.
A Facebook posting, “rant” or “vent” is an easily accessible mechanism that absolutely any person with a device can utilize as a tool. There’s nothing particularly professional or effective about a Facebook “rant” and due to their ubiquity, and the fact that many are written “off the cuff” or in passing emotionally-driven moments, they’re seen as very weak or, at best, very limited forms of advocacy. Strom posted a deeply emotional Facebook posting on a very personal experience, and used her unique knowledge and professional position to inform her posting and to underpin her claims of poor care and lack of compassion. As a nurse, she has far more sophisticated tools at her disposal, with knowledge of how to advocate personally and professionally, knowing systems and how to maneuver through them (even problematic systems, as she suggests in her post). It’s not clear if she was driven to this, exhausted by lack of action through these other avenues – but this case will continue to raise questions about how we, as health care professionals, manage the personal and professional intermingling that social media involves. The message from the Saskatchewan Registered Nurses’ Association is clear: Don’t mix them up. Use social media with care.
As health care professionals, sitting in front of a screen when we are upset, angry or disheartened by the systems in which we work can result in problems – and for many of us, that may be the time for us to close our browser window, step back and return later, or look to other avenues to have our voices heard.