The ethics of action

"It's a bit rich when health ministers say nurses are holding patient safety to ransom."
“It’s a bit rich when health ministers say nurses are holding patient safety to ransom.”

One of the most confronting issues for nurses has long been whether to engage in industrial action.

Leading nurse ethicist, Professor Megan-Jane Johnstone, believes there are times when nurses need to use industrial action to achieve the best possible safety and care outcomes for their patients.

Professor Johnstone is Chair in Nursing and Associate Head of School (Research) in the School of Nursing and Midwifery at Deakin University, and a consultant in ethics and human rights to the International Council of Nurses.

She told The Lamp: “Society, and even nurses, have taken a long time to accept [industrial action] as an ethical way to fulfil their professional responsibility to advocate for the needs and moral interests of the individuals, groups and communities for whose health care they share responsibility.”

In 1989, when the first edition of Professor Johnstone’s widely acclaimed book, Bioethics: A Nursing Perspective, was published, the subject of nursing ethics was largely invisible.

“This made it very difficult for nurses to have their concerns about ethical issues heard, let alone addressed. The first two of the five revised editions took an almost defensive stance on the rightness of industrial action in certain situations.

“By the time of the third revised edition much had changed. Nursing ethics had gained legitimacy and respect as a distinctive field of inquiry in its own right,” she said. “And the language had changed from discussion of strikes, to emphasis on industrial action including negotiations, going slow or not performing certain tasks. People started to recognise that nurses were just as entitled to take industrial action as any others.”

Professor Johnstone, who is also a Resource Expert for Bioethics Beyond Borders (BBB), a global network of bioethics experts, says despite this nurses still struggle with the idea of industrial action.

“The pressure is multifactorial. I have no doubt they feel a big obligation to the people they’re caring for. That’s what they studied for, gained their credentials to do and they are consummate professionals.

But while taking industrial action may be the right thing to do, that isn’t to say it would be the easy thing to do. I would worry if nurses didn’t have anxiety about taking it. We try to educate our students to be reflective practitioners. They won’t just sit up one morning and say ‘goodie we’ll take industrial action.’ They will think deeply.”

Even though nurses may feel betrayed by an employer they often still feel loyalty to their organisation.

“A decision to either withdraw labor or inconvenience family or patients is a really tough call. On the other hand, it’s time people realised that dedication doesn’t pay the rent.

“Nurses have studied hard and most have gone on to do postgraduate works because nursing has become very specialised.

“Although the media try to paint a different picture, nurses’ organisations run these industrial disputes very responsibly. Withdrawing labor is an absolute last resort. It’s a bit rich when health ministers say nurses are holding patient safety to ransom, when nurses are struggling to maintain their work demands. It’s governments that hold patient safety to ransom.

“In a wholesale dispute, people walk off en-masse. Yet nurses never walk off en-masse, never totally abandon patients. Essential nursing services are maintained. The organisers and the nursing body itself, in engaging in this sort of action, ensure it is framed very responsibly and they give authorities notice so that nurse services are maintained.”

Professor Johnstone says the relatively recent worldwide patient safety movement has helped to focus attention on the importance of nursing work.

“The research is now shining the spotlight on the fact that nurses are absolutely the lynchpin to the safety and quality of health care, that where you have good nursing systems in place you get an equation of good quality care and reduced morbidity and mortality.”

Professor Johnstone says nursing and nursing research are highly regarded in the field of public health and in medico legal systems.

“The people who are not listening are politicians and bureaucrats and this is extremely frustrating and difficult to address.

“It is hard to ignore that, despite the progress that has been made over the past century and more, as has been famously argued ‘the nurse question is and remains the woman question’. Certainly there is room to question that if nursing wasn’t a female dominant profession, would they have to fight the same old battles to get the respect and recognition they deserve?

“Even though as a society we have moved forward in terms of equal rights for women, emotionally we’re still stuck in the dark ages. I don’t think we can avoid the gender issue. It’s the elephant in the room. I think people repress the awareness of subtle discrimination. I wonder if nursing was a male-dominated profession whether we would constantly have to fight the same old battles.”