On Feb. 25, 2015, a month after her grandfather's death at St. Joseph's Health Facility in Macklin, Sask., Carolyn Strom posted the following comments on Facebook:
"My grandfather spent a week in palliative care before he died and after hearing about his and my family's experience there, it is evident that not everyone is 'up to speed' on how to approach end-of-life care or how to help maintain an aging senior's dignity.
"I challenge the people involved in decision making with that facility to please get all your staff a refresher on this topic and more. Don't get me wrong, 'some' people have provided excellent care so I thank you so very much for your efforts, but to those who made Grandpa's last years less than desirable, please do better next time."
For those rather innocuous comments, Ms. Strom, a registered nurse, has been found guilty of professional misconduct by the Saskatchewan Registered Nurses' Association.
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A penalty hearing has not yet been set, but Ms. Strom could face sanctions ranging from a fine through to being stripped of her licence to practice.
This is preposterous. The SRNA, as a regulatory body, is supposed to ensure that nurses act ethically and the public is afforded the highest level of care.
It is not supposed to behave like a kangaroo court that sanctions nurses for hurting the feelings of other nurses. It is not the Facebook police. Nor is its role to muzzle nurses who advocate for better patient care.
The SRNA discipline committee initially said RN #0037024 violated the Registered Nurses Act by acting unprofessionally in five different ways:
Violation of confidentiality by identifying her grandfather by name, a charge that was withdrawn;
Failure to follow proper channels: making complaints publicly rather than directly to the health-care facility;
Impact on reputation of facility and staff: By saying some employees are not "up to speed" and care was sometimes "subpar," she has "tarnished reputations;"
Failure to first obtain all the facts before going public;
Using status of registered nurse for personal purposes.
One issue here is whether Ms. Strom – or any other professional, for that matter – can be sanctioned for comments they make off-the-job.
The answer to that is: Yes, in some cases. For example, the courts have ruled that a teacher can be fired for making anti-Semitic comments outside of school. But the courts have also ruled that a nurse can protest outside an abortion clinic and not be sanctioned.
The discipline committee ruled that Ms. Strom's constitutional right to free expression was violated but that it's a reasonable limit because she identified herself as an RN.
That's questionable but the real issue here is whether what she said in her Facebook posts was unreasonable or unprofessional.
Under the Saskatchewan Registered Nurses Act, professional misconduct is defined as "any matter, conduct or thing, whether or not disgraceful or dishonourable, that is contrary to the best interests of the public or nurses or tends to harm the standing of the profession of nursing."
Is pointing out that end-of-life care could be better for seniors in institutional care disgraceful or dishonourable? Is it contrary to the public interest?
Of course not: It is the kind of frank talk and advocacy we could use a lot more of in our health system.
That Ms. Strom named names – identified her grandfather and the institution where he was cared for – may have put some people's noses out of joint, but that's too bad.
It is worth noting too that ruling is heavily redacted to remove the name of institutions, complainants and so on, showing that the discipline committee has a lot to learn about transparency.
In fact, the message being sent by this ruling is that no one should dare complain about care, whether they are a nurse or family member. It displays haughty, anti-patient attitude.
In the final paragraph of its ruling, the SRNA discipline committee states that it "does not seek to 'muzzle' registered nurses from using social media. However, registered nurses must conduct themselves professionally and with care when communicating on social media."
That health professionals should be held to a higher standard is okay.
But Ms. Strom's comments were measured and fair, and she is being held to a standard that no one can meet.
The way Ms. Strom has been treated disgraces the profession far more than anything she has said.
André Picard