The Plight of Canadian Nurses and The Dilemma They Face

When registered nurses face barriers that prevent them from adhering to established standards of ethical practice, the consequence is moral distress manifesting in feelings of anger, frustration, and guilt, among others. Working in this state—particularly when coupled with fear of coercion and punishment—can result in significant and potentially long-term psychological harm for healthcare workers.

It should go without saying that no healthcare provider should work in conditions that result in trauma–moral or otherwise.

In the case of Canadian nurses who either refused to be vaccinated or to promote the mRNA COVID-19 genetic vaccine during the declared pandemic, many have been openly discriminated against at their workplace and the cost they have paid for their conscientious refusal has been very high. Many have lost their employment, have been refused the right to collect employment insurance, and have been abandoned by their union which has chosen not to represent their interests and rights against their government employer.

Openly dissenting nurses, however, are not the only ones who have suffered because of coercive pandemic policy. Those nurses who chose to be vaccinated and to remain working within the healthcare system have also been subject to considerable psychological hardship. Indeed, the extremity of this hardship has been illustrated by two surveys, conducted by Claudia Chaufan, Natalie Hemsing, and Rachael Moncrieffe.

Conducted in both Ontario and British Columbia, these surveys were designed and carried out to gather the “views of [healthcare workers] about mandated vaccination and about its impact on patient care”1 and “how the policy [of vaccination mandates] affects the capacity and quality of the healthcare system.”2 While these cross-sectional surveys are not representative or generalizable to the population of healthcare workers as a whole, they do provide the basis for descriptive statistical analyses that address a significant gap in our knowledge about the lived experiences of healthcare workers during the declared pandemic.

The results of these two surveys paint a sobering picture of the predicament in which Canada’s nurses and other healthcare workers have found themselves while attempting to provide patient care in accordance with their profession’s established ethical and procedural standards. Given both the gravity and the experiential nature of their findings, these surveys merit quotation at some length:

[Among those surveyed] “regardless of vaccination status, most respondents reported safety concerns with vaccination and felt unfree to make their own vaccination choices…, [most] also reported experiencing anxiety or depression, with about one fourth considering suicide, as a result of mandates…

Within the minority of vaccinated respondents, most reported being dissatisfied with their vaccination decisions, as well as having experienced mild to serious post vaccine adverse events, with over half within this group reporting having been coerced into taking further doses, under threat of termination, despite these events. Further, a large minority of all respondents reported having witnessed underreporting or dismissal by hospital management of adverse events post vaccination among patients, worse treatment of unvaccinated patients, and concerning changes in practice protocols.”

The researchers conducting this survey concluded that their findings suggest healthcare workers “experienced both [moral distress and moral injury] when recommending or administering vaccines against their own personal convictions.”3

No healthcare provider should work in conditions that result in trauma–moral or otherwise. Nevertheless, it is precisely when such terrible conditions are an unavoidable reality–when the ethical and procedural integrity of patient-centred care is threatened–that exemplary leadership is most needed from registered nurses.

As advocates, nurses are responsible for ensuring that patients can determine their own needs and make their own healthcare decisions free of coercion. In accordance with the established ethical and procedural standards of the nursing profession, to fulfill their responsibility, to be truly “fit-for-practice”, nurses must be ready and willing to challenge the factors that threaten the ethical integrity of both their profession and the greater body of patient-centred care that constitutes Canada’s consent-based personalized medical system.

All of this is true, and yet, for their integrity, those Canadian nurses who challenged pandemic policy, which they determined to be contrary to medical ethics and to their standards of practice, have been made to suffer terribly.

Canadian nurses who challenged Covid-19 pandemic policy have suffered discrimination in the workplace, vilification in the media, loss of livelihood and absence of legal remedy. In addition to all of this, as one of BC’s terminated nurses recently put it: “nursing professionals have had their professional belief system dismantled. They have, quite simply, lost the comfortable belief that, as healthcare professionals, they are operating in an ethical environment.”

For these disenchanted nurses, as well as for a great many of their vaccinated co-workers, it is no longer possible to believe either that patients and patient care are the priority of healthcare or that there will be either valid scientific bases or ethical guidelines for the tasks with which nurses are commissioned within the healthcare setting.

Conclusion

During the declared pandemic, dissenting registered nurses exhibited leadership by evaluating Covid-19 policy and treatment protocols and then by refusing to comply in their administration.

When, upon critical examination, these nurses determined Covid-19 policies and procedures were inconsistent with the nursing profession’s ethical codes and standards of practice, it became their professional responsibility to refuse to comply and to challenge the legitimacy of these policies and procedures.

As elaborated in the “Framework for the Practice of Registered Nurses in Canada 2015”, registered nurses’ leadership is exhibited in critical thinking, action, and advocacy. Indeed, it was and is their professional responsibility to exercise autonomous decision-making in advocating for the rights of both their patients and themselves.

Unfortunately, because of their commitment to fulfill their ethical and procedural responsibilities, these registered nurses have paid a high price.

The processes set in motion during the declared pandemic have undermined the confidence of nurses to engage in the informed, autonomous decision-making their profession requires.

In a work environment where medical ethics and procedural standards have been greatly diminished, nurses have been consistently shown that their professional opinion and conduct are institutionally irrelevant, that contrary to their training and procedural standards, they will be required by their employer to do what they are told as employees regardless of whether this compromises their value system, and regardless of whether this compromises patient safety and autonomy.

Throughout the declared pandemic, Canadian nurses were repeatedly and consistently punished for championing informed consent, together with patient safety and autonomy.

As a result, Canada’s nurses have been significantly hampered in their ability to make the decisions and assume the responsibilities required to maintain the ethical and procedural integrity of their profession. In many instances, the policy and practice introduced during the declared pandemic cannot be reconciled with the long-established ethics and procedural standards of the nursing profession.

Consistent with the principle that every treatment decision has consequences which affect not only those for whom it is being made but the decision-makers themselves, Canada’s nurses have been improperly forced to balance the rights of patients to informed consent and personalized treatment against their own need to retain gainful employment.

It remains to be seen how remedy may be sought and achieved for both the terminated nurses and those who continue to practice while suffering unacceptable levels of duress.

Sources referenced in this article include:
https://jphe.amegroups.org/article/view/10313/html Covid-19 vaccination decisions and impacts of vaccine mandates: a cross-sectional survey of healthcare workers in Ontario, Canada
https://www.medrxiv.org/content/10.1101/2024.12.09.24318733v1 Covid-19 vaccination decisions and impacts of vaccine mandates: A cross-sectional survey of healthcare workers in British Columbia, Canada
https://www.medrxiv.org/content/10.1101/2024.12.09.24318733v1.full-text

You can read the entire ‘Ethical and Procedural Responsibilities of Registered Nurses in Canada’ document at:

1) Sub stack: l.j.mcleod@shaw.ca newsletter
https://ljmcleodshawca.substack.com/p/ethical-and-procedural-responsibilities-8e3

2) Canadian Citizen Care Alliance
https://www.cccalliance.ca/ethical-and-procedural-responsibilities-of-registered-nurses-in-canada/

To find out more about Lynda McLeod and the health coaching she provides see: https://www.createwithlynda.com/