Canadian Nursing Association Resolution to Promote Science Based Nursing and Autonomy Fails

Hi all,

To publicize the fact that nurses are losing professional ground to magical healthcare practitioners here in BC, and that since 2009 nurses have been legally required to take orders from naturopaths, I submitted a resolution to the Canadian Nurses Association as an individual member to protect the autonomy of nursing in future.

I had previously raised this issue with the CRNBC and also with the ARNBC but neither were interested in pursuing it, (CRNBC is solely focused on regulation rather than looking out for the profession now) and it probably isn’t a key priority for ARNBC at the moment due to the ongoing legal battle with the BCNU.

The resolution simply suggested that the CNA advocate that registered nurses (RNs) in Canada not be subject to legislation that requires them to take direction/orders from other health care professions that do not have a superior level of both academic and clinical preparation (that must include Canadian publicly accredited university graduate level academic qualifications, and substantial hospital-based education and training in their field).The full resolution is available here.

This was considered at today’s annual meeting, and after a short debate (4 mins and 35 seconds) it was narrowly rejected by the members. I am not particularly surprised, but am rather saddened that the profession has not taken a simple action that would help strengthen the professional status of nursing in Canada, and protect nurses from further professional exploitation.

The arguments that went against it were mainly from BC (no surprise there) and were:

  1. It isn’t a problem as nurses can always refuse to act against orders given, and
  2. Strong language about using “Canadian” accredited qualifications and “superior levels of qualification” does not recognize the autonomy of other professions and international qualifications.

Vote

  • Yes: 77
  • No: 78
  • Abstain: 0

The point about international qualifications is reasonable. and could easily be included with an amendment such as “or equivalent” but the spirit of the resolution was clear enough, so a shame it didn’t pass with an amendment. Got support from the North West Territories though (yea, go NWT)!

Nurses continue to be at the mercy of political trends that leave new CAM practitioners who gain regulatory status the ability to identify themselves as better qualified than nurses though quackademic credentials. So, far from moving away from the role of “physicians handmaidens” and promoting advanced practice and professional autonomy nurses will continue to be seen as fair game in the Canadian healthcare system to become subservient to any complementary and alternative practitioners who care to call themselves “doctorally prepared” (through whatever means or credential).

So I guess I am to tell my students, you are “autonomous practitioners” in theory, but in the healthcare system at large you are recognized as subservient to anyone who holds a piece of paper that is recognized by the provincial government as some sort of health professional and wants to employ you. It is rather hard to promote a positive role for nursing when practitioners who actually practice magical healthcare and have US based quackademic qualifications are regulated above Canadian nurses. Maybe I’ll get ahead of the game and just set up a course in magical healthcare for nurses for our next undergraduate curriculum revision.

Sad times indeed, and I do wonder what the status of the RN will actually become over the next few years. Looks like reversion to a technical role in support of other health professionals is well on the cards, with the odd restricted role for specialist advanced practice (where the system is under-resourced). So, what happened to the CNAs stated aim to “strengthen nursing and the Canadian health system?”

Bernie

 

 

The Power of Authority and the Folly of Hubris in Science

A shorter blog from me this week, as I am busy going through the last stages of formatting my forthcoming science book (more details coming soon). Apologies, if it is a tad incoherent as it was blasted off in a bit of a rush. Actually, it was an issue with my book that triggered off my thoughts on this subject; that and the case of Reinhart Rogoff, the PhD student who pointed out some key flaws in the work supporting an established economic theory.

I couple of months back I had asked a distinguished and pretty famous professor (who shall remain nameless) to write a foreword for my forthcoming book. They had generously agreed, and so I thought I was onto a good thing. Nothing like having the name of the science glitterati attached to my venerable tome to give it some academic heft; or so I thought! However, when the foreword appeared I found it quite unusable; a) it patronized nurses quite badly in the first few paragraphs, b) generally equated social scientists with village idiots, and “real” (read physics/chemistry/biology etc.) scientists as academic gods,  and c) suggested all would be well in nursing if we adopted RCTs for everything. I did send back some suggested changes, which seemed to invoke incandescent rage on the behalf of its author; particularly that I should challenge the sage wisdom presented. After a lengthy round of e-mail exchanges we parted on good terms, but agreed to differ, as my suggested edits were not acceptable to him. I do feel rather bad about the whole affair (as it was me who asked, and the prof was doing this in goodwill for free). But, the idea was to try and have a few positive and pithy paragraphs expounding on the wonders of science and its contributions to society and healthcare, thereby engaging readers; not a section encourage them to hurl the book into the nearest trash can. The changes I requested were not actually that huge, but I got the distinct sense that academic pride had more to do with this than differences over substance.

Anyhow, last week I also read about  PhD student Reinhart Rogoff, who identified that a famous academic paper cited to make the case for austerity cuts contained major errors. The main surprise was that the mistakes (made by two eminent Harvard professors) were spotted by a student doing his own research.

Both of these events seem to speak to the dangers of hubris in science. One of the things I love about science is that there are no “experts” and anyone can challenge established wisdom when they find it wanting. However, more recently I worry that the scientific establishment seems to forget this.

Let us take the example of helicobacter Pylori and gastric ulceration. When the Australian scientists J. Robin Warren and Barry Marshall identified the new bacteria Helicobacter pylori in 1982 as a cause of peptic ulcers disease, it completely transformed our understanding of the microbiology and pathology of the human stomach. Before then the accepted medical wisdom was that stomach ulcers occurred as excess acid damaged the gastric mucosa, and treatment should be aimed at reducing or neutralizing that acid, with surgical techniques being most effective (Lynch, 2005). Initially their new ideas were not widely accepted, and criticized. I can recall as a student nurse asking the clinical expert teacher on a surgical unit about the relevance of this new bacteria which I had just read about. I was swiftly reprimanded for heeding such nonsense (“when the cuckoos come home to roost…” was the phase used I recall)! However, as further research evidence arose from a range of repeat studies, results confirmed a link; the role of H. pylori in peptic ulcer disease was firmly established it revolutionized the treatment of this condition. This is a good example of a “revolutionary” paradigm shift in medicine, and illustrates the issues with becoming so attached to one idea that you fail to adequately consider others.

Also, I find the tendency towards creating “idols” out of scientists somewhat problematic. It seems a trend more prevalent this side of the Atlantic, where I find students and faculty more interested in “who” said what, rather than “what” they said. This strikes me as rather a short-tem view, and although I agree it’s important to give credit where its due, and cite appropriately, in the long-term it is the ideas that are important not the people who came up with them. This seems to me a bit like, focusing on Hitler’s fashion sense and personality rather than analysing his ideas, actions and policies.

In a recent round of government grant applications here, I noticed that who made up the research team was weighted quite heavily in the assessment criteria. Now, ostensibly this is to ensure the team is adequately qualified to carry out the research, but my experience it has become a bit of a “beauty contest.” I suspect that if the primary researcher is seen as a “great guy” in the field then the application is looked at far more favourably than a more original idea by a less well-known scientist.

I have come across this tendency towards personality cults and nepotism in the Uk too. When I was employed at a certain university in middle England, I was sent on a staff selection and interviewing course. In one session we were told “Make sure you ask what personal contacts the candidate can bring into the university; we need to get more people with good and famous connections.” When I said I thought this might not be the most ethical approach to recruitment, and that offering a job to someone because they (for example) knew members of the royal family, might be slightly inequitable, it was dismissed with “No, that is nothing to worry about and perfectly normal practice here!”

All in all I think we can learn a good lesson from Reinhart Rogoff, and for me, one of the best thing about science is that (in spirit at least) it is about the best argument for an explanation, rather than who is making the argument. But then maybe that is just because I am not famous, don’t have a cult following, know Mick Jagger, or come to that any other celebrities. As for my book foreword? I decided I wanted something that would strike a more positive tone, rather than a famous person to say it, so have given the job to Rog!

Cheers

Bernie

Reference

Lynch, N.A. (2005). Helicobacter pylori and ulcers: A paradigm revised. FASEB. Retrieved, 2011, from http://www.faseb.org/Portals/0/PDFs/opa/pylori.pdf

 

Energy at work; another example of anti-science agendas?

Hi all,

Roger is tied up so I’ll be posting this week, as we settle back into our regular bi-weekly postings. I had an interesting summer writing grant proposals (more on that subject in a later post) and just got back from a conference in the UK. Sadly I have yet to be reunited with my luggage by Virgin Atlantic, but I live in hope.

Upon my return, the latest copy of Canadian Nurse was on my doorstep, and I was interested to find a four page article titled “Energy at work” on new age nursing and the place of alternative therapies in practice. Given this is a supposedly professional journal, I was expecting a balanced and informative article, when in reality I got a thinly disguised article advocating the wonders of therapeutic touch (TT). Granted, it did acknowledge that there was no scientific evidence TT works, or that the human energy fields exist, but overall the article was rather embracing of these alternative approaches.

One of the practitioners, a registered nurse bemoaned the fact she couldn’t use TT in her practice and was not allowed to say “Can I hold you hand and send you a little Reiki?” The fact this would be a very inappropriate thing for an RN to say to a patient seems to go unchallenged in the paper. This is really akin to a physcian saying “Would it be Ok if I inspect these animal entrails to confirm my diagnosis?” An event that would (hopefully) result in a disciplinary action at least:

1) We shouldn’t use or promote any practice that has no evidence of effect on unsuspecting members of the public, and
2) we shouldn’t promote our own personal spiritual beliefs upon others, no matter how well intentioned.

Sadly, articles like this do little to help a balanced discussion, or value the contribution of science in healthcare. Worse still they promote the idea that these alternative practices are just as valuable as evidence based ones. Indeed, some do have value, but this makes nurses look look slightly barmy. I for one, would rather nurses to be promoted as serious health practitioners rather than gullible new age gurus.

Interestingly, the article notes there are currently only 80 members of the Canadian Holistic Nursing association. Which makes me question why the Canadian Nursing Association would publish another paper about these practices (they published a virtually identical paper 6 years or so back) given they are such a minority of the 230 thousand or so RNs in Canada? There are probably 80 RNs in Canada who still believe in alien abductions or that Elvis is still alive, so how about some articles targeted for them from Canadian Nurse if they are aiming to appeal to very small minorities of the profession?

Anyhow, it isn’t just the CNA who seem to be afflicted with an agenda to promote bad science as an equally valid alternative to EBP.On my travels in the UK I came across the Bristol Homeopathic Hospital.

 

This NHS funded hospital offers homeopathic service as a general service for children and adults with a wide range of chronic illnesses and a complementary cancer care service. It claims on its website that homeopathy is useful in the management of:

  • Rheumatology
  • Allergic conditions
  • Asthma
  • Eczema and other dermatology conditions
  • Menstrual and Menopausal problems
  • Digestive and Bowel Problems
  • Stress and Mood disorders

Well not according to Cochrane, or any other credible sources I am aware of. Fine for individuals to pay for this if they wish, but it did make me wonder why UK tax payers money is being spent supporting this? Maybe there is a surplus of cash in the UK health service I have not heard about…

Anyhow, maybe I am just grumpy given my luggage loss or maybe my Chakras are not aligned, but I promise we will not dwell on complementary therapies too much this year, as 1) plenty of other sites cover this area well (such as FSM), and 2) they represent rather an easy target for scientific arguments to challenge, and 3) those that believe are unlikely to change their views based on the evidence.

So this year we hope to tackle some more challenging arguments and ideas in the philosophy of science.

Onwards and upwards!
Bernie

Reference

Jaimet K. (2012) Energy at Work. Canadian Nurse, 108(7) 33-36