Kaci Hickox and “Speaking Truth to Power”
I am living in Kathmandu Nepal right now, where I teach critical care nursing skills. We’re having an epidemic in Nepal – of heart disease. Don’t worry, you won’t catch it from me – I don’t smoke. We have no Ebola in Nepal.
In USA I sometimes teach the part of the curriculum where we discuss the idea of subservient nurses, and I often usually start off by asking the question: “Do nurses follow doctor’s orders?”
The answer may surprise you. If you want to talk about Kaci Hickox, subservient nurses, and the advocacy role, follow me below the orange piece of “police line – do not cross” tape, now laying in a heap in Aroostook County, Maine……
A Teachable moment for America
I’m writing this because we just went through a huge “teachable moment” for the nursing profession and the USA. In case you have been cowering in fear of Ebola under a rock, you know that the governor of New Jersey decided to make an example of the next health care worker returning from West Africa, and set up the New Jersey version of a “black site” – a tent inside a parking structure, with no running water or toilet. He then kidnapped a nurse named Kaci Hickox, and told the television audience that she was obviously ill. Evidently, Ms. Hickox’ mother was watching, and got upset. Ms. Hickox stood up for her rights – and the rest is history.
In the process of working this out through the courts, (during which Ms. Hickox was thoroughly vindicated), we saw a coordinated effort to smear Ms. Hickox in her personal judgement. The GOP media machine started to spread the meme that she was “selfish,” and “now she is unemployable,” that she should have shut up and followed the dictum of the Governor. They encouraged people to complain about her to the Maine State Board of Nursing. No, I can’t prove the source of these, but if you follow the political news, you know that this is the typical tactic used by the right wing in the USA.
She was not selfish. She was simply basing her decisions on the known science. She was pushing back against a governor who was clearly using her for political grandstanding. I just don’t think she would have become a public figure unless Chris Christie made her into a target.
What was she thinking?
She was doing what we, as faculty of nursing, hope that every nurse will do. She was “speaking truth to power.”
The question from the header was “do nurses take orders from doctors?” and the answer is – no. They do not. We use the phrase “doctor’s orders” because of the military tradition of hierarchical licensure, but it is not legally accurate.
The specific legal phraseology
What nurses do is to decide “whether to accept delegation from doctors” or not. There is a very important distinction to be made here. “If a doctor ordered you to jump off a cliff, would you do it?” I can still remember one of my old head nurses saying. There is ample case law that establishes the fact that a nurse has their own body of knowledge, is expected to apply their own judgment, and to question any order that appears inconsistent with safety of the patient or known medical judgment. On a daily basis, nurses around the USA apply this principle in myriad ways. For example: doublechecking the correct dose of a medicine ordered by a physician; making sure that the doctor is operating on the correct body part in surgery; reminding the doctor to wash his or her hands; this is only a superficial list. These actions can take the form of simple nagging the doctor (benign) , all the way up to confronting the doctor (high stakes) or being a whistleblower.
The nurse is responsible to apply their own knowledge and judgment and not do anything blindly. The nurse takes these actions to protect the patients they serve. There are times when the nurse speaks on behalf of the patient’s wishes, advocating to help that person to get what they need from the health system. Anecdotally, there are many people who will say “I never knew what nurses actually did until my ___ (mother, father, loved one) was sick” and it’s usually followed by a story involving a nurse in the advocacy role. Advocacy is powerful.
You Must speak up. In every school of nursing, this is an ethical principle we hammer into the students, both in the classroom and at clinical. You Must Speak up. This goes all the way to Florence Nightingale in Scutari during the Crimean War. Being silent is worse than being over-ruled.
Many years ago (way back in the 1970s in California) there was a case where a doctor repeatedly committed a sex crime against helpless patients in the O.R. witnessed by nurses. Finally he was reported. The doctor went to jail, and the hospital lost it’s license as you would expect. But because they failed to speak up, seven nurses also lost their license to practice. You must speak up.
This is as close to a sacred duty for nurses, as it gets. And so, when I as a nurse listen to Kaci Hickox, what she said and did was measured against this standard. Was she applying scientific knowledge and the best medical advice? Yes. Was she taking steps that would advance the use of sound practice in the future? Yes. Was she acting to make sure that her “patient’ ( the American public) became more educated? Yes. Was she a risk to the public? No.
And so, my message to Kaci Hickox, RN, MPH is – thank you for speaking up. If Florence Nightingale, the progenitor of the modern nursing profession, the woman who cut her teeth on tracking infectious disease in the Crimean War ( and invented the pie graph) were here today, she’d have tears in her eyes.
Ms. Hickox - you have upheld a long tradition of nursing advocacy, and been vindicated by the courts. Thank you.