Wednesday, 21 June 2017

Silent Prayers

Bert (not his real name) was a patient on my District Nurse team’s caseload, he needed daily visits to help him take his medication, and he was one of my favourite patients, even though we’re not supposed to have favourites. He and I could talk for far longer than the time I was allocated to his care. Bert was a great believer in capital punishment, not just for murder but for a whole range of different crimes. Every fibre of my being is opposed to capital punishment; no matter how severe the crime the state does not have the right to enact vengeance to such a degree, because capital punishment is no more than vengeance. Yet Bert and I never argued about it. Every time he started talking about capital punishment I’d just quietly change the subject.

My job there was to provide Bert’s nursing care needs, not to argue with his options or to try and change them. I have many patients with whose views I do not agree, I am a very opinionated person (Just read some of my previous blogs to see that) but when I am working as a nurse it is not my place to be forcing my opinions onto my patients; I am there to be their nurse not someone to challenge their views and to even call their views wrong. I would like to do that, so many times I would like to do that, but I just cannot.

This isn’t just my opinion, it is also part of my professional code of conduct (1). Section 1.5 says I must “respect and uphold people’s human rights” (1). The Human Rights Act 1998 lists 18 articles that make up our human rights (2), Article 9 is Freedom of Thought, Conscience and Religion and Article 10 is Freedom of Expression. How can you say you respect someone’s human rights and in the next breath tell a person that their views and beliefs are wrong?

Last year Sarah Kuteh, a nurse at Dartford and Gravesham NHS Trust, was dismissed for what appeared to be expressing her Christian believes (3). She quickly took to You Tube to defend herself (4), saying that she had “discussions” with patients when she asked them what their religious beliefs were. The tabloids were quick to pick up her story. The Daily Mail called it a “persecution of Christians” (5), the Telegraph claimed she was sacked for “offering prayers” (6), “How could telling anyone about Jesus be harmful?” the Mirror asked (7), and the Daily Express claimed she was sacked for offering to pray with fellow Christians before surgery (8). She even appeared on This Morning television program defending herself (9).

Not unsurprisingly Sarah Kuteh took her case to an Industrial Tribunal (10), backed by the organisation Christian Concern (11). Her tribunal was earlier this year and out of it came some very uncomfortable truths.

Sarah Kuteh was open about the fact she’d been working in a pre-admission clinic, and part of her role was to fill out a pre-admission questionnaire with patients. What she wasn’t honest about was when the patient said they had no religious beliefs, in answer to only one question in the questionnaire, then she would preach at them about her own beliefs (12). She told one patient his chance of surviving cancer was better if he prayed (13). She questioned another patient so intently that he was left feeling shaken (14), she had constantly questioned him about his beliefs, offered him a bible and wanted him to join her in singing a psalm. He felt patients shouldn’t have had to face such religious preaching when they were in such a vulnerable position. Another patient felt very awkward after she quizzed him about what he thought Christianity was (14). She implied to another patient that they would be cured if they believed in God (15). Yet another patient complained that she spent more time talking about Christianity than she did on the pre-admission questionnaire (13). None of these patients had said that they asked her about religion, all of them complained that she had preached at them, forcing her beliefs onto them.

Dartford and Gravesham NHS Trust had received eight complaints about Sarah Kuteh, all complaining that she’d preached her beliefs at them (14). After the first five complains Sarah Kuteh was disciplined for her behaviour, this was chaired by the Trust’s General Manager of Medicine and Sarah Kuteh received a Formal Warning (14). This was not the story she implied in her You Tube video (4). She didn’t heed this warning because there were three more complaints about her behaviour after she received it. This behaviour lead to her dismissal, after a formal disciplinary hearing chaired by the Trust’s Executive Director of Nursing and Quality (14). The seniority of the people chairing her hearings is testament to how serious the Trust took her behaviour. Anyone who works in healthcare knows that patients are reluctant to complain, for these eight complaints about her how many other patients did Sarah Kuteh leave upset or distressed by her behaviour?

The Industrial Tribunal did not find in her favour, they found for her employer and that she had been fairly dismissed (15). With the weight of evidence against her how could they have found in her favour?

If Sarah Kuteh had been preaching a far right or far left wing message at patients, if she’d been preaching hard line atheistic views would there have been the media circus around her dismissal as there was? A very well oiled Christian propaganda machine kicked in with her case, getting out her message that she had been dismissed solely for standing up for her beliefs, the media coverage of this case is the evidence of this. But this case isn’t about Christianity or religion or even beliefs.

This case was never about religion. It related to professional nursing responsibilities, behaviour and conduct in a public facing role and position of trust.  Dartford and Gravesham NHS Trust Spokesperson (15).

This case was always about someone forcing their views on other people, people at very vulnerable times in their lives. This case is about someone forcing their views on other people and ignoring those people’s own views and wishes, discrimination of the worse type. This is about a nurse ignoring her responsibility to nurse her patients so that she could preach her views at them. People facing surgery can be very vulnerable, add to that all the worries and concerns that come with a cancer diagnosis and you have extremely vulnerable patients.  Sarah Kuteh seemed more interested in promoting her own views than meeting her patients’ needs. At times her behaviour seemed to border on bullying.

As nurses we are required to deliver non-judgemental care for our patients (1), how can we do that when we tell our patients their beliefs are wrong and our beliefs are the right ones? This is the opposite of non-judgemental.

Drew Payne

 This was the Dartford and Gravesham NHS Trust full response to Sarah Kuteh's dismissal

Update (17/08/2018):

Following her dismissal, Sarah Kuteh was referred to the Nursing and Midwifery Council (NMC), the nursing regulators, over her actions (16). The NMC tribunal imposed a four-month conditions of practice order on her, which meant that she could only practice as a nurse when under the close supervision of a senior nurse (16). This might not sound much but in reality this was a tough sanction. She could not perform the simplest of nursing tasks unless a senior nurse was observing her. As nurses we are independent practitioners, we are responsible for our own actions and work within the scope of our practice. As a qualified nurse, to have to return to the status of a student nurse were all our actions are supervised will feel stifling and restrictive. But Ms Kuteh behaved extremely unprofessionally, acting in a very discriminatory way and forcing her views on patients and ignoring the patient’s own views.

What was worrying was that Ms Kuteh was supported by the right-wing Christian organisation Christian Concern at her tribunal (16). This was the same organisation that was supporting her after her dismissal, with all the propaganda that painted her as a “victim” and spreading so many untruths about really happened leading up her dismissal. In a statement, Christian Concern told the panel Ms Kuteh conceded that giving her own Bible to a patient had been “going too far”, and that she should have used a Bible from the hospital chaplaincy instead (16). If this Sarah Kuteh’s insight into her behaviour then I am very disappointed that she has not learnt anything from what happened to her. But this was a statement from Christian Concern on her behalf so I am not certain how reliable and true full it is, does it even represent her views?

What was really surprising was the professional attitude of the NMC to her actions. They took seriously her actions and how she had acted unprofessionally, and then they imposed an appropriate section on her. They didn’t strike her off the register of nurses, which would have been completely over the top, and neither did they ignore her actions. For once the NMC has behaved appropriately. Is this a new trend with the NMC? I am not sure, my latest blog is about another nurse treated very shamefully by the NMC (17).

Drew Payne

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