Ms. Terri Reuser, R.N.

P.O. Box 646

Turner Valley, Alberta
T0L 2A0

May 10, 2011

Dear Dr. Swann,

I am happy that the topic of abuse by healthcare administration is finally coming forward into public
consciousness. I am an RN who managed to escape the pressures of public healthcare and an abusive
employer and am now currently working as a clinical educator for an NGO. My concerns also involve the
government agency Protection for Persons in Care and my professional association: College and
Association of Registered Nurses of Alberta; none of whom were interested in getting to the truth of the
matter.

I've been an RN for nearly 25 years in this province and never before has there been such distress
amongst health professionals. With the advent of non-regulated workers (a.k.a. “HCA’s” or “PCA’s” – or
personal care attendants) care began to decline. RN’s who were primarily responsible for bedside care
were in the position to speak up not only professionally but morally as well. Having concerns of poor
patient care dismissed by management was difficult to deal with.

In the summer of 2006 I seriously started bringing my concerns forward about an abusive RN and
potential problems in addition to concerns about PCA’s who often did not follow direction given by the RN.
The assistant manager was to deal with these issues via our “Professional Responsibility Committee”, but
never did.

In late 2007 I applied for and was given the position of RN/Educator on a Long Term Care unit. I had
worked on that unit for approximately 15 years as a staff nurse, so I didn’t foresee the problems that
eventually came about. I believed in that position, I would have some influence and could change things
for the better.

In my position, I was responsible for gathering information about the then-new “Continuing Care
Standards Health Service Standards” and bringing that information back to the unit from Alberta Health
and Wellness and Calgary Health Region. The problem was that the manager didn’t have an
understanding of the “standards” and the obligations we had to implement those standards. She was
apparently not listening in any of the meetings about these provincial standards. She wanted whatever
was easiest. The pushback from HCA staff, supported by both the manager and the assistant was
horrendous.

In addition, concerns about patient care continued to be ignored. As an example, I saw a woman with
dementia put into her room in a geri-chair and the door closed; left to cry alone in her room. Whenever I
tried to suggest other ways of dealing with dementia, I was met with crossed arms, glares and resistance
from the assistant manager.

Because of where my desk was, I could hear how the PCA’s responded to residents in the dining room.
One particular PCA was the most abusive and when I brought documented concerns forward, I was told
that: “XXXXX is a wonderful PCA”. Any comments from me about quality of care and issues of increased
urinary tract infections, skin breakdown and spread of MRSA were met with the same type of response.

Many nursing decisions were actually being made by unqualified PCA/HCA staff and the assistant
manager supported these sorts of decisions.

Another resident had had her arm twisted up behind her back and marched to her room because she
didn’t obey the RN’s direction. She fell striking her head which required stitches.
When I brought my concerns about that specific event (the resident had told me about it and she had
stitches to prove it) and about my concerns regarding that particular RN to the manager, she essentially
brushed me off. I was made to feel like it was “me” with the problem. In fact, she called me a
“firecracker”. When I said: “read his charting”, I was told: “he just charts weird”.

It wasn’t until I secretly took the woman’s husband aside and told him what I knew that the manager
responded. He wasn’t given the complete story until then and in fact maybe not even then.

In March/April, 2008, I developed an “education plan” for the unit in which I identified all sorts of
inappropriate behaviour on the part of the PCA’s and the plan I had for dealing with issues and restoring
some sort of order so we could move forward with standards of care. My manager flipped through the
pages of the document and handed it back to me.

In June, 2008, my manager “spoke” to me. I was summoned to her office under the guise of a meeting. I
was embarrassed and humiliated in front of the assistant manager. I was called names and told that I
didn’t know what I was doing and didn’t know what I was talking about. I was accused of many things by
“the staff”; when I asked who specifically were making allegations, she refused to tell me. The manager
even specifically told me to “stop telling them to wash their hands”.

In late June/July, 2008 I went so far as to enlist the help of certain nurse-managers whom I could trust to
ask advice. The consensus was that my manager simply didn’t have the skill and the assistant didn’t
have the energy to do what was necessary. I began to realize that I wasn’t going to be able to fulfill my
responsibilities as an employee, an RN or as an educator.

In August, 2008 the last thing I wanted to hear was that one of the residents – a resident of the
community for more than 50 years – had been slapped by the aforementioned “wonderful PCA”.

The RN who told this to me had been witness to this in April 2008. I told her she must immediately report
to the manager, even though the resident had died back in July 2008. I could not report this as it was
second hand and the manager was of the opinion that I was “picking on” the PCA responsible. I would
never be believed.

The manager came to me and in hushed tones tried to tell me that we didn’t need to report this incident. I
argued and said we absolutely must. I was told by the manager: “I asked XXXXX if she slapped XXXXX.
She told me she didn’t do it and I believe her”. Essentially, she saw no need to report this even though
it’s the law to report to “Protection for Persons in Care”. She would later use ignorance as the reason she
didn’t make that phone call to the hotline.

The unit was in an uproar and somehow all of it was my fault. Doing the right thing was somehow the
wrong thing. No one talked about the harm to the residents or how they were suffering with all of the
uproar and emotions.

Early September, 2008 I wrote a letter to my manager’s senior manager. I supplied handwritten
documentation to support every one of my allegations. I met with her to try and discuss all of my
concerns. She put me off “until further notice”, which brought on more stress.

She did tell me that the issue of my manager not reporting to Protection for Person’s in Care (PPIC)
would be investigated.

Mid-September, 2008 an “investigator” from PPIC came in. No fault was found, and I was never
interviewed even though I’d been the first one to hear of the incident.

The daughter of that woman chose to appeal that decision. With the help of my husband (who was a
police officer with investigation experience) and myself, she won the appeal and there was another
investigation by PPIC that was done properly. The PCA was found to be responsible; however, there was
no onus on the employer to do anything.
November, 2008 I was so stressed that I had to go on disability. My short term disability was about to
run out, and there was still no word from anyone in management. I couldn’t go back to that workplace.
My career was over. I suffered moral distress to the point of being diagnosed with post traumatic stress
disorder - I was forced onto long-term disability which is where I sat for 18 months.

Essentially I was bullied by administration and colleagues for trying to bring issues of patient safety (and
injury) forward. When I was well enough, I put my concerns in writing and launched a complaint with
CARNA against my manager, the assistant manager and several colleagues.

Another year-long investigation found out what I already suspected: my manager faced no repercussions
and the RN who had initially failed to report the PCA slapping the resident to PPIC took the fall for all of
them. The manager pleads ignorance and got off; the RN pleads ignorance and got into trouble. Then,
CARNA tried to point a finger at me – like I had should have done more when, if it weren’t for me, none of
this would ever have been reported.

My professional autonomy was slowly sucked away. Speaking up brings on bullying and isolation instead
of solutions to dilemmas. Those who moved into administration were soon propping up the needs of the
organization and ignoring the opinions and needs of the front line workers who know patients are
suffering. As members of a profession, nurses all have an obligation to speak up, including those who
have become administrators who have put their administration duties above their primary duty to put
patients first.

Sincerely,

Terri Reuser, R.N.