Preaching to patients
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In a recent case from an employment tribunal, a band 5 nurse appealed against her dismissal for initiating discussions about religion with patients. Initially a junior ITU sister, the nurse, a committed Christian, had been transferred to work in a surgical pre-assessment role. The pre-assessment included an enquiry about patients’ religion, although provided no invitation for further discussion of the subject.
Some months after her reassignment, staff began to receive complaints from patients about the nurse raising matters of religion with them. One complaint related to a patient facing bowel resection for cancer, who was told that his survival would be more likely if he prayed to God. Other complaints were less specific, reflecting patients’ irritation or awkwardness at what they saw as unwarranted and unwelcome probing or advice on religious themes; they ‘…didn’t like (her) preaching.'
As a consequence, the nurse was told by her matron that ‘…a number of patients were offended that you spent a fair amount of the allocated pre-assessment time on the subject (of religion).' She gave an assurance that she would not engage patients on this topic unless asked to do so. Nonetheless, the nurse subsequently gave a patient a Bible and offered to pray for her. Another patient complained that the nurse was preaching at her, making her feel uncomfortable. A further patient was offered a Bible, being told that the only way to get to the Lord was through Jesus. On having his hand gripped, he was asked to sing the 23rd psalm with her; astonished, he did so, accompanying her for the first verse. He described this encounter as ‘very bizarre’.
The court noted the nurse’s plea that her employer failed to recognise her genuine attempts to comfort her patients. But equally, found no dispute that any person being pre-assessed for surgery was foreseeably ‘…worried, possibly suffering from stress, and potentially vulnerable’. The nurse had been given a direct and lawful instruction to desist from initiating religious discussions with her patients, and acknowledged her disobedience.
The Court of Appeal upheld the employment tribunal’s decision to dismiss the nurse. The court made clear the importance of the right to freedom of religion, and found no blanket ban on religious speech in the workplace imposed by her employer. Citing the NMC code para 20, in relation to upholding the reputation of the profession, the court noted that nurses and midwives must make sure that they do not express personal beliefs (including political, religious or moral beliefs) to people in an inappropriateway. The distinction between inappropriate and appropriate expressions of religious beliefs in a clinical setting is echoed by the GMC.
The case provides a timely reminder to all clinicians as to the importance of limiting the expressions of our political (and religious) views to those that are appropriate. As is so often the case, this judgement identifies the inappropriate but leaves to a clinician the definition of the appropriate. Whilst entirely consistent with the ancient principle that all that is not proscribed by English law remains lawful, this case provides us no help with these purely subjective judgments.
Plainly, the spiritual needs of every patient must be considered and assessed. Such an evaluation is part of the care we offer to all patients. If after assessment it is clear that the patient would benefit from spiritual support, please ensure that a colleague trained by the spiritual care team is introduced to the patient. If you are unable to identify anyone suitable, the chaplaincy would be a good place to start.
Department of clinical law, June 2019