St.
Vincent Hospital (Santa Fe, New Mexico, U.S.A.)(1995)
Markham
Stouffville Hospital (Ontario, Canada)(1999)
St. Vincent Hospital
Introduction
St. Vincent Hospital is a nonprofit, nonaffiliated hospital located in Santa Fe, New
Mexico, U.S.A. The following memorandum of understanding was signed in 1995 in order to
accommodate nurses who objected to circumcision for reasons of conscience.
Of particular note:
- The commitment of the hospital administration to the
principle of accommodate is indicated by its willingness to call in replacements (not
excluding the unit manager/director), pay overtime, and allow adjustment of schedules.
- An important distinction is made between immediate
post-operative care and subsequent care.
- Professional discussion is encouraged through the use
internal files and bulletin boards to communicate information about the procedure.
The MOU is reproduced here by permission of St. Vincent Hospital.
Addendum 3
MEMORANDUM OF UNDERSTANDING
for
CIRCUMCISION PROCEDURE
January 31, 1995
It is the policy of St. Vincent Hospital to continue
offering circumcision procedures to families in this hospital. Nursing staff, physicians
and the administration (all parties) agree that patients and parents will continue to be
offered as positive an experience in the hospital as possible, recognizing that the
parents’ choice in this informed decision. All parties are interested in providing
the highest standard of quality patient care. All, also, acknowledge the rights of nurses
to conscientiously object to circumcision (CO nurses) and also, the rights of nurses who
are willing to assist in the circumcision procedure (consenting nurses).
The MOU has been written in a specific effort to set
parameters, boundaries and guidelines for handling the circumcision procedure on the
maternity units of St. Vincent Hospital. This MOU is limited to the issue of circumcisions
and specific to nurses assigned to work in the maternity units. This MOU will apply to all
persons working in the department, and supersedes any conflicting policies, agreements or
procedures except as expressly incorporated herein.
Scheduling Guidelines for Procedure:
1. The Hospital will request that the physicians try
to schedule circumcision procedures from 7 am - 7 pm, Monday through Saturday, in advance
of the actual procedure being done.
2. The Perinatal Committee has agreed to establish written
guidelines as soon as possible for performing the procedure, which will be posted on the
maternity units.
3. The physicians, consenting nurses and conscientious
objector nurses will jointly create an information packet to be offered to parents, as far
as possible, in advance of the procedure.
Staff RN Scheduling by Administration
The administration has agreed, within the following guidelines, that the conscientious
objector nurses will be relieved of duties of circumcision. Those duties are: witnessing
the consent, dispensing pre-op medications, preparation of the room, immediate post-op
care such as stopping the bleeding and applying vaseline dressing, cleaning up afterwards
and stocking the room. Subsequent post-op care is not considered part of the circumcision
procedure. Subsequent post-op care includes the following: periodic observation of the
wound, wound care as needed, teaching of the family, and in the event that the wound has
not been shown to the family by the doctor or assisting nurse, the CO nurses are willing
to perform the task.
The administration has agreed, within the following guidelines, that the conscientious
objector nurses will be relieved of duties of circumcision. Those duties are: witnessing
the consent, dispensing pre-op medications, preparation of the room, immediate post-op
care such as stopping the bleeding and applying vaseline dressing, cleaning up afterwards
and stocking the room. Subsequent post-op care is not considered part of the circumcision
procedure. Subsequent post-op care includes the following: periodic observation of the
wound, wound care as needed, teaching of the family, and in the event that the wound has
not been shown to the family by the doctor or assisting nurse, the CO nurses are willing
to perform the task.
1. Scheduling is the prerogative of management, taking
into account as priorities the needs of the unit, patient care needs and individual
staff’s scheduling preferences. As always, schedules developed by staff on the unit
are subject to review and final approval by the manager/director.
2. Those nurses claiming conscientious objector status to
circumcision shall report their status, in writing, to the manager/director of the unit,
who will then submit a copy to Human Resources.
3. Nurses will notify the manager/director if they are
willing, on occasion, to adjust their schedule by starting their shift earlier or staying
later if necessary. For example, if a nurse is scheduled for an evening shift and a doctor
wants to do a circumcision at 1300, the evening nurse could come in to work from 1100 to
1900 instead of from 1500 to 2300. This avoids time and one half.
It is a priority that all nursing staff represent the
Hospital in a positive manner to families. It is understood by all parties that in order
for the maternity units to run smoothly and efficiently, there must be an emphasis on
teamwork among the staff nurses. This MOU in no way changes the current standard of
practice regarding cross-training to other related areas, assisting fellow staff members
in translations, starting IV’s, and specific teaching for mothers on how to care for
their babies. The nurses agree to continue to communicate with management at the beginning
of the shift regarding staffing needs. With that understanding, the following parties
agree to:
Consenting Nurses are Expected to:
1. Do duties and tasks associated with the
circumcision procedure.
2. Assist the doctor while CO nurses take their
assignments during the circumcision.
Conscientious Objector Nurses are Expected to:
1. Make a fair exchange in trading units of work with
consenting nurses.
2. Take the consenting nurses’ assignments while they
are assisting the doctor with the procedure. CO nurses will cover assignments on peds
& med/surg. if the consenting staff are drawn from those units, and while the
consenting staff are on the maternity unit to assist with the circumcision.
All Nurses are Expected to: Nurses are Expected to:
1. Handle themselves in a professional manner when
dealing with the families before and after the procedure. The nurses will endeavour not to
show their disapproval or dismay about the families’ decision concerning
circumcision.
2. Provide answers to questions concerning specific
approved informed consent materials ordered by the doctor, but not provide additional
personal counselling. They will assist the families in contacting their physicians for
additional information and/or counselling.
3. Will provide post-op care for their assigned
patients with the understanding that they will have some flexibility in taking those
patients if sensitivity to the procedure prevents them from being able to follow through
with the after care.
4. Will show respect and sensitivity to all nurses who
work on the unit.
5. Participate in a mandatory inservice focussed on
patient, staff relations and communications on the subject of circumcision and issues
surrounding it.
Staffing Protocol:
If there is not a consenting nurse from the department on duty at the time of a scheduled
circumcision, the charge nurse is expected to exercise all options available to her, which
may included but are not limited to the following:
If there is not a consenting nurse from the department on duty at the time of a scheduled
circumcision, the charge nurse is expected to exercise all options available to her, which
may included but are not limited to the following:
- Utilize the unit’s on-call staff. When scheduling,
a green star will be used to indicate if a consenting nurse is needed there. (This would
be done only if there is no consenting nurse already scheduled.)
- Utilize the SOS nurse, if skilled and available, and if
she/he consents.
- Utilize staff from other units, if skilled and
available, including peds, OR, or med/surg who consent to assist.
- The unit’s manager/director could assist, if no
other staff could be found.
Accountability
Any physician, patient or staff complaints that arise will be investigated, and if
discipline results, it will be handled through the Union’s contracted grievance
procedure. Each nurse will do their best to maintain a professional and non-judgmental
approach to the care given to all patients/families.
Unit preparation to accommodate staff from outside the
department who come in to do circumcisions:
Clear and specific directs on how to assist will be developed by unit staff and displayed
in the circumcision procedure room. The intent is that staff from outside the department
can come in and easily be able to assist with circumcisions. The maternity staff will
promptly and courteously hand questions that staff from outside the department may have in
assisting with the circumcisions.
Clear and specific directs on how to assist will be developed by unit staff and displayed
in the circumcision procedure room. The intent is that staff from outside the department
can come in and easily be able to assist with circumcisions. The maternity staff will
promptly and courteously hand questions that staff from outside the department may have in
assisting with the circumcisions.
Related issues
- The Hospital’s no solicitation/distribution policy applies with respect to the
solicitation and distribution of materials regarding circumcision. Literature regarding
this issue may be submitted into two reference files, located in the medical library and
one in the newborn nursery. This file can be updated by the manager/director, nurses and
physicians. References to new literature, pro and con on the issue that have been put in
the reference files, can be noted on the appropriate unit bulletin board..
- When hiring new nursing staff, the administration will
supply them a copy of this MOU and the informed consent package.
- There is a Hospital policy for reporting an adverse
outcome that is at variance from the standard of care. It is understood by the
administration and staff that any of them can file a variance report.
- A copy of this MOU will be maintained on the maternity
unit at all times. A copy will also be given to all currently assigned nurses on the
maternity units. A copy will be kept in the Human Resources labour relations file.
Both parties agree to the above language for this
Memorandum of Understanding effective on the date of January 31, 1995. This agreement will
be reopened upon written request by either party. If this issue cannot be resolved by the
parties within 30 days, the parties will submit the matter to mediation.
______________________________
Kathy Hall
VP, Community/Human Relations
St. Vincent Hospital
______________________________
Delma DeLora, RN, VP Nurses
District 1199 NM
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