Whistleblowing

1
Whistleblowing

• LaLine Angus, Joyce Bailey, Benjamin Quiroz,
  Heidi Ritting, Natasha Wills

2
Introduction

• Definition disclosure of illegal, immoral, or
  illegitimate practices that are under employer
  control by either former or current organization
  members to persons or organizations that be able
  to effect action (Near Miceli, 1995).
• Whistle blowing happens in all types of
  professions, including nursing.
• Internal vs. external whistle-blowing

3
Whistle-blowing and Nursing

• Its an ethical responsibility, but not the first
  solution to the problem.
• Why is it still difficult to do?
• Only a fraction of complaints by whistleblowers
  receive favorable outcome (U.S. Senate, 2009).
• Research on reasons why nurses do not report
  risks
• Nothing will be done (58)
• Not wanting to get colleagues in trouble (50)
• Fear of being seen as a snitch (48)
• Fear of dismissal or being disciplined (46)
• Not feeling safe (25)
• Not knowing who to talk to (22)
• Concern is a suspicion (20)
• I am only a nurse (11) (Waters A., 2008,
  p.13)
• An ethical culture is necessary to prevent and
  manage whistle blowing.
• Whistle blowing is often the result of an
  organizational culture that lacks the
  accountability for its adopted values.

4
Considerations for Whistle-blowing

• Grave injustice or wrongdoing that has not been
  resolved despite using appropriate channels
• Morally justifies course of action by appeals to
  ethical theories, principles, or other components
  of ethics as well as relevant facts of the
  incident
• Should have thoroughly investigated the incident
  and is confident the facts are well understood
• Should understand that loyalty is to the client,
  unless compelling moral reasons override this
  loyalty
• Should ascertain that doing this will cause more
  good than harm to clients, and clients will not
  be retaliated against
• Should understand the seriousness of actions and
  assume responsibility for them

5
Duty to Blow the Whistle

• Whistle-blowing should not be considered the
  first avenue, but the last, after all else has
  failed.
• When to blow
• Serious and considerable harm to the public is
  involved
• Have reported to immediate supervisor already
• Have exhausted all channels available for
  correcting the issue within the organization
• There is documented evidence with the ability to
  convince an impartial party
• There is good reason to think going public will
  result in changes

6
Statistics on Whistle-blowing

• 2002 in the America
• 90 of whistleblowers lost their jobs or were
  demoted, regardless of the industry
• 27 faced lawsuits
• 26 had psychiatric or medical referrals
• 17 lost their homes
• 8 went bankrupt
• ALL as a result of whistle-blowing!

7
Whistleblowing in Nursing

• Of 752 nurses surveyed
• 68 said they had a serious concern related to
  patient safety in the past 3 years
• Of that 68, 87 reported it to their manager
• Only 29 of managers addressed and resolved the
  concerns presented
• 47 of the reporting nurses said the matter had
  been handled poorly, or not handled at all
• 23 said the situation went on to cause harm to
  the patients. (Waters A., 2008, p.12)

8
Personal Stories

• Graham Pink was a charge nurse who wrote a string
  of passionate letters to his employers, the
  health authority, the health secretary and
  finally the press about the inadequate care on
  his elderly care ward at Stepping Hill Hospital
  in Stockport. He told of elderly patients lying
  in bed in their own excrement and the chronic
  lack of staff to care for them. He was sacked for
  gross misconduct in 1991 after writing his
  letters.
• Karen Reissmann, a community psychiatric nurse,
  was sacked last November (08), after leading
  protests against possible cuts to NHS mental
  health services. She and her colleagues feeling
  that service reorganization would leave too few
  staff to deal with a large number of clients. Two
  months after her initial suspension, the trust
  accepted that client numbers were higher than it
  first thought and put in extra staff. Karen is
  still campaigning against her sacking.(Nursing
  Times, UK)

9
Improving Whistle-blowing Outcomes

• Create an organizational culture that embraces
  change in a non-punitive manner
• Value and protect anonymity
• Creation of a collegial ethics committee to
  provide checks and balances to the organizational
  ethics committees already established
• A no-tolerance policy related to passivity
• Have specific language from the ANA and laws in
  place to protect nurses who come forward
• Encourage education and open discussion that
  supports and rewards the people who speak up

10
Viewpoints in the Nursing Field

• Are nurses who fail to blow the whistle on bad
  practice protecting themselves?
• Nigel Jopson says YES
• It is never easy to blow the whistle but, at
  times, it is the only way to move things forward.
  We surely did not come into nursing to tolerate
  seeing people abused or damaged, deliberately or
  by neglect. If we are not willing to stand up for
  ourselves, will we stand up for our patients? We
  are very privileged to do our job and, with
  privilege, comes responsibility. If we see
  something wrong we simply must do something to
  put it right. While we have the NMC code of
  conduct to guide us, surely we know that as
  responsible human beings we cannot condone abuse
  or neglect?
• Ian Pierce-Hayes says NO
• As nurses, our first consideration must be the
  interests and safety of patients. However, the
  whole notion of whistleblowing is often far from
  clear-cut and the recriminations for those who
  have been brave enough to raise their concerns
  can be so severe and bitter that it can lead to
  an atmosphere of fear and intimidation that
  prevents any discussion let alone criticism
  of practice.
• It is not individual nurses acting in their own
  interests who are the problem but the failure of
  managers and employers in preventing honest and
  open discussion that is letting patients down.
•  

11
Compare/Contrast to Other Work

• Enron Enron knew about their falling stocks and
  began an insider trading deal with private
  parties. Sherron Watkins (former Enron
  accountant), blew the whistle on her boss CFO
  Andrew Fastow and Kenneth Lay. After blowing the
  whistle, Enron sent her a letter stating, "...on
  the consequences of terminating you."
• Tobacco Companies Jeffery Wingand blew the
  whistle on the tobacco industry, even with the
  huge personal risk to himself and his family. In
  1995, he exposed the decade of lies the tobacco
  companies were telling. Wingand was the first
  insider to expose the truth about cigarette
  companies knowingly getting people addicted to
  nicotine.

12
Scenario for Discussion

• A 15yo female presents to the Emergency
  Department with a chief complaint of attempted
  suicide. She is restrained, c-collared, on a
  backboard and her hands are taped together. She
  is very combative. An NG tube is inserted and
  50ML of charcoal is administered. Approximately
  30 minutes later she is vomiting. Whats the
  problem? Who do you report it to? What if that
  person was involved?

13
Questions

• Whats the problem?
• Is the patients safety being comprised?
• Who do you report it to?
• What if that person was involved and didnt see
  the problem?
• What do you do if it happens again?
• Pros/Cons of taking it a step further?

14
Conclusion

• Have all evidence of incident gathered and
  documented, speak to co-worker involved (if
  possible), and go up the management ladder to
  report the issue (if necessary)
• If a patient is ever in harm or your moral
  instincts kick in, YOU SHOULD blow the whistle
• Hold everyone accountable, including yourself
• Dont be scared to do the RIGHT thing
• SO, WHAT WILL YOU DO?

15
References

• American Nurses Association (2001). Code of
  ethics for nurses with interpretive statements.
  Silver Spring, MD The Publishing Program of ANA.
• Graczyk, M. (2006). Enron Whistleblower "I
  Warned Ken Lay". Truthout.Retrieved April 19,
  2009 fromhttp//www.truthout.org/article/enron-wh
  istleblower-i-warned-ken-lay?print
• Huston, C. J. (2006). Professional issues in
  nursing challenges opportunities.
  Philadelphia, PA Lippincott Williams Wilkins.
• Jopson, N., Pierce-Hayes, I. (28). Are nurses
  who fail to blow the whistle on bad practice
  protecting themselves? Retrieved April 5, 2009,
  from Nursing Times Web Site http//nursinglive1.n
  ursingtimes.net/nursing-times-this-weeks-issue/are
  -nurses-who-fail-to-blow-the-whistle-on-bad-practi
  ce-protecting-themselves?/1433216.article
• Lachman, V. D. (2008). Whistleblowing role of
  organizational culture in prevention and
  management. Medsurg Nursing, 17(4), 394-396.
• Legal Database. (n.d.). Whistleblower
  Laws/Sarbanes Oxley Act. Retrieved April 12,
  2009, from http//www.legal-database.com/whistlebl
  ower-laws.htm
• Leung, R. (2005). Battling Big Tobacco. CBS
  News. Retrieved April 19,2009from
  http//www.cbsnews.com/stories/2005/01/13/60II/mai
  n666867.shtml
• Mason, D. J., Leavitt, J. K., Chaffee, M. W.
  (2007). Policy and Politics (5th ed.). St. Louis
  Elsevier Inc.
• Occupational Saftey And Health Administration.
  (n.d.). The Whistleblower Protection Program.
  Retrieved April 5, 2009, from United States
  Department of Labor Web Site http//www.osha.gov/
  dep/oia/whistleblower/index.html
• Office Of Compliance Assistance . (n.d.).
  Whistleblower protections. Retrieved April 5,
  2009, from United States Department of Labor Web
  Site http//www.dol.gov/compliance/laws/comp-whis
  tleblower.htm
• U.S Senate. (26). GAO Nation's Whistleblower
  Laws Inadequately Enforced, Needs Additional
  Resources. Retrieved April 12, 2009, from
  http//murray.senate.gov/news.cfm?id308796
• Waters, A. (2008). Nurses fear their concerns
  about care will be ignored. Nursing Standard,
  22(37), 12-13.