Chapter 16 Whistle-Blowing in Nursing
Copyright © 2016 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Whistle-Blowing
Action by a nurse going outside organization for public’s best interest when organization is unresponsive to reporting danger through organization’s proper channels
Two types:
Internal: reporting concerns via chain of command
External: reporting concerns outside organization
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Groupthink and Whistle-Blowing
Groupthink: inappropriate conformity to group norms
Going outside with significant personal, professional risks
Cases involving Enron, WorldCom, Morgan Stanley, federal prison in California, Wells Fargo Bank
Awareness of problem; ignore until crisis occurs or problem becomes public
Reality: professionals torn between what they believe they should do and what they actually do
Research by Fagan, Parker, and Jackson (2016): “speaking up”
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Examples in Nursing #1
Multiple cases of whistle-blowing by nurses
Nursing home abuse, neglect
Inadequate, inappropriate care
Unsafe nurse staffing
Unprofessional physician conduct
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Examples in Nursing #2
Primary reason for not raising a concern: nothing would be done
Whistle-blowing never first solution; need to follow chain of command
Guidelines for whistle-blowing (see Box 16.1)
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Question #1
Is the following statement true or false?
Whistle-blowing involves adhering to groupthink.
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Answer to Question #1
False
Groupthink refers to an inappropriate conformity to group norms. Whistle-blowing involves going outside the norm.
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Cultural Background
Cultural background, a possible influence—reluctant due to being raised to respect clear chain of command and hierarchy
English-as-a-second-language nurses—reluctant due to problems with communication
Higher stakes; fear of retaliation
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Personal Risks #1
Negative reactions from coworkers
Loss of job
Employer retaliation
Legal retaliation
Personal effects (distress, acute anxiety, flashbacks, nightmares, disturbing thoughts)
Effects on family life
Reporting problems anonymously is difficult
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Personal Risks #2
Whistle-blowers never assume doing right thing will protect from retaliation
Need to determine legal duty for reporting; research specifics of protection under law; anonymous reporting if possible; preparation to defend claim
Attempt to solve problems internally before going public
Pros and cons (see Box 16.2)
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Ethical Dimensions
Conflict between commitments to principle and duty
Loyalty to employer versus patient protection (major reason for delay)
Advocacy, group loyalty, and “saving face”
Consequentialist view: maximize benefit; minimize harm
Deontological view: duty to keep promises or protect patients
ANA Code of Ethics for Nurses and other ethical codes: role of patient advocacy
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Question #2
Is the following statement true or false?
A consequentialist views whistle-blowing in terms of maximizing the benefit while minimizing the harm.
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Answer to Question #2
True
Whistle-blowing is viewed by a consequentialist as focusing on changing a situation for the better, that is, maximizing the benefit while minimizing the harm.
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Whistle-Blowing as Failure of Organizational Ethics #1
Organization failing to address accountability for patients’ safety and welfare
Nurses encouraged to speak up and be supported when doing so
Reality: if person willing to go to the trouble and risk repercussions, then concerns need to be taken seriously
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Whistle-Blowing as Failure of Organizational Ethics #2
Suggestions
Ethical committee chaired by nurse with biomedical issue experience
Nurse manager promotes values of patient advocacy
Organizational support of individuals willing to take risk
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Legal Protection #1
No universal legal protection for whistle-blowers
Federal protection
1st, 14th Amendments to the U.S. Constitution
Title VII of Civil Rights Act or Fair Labor Standards Act
President Donald Trump’s 2017 executive order establishing an Office of Accountability and Whistle-blower Protection
State protection
Variable standards for proving retaliation
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Legal Protection #2
False Claims Act: for fraud committed against federal government
Exhaust internal chain of command
File complaint with DHHS
If considered valid, litigation proceeds
Whistle-blower receives percentage of damages awarded
As of 2016, False Claims Acts had been adopted by 29 states, District of Columbia, NY city, and Chicago
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Legal Protection #3
Other federal legislation
Whistleblower Protection Act of 1989
Whistleblower Protection Enhancement Act of 2007
National Labor Relations Act
Sarbanes-Oxley Act of 2002 (best protection for nongovernmental employees)
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Question #3
Is the following statement true or false?
The False Claims Act provides protection for fraud committed against the state.
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Answer to Question #3
False
Although there are state versions of the False Claims Act, the Act was passed to encourage whistle-blowers to come forward regarding fraud committed against the federal government.
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Whistle-Blowing as an International Issue
2014 Annual Report to Congress on the Dodd-Frank Whistleblower Program
Highest numbers of international reports came from the UK, Canada, Australia, China, and India
In 2017, the British National Health Services published draft regulations to give legal protection to NHS whistleblowers
Copyright © 2020 Wolters Kluwer • All Rights Reserved
End of Presentation
Copyright © 2020 Wolters Kluwer • All Rights Reserved