Chapter 16 Whistle-Blowing in Nursing

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September 14, 2022

Chapter 16 Whistle-Blowing in Nursing

Chapter 16 Whistle-Blowing in Nursing

 

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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

 

 

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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”

 

 

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Examples in Nursing #1

Multiple cases of whistle-blowing by nurses

Nursing home abuse, neglect

Inadequate, inappropriate care

Unsafe nurse staffing

Unprofessional physician conduct

 

 

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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)

 

 

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Question #1

Is the following statement true or false?

Whistle-blowing involves adhering to groupthink.

 

 

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Answer to Question #1

False

Groupthink refers to an inappropriate conformity to group norms. Whistle-blowing involves going outside the norm.

 

 

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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

 

 

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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

 

 

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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)

 

 

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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

 

 

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Question #2

Is the following statement true or false?

A consequentialist views whistle-blowing in terms of maximizing the benefit while minimizing the harm.

 

 

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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.

 

 

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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

 

 

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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

 

 

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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

 

 

 

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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

 

 

 

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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)

 

 

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Question #3

Is the following statement true or false?

The False Claims Act provides protection for fraud committed against the state.

 

 

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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.

 

 

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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

 

 

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End of Presentation

 

 

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