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 It�s 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. What�s the problem? Who do you report it to? What if that person was involved?

13. Questions What�s the problem? Is the patient�s safety being comprised? Who do you report it to? What if that person was involved and didn�t 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 Don�t 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-whistleblower-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.nursingtimes.net/nursing-times-this-weeks-issue/are-nurses-who-fail-to-blow-the-whistle-on-bad-practice-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/whistleblower-laws.htm Leung, R. (2005). Battling Big Tobacco. CBS News. Retrieved April 19,2009from http://www.cbsnews.com/stories/2005/01/13/60II/main666867.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-whistleblower.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?id=308796 Waters, A. (2008). Nurses fear their concerns about care will be ignored. Nursing Standard, 22(37), 12-13.