Nurses hold a unique position within the health care system. Nurses are often in contact with people from all levels of authority, from those who give basic patient care to those who decide on organizational policy. As in all professions though, not everything we see is as it should be. But the question is – should we say something, should we tell someone, should we be a whistleblower?
The American Nurses Association Code of Ethics has nine provisions that clearly outline a nurse’s responsibilities to patients, coworkers, and the public at large. They include:
- The nurse’s primary commitment is to the patient, whether an individual, family, group, or community;
- The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient; and
- The nurse participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality healthcare and consistent with the values of the profession through individual and collective action.
Taken at face value, it would seem that we don’t have a choice. When nurses see something that is harmful to our profession and to patient care, we must speak up – but at what cost?
In 2009, two nurses in Texas spoke up about a doctor’s substandard care. The original complaints were made anonymously, but the community found out who the two nurses were. They lost their jobs and were charged with a crime related to information they used to report the physician. The nurses were later vindicated, but at tremendous personal, professional, and financial cost. Stories like this can keep many people from speaking up.
Mistakes happen. In health care, medical errors can cause death or injury, but since we are human, they still can happen. This is why mistakes must be reported and addressed. The accident or incident reports should not be seen as punitive, but as instructional:
- Why did this mistake happen?
- What can be done to prevent a similar mistake?
- How was the mistake corrected?
When this step is seen as a way to punish staff for making errors, mistakes are much less likely to be reported. Instead, they may be covered up, which means they can’t be corrected and staff can’t learn from them.
As mistakes continue to happen or perhaps worse, deliberately illegal or unethical actions are taken, the situation can spiral out of control to the point that whistle blowing seems to be the only option.
Changing the culture
Finding, reporting, and taking responsibility for fixing errors or wrong doing needs to become the new normal. In other words, the culture in the health care system needs to change. Staff members need to feel comfortable in speaking out when there is something wrong and know that they will be supported in their efforts to help improve the quality of care in their facility.
A change in culture must come from the top. Managers need to provide an environment where employees feel safe reporting incidents, enabling the staff to feel that they are part of the team. This is particularly important when the staff member that has made the error or is behaving in an unethical way is considered to be a superior.
Peers can help too. The term “team work” encompasses not only patient care but peer care. We need to be supportive of each other, particularly when times are tough and work is at its hardest. If errors happen, they shouldn’t be seen as a “gotcha,” but as a sign that something needs to be fixed so this type of thing doesn’t happen again.
When the whistle must be blown
Sometimes, the call has to be made and someone or something needs to be reported to a higher level. As in the case of the Texas nurses, there can be reason to worry about how you will be seen if you are the one to blow the whistle.
There is work being done to help protect workers who need to expose issues in the workplace. The United States Department of Labor’s Occupational Safety and Health Act (OSHA) and a number of other laws help protect workers in federal jurisdiction. All 50 states have their own state plans and many are working on improving them. In Oregon, nurses are already protected from retaliation if they report misconduct that they believe is a violation of legal, policy, or professional standards. Last year, the state began a debate to extend this protection to other health care professionals.
Nurses can band together to provide a safe environment for everyone, but we need to work together at a team.
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