Essay on "Whistleblowing in Nursing"

Essay 8 pages (2192 words) Sources: 10

[EXCERPT] . . . .

Nurse Whistleblower

Whistleblowing in the Australian Nursing Profession: Practical Observations and Ethical Implications

The world is growing ever smaller, as interconnections between previously disparate people and groups become ever tighter and more common, and suddenly there are fewer degrees of separation between all individuals and other features and events in the modern world. This also creates a greater general complexity, where influence is often less directly but more strongly applied through the network of connections that have been paved and/or discovered in recent years; what happens to one individual or in one particular circumstances is now recognized as having much wider and more profound implications on others and on the world in general than ever before. This creates a responsibility for everyone involved in pretty much any act, and certainly any act that is already known to have broad and far-reaching implications, to ensure that these effects are made as positive as possible.

Often, doing the right thing in this regard is easy -- conducting oneself in an ethical and aware manner can be enough to make a responsible citizen. Other times, however, a more active role in the identifying and denouncing of dangerous, unethical, or irresponsible behaviors is necessary. Even people that have done no wrong themselves still have a certain responsibility to protect innocent individuals and the world at large from the ill-effects of the bad acts of others. People who answer this somewhat more difficult yet highly necessary call to ethical duty have come to be known as whistle-blowers.

Whistle-blowing has been made most famous in government and corporate scandals, where the speaking out of one individual has led to the discovery of major crimes and/or corruption. The nursing world is also in need of whistle-blowers, however, and though they might receive less media attention the effects of nurse whistle-blowers on individual and larger-scale health outcomes and on nursing practice can be quite profound. In this paper, the implications and likely outcomes of a whistle-blowing experience for patients, nurses, and other stakeholders in Australian healthcare are examined. Purely ethical issues as well as directly practical aspects of whistle-blowing will be examined, and the wide-reaching implications and influences of whistle-blowing on the nursing profession in Australia will also be assessed. Through this analysis, it is hoped that a clear picture of the need for nurse whistle-blowers will emerge, and convince others to be louder advocates for ethical nursing practices.

Ethics in Healthcare

The primary ethical directive of the medical community, derived from the Hippocratic oath commonly taken by physicians but applying equally to nurses, administrators, and all stakeholders is the now-famous "first, do no harm." With only a slight expansion, this means that all medical professionals have an ethical duty to protect their patients and their communities from harm, and this ethical duty is perhaps even greater for nurses (Lachman 2008). As patients' primary source of information and care in many settings, nurses have greater responsibility to prevent harm based on this greater trust (Lachman 2008).

For nurses, then, the provision of ethical care must include the monitoring of other care features, such as those administered by physicians and/or other nurses, and of keeping the patient informed as much as is practical regarding their care options and outcomes (Lachman 2008). The ethical practice of nursing automatically includes oversight of care procedures, not in terms of granting authority over other medical professionals or over the patient, but rather in the sense that the nurse bears a responsibility to his or her patient to ensure that care is managed in a way that will do no harm and improve the quality of life as much as possible. A nurse's ethical duties are not limited to their training and defined role in given institutions and situations, then, but rather extend somewhat further to include an awareness of care and health patterns and individual behaviors that might influence their patients health.

Whistle-Blowing in Nursing

"Blowing the whistle on" someone stems from a literal practice, where a whistle would be used to call immediate attention of the public and/or law enforcement to a crime or danger. As mentioned above, the term "whistle-blower" has recently gained renewed popularity in the business world, and indeed it is far more widely used and familiar as a term of business organizations, and its adoption in the medical community is seen by some as yet another example of the encroachment of business concepts and organizational theories into the world of medical practice (Robinson 1993). The same basic definition of a whistle-blower still persists in medical/nursing contexts; they are one within the organization that calls attention to dangers in operations (Robinson 1993).

There are certain specifics of whistle-blowing in nursing practice that need to be identified in order for a meaningful exploration of whistle-blowing's effects and implications to be conducted. In order to bring issues of importance to the attention of those that have the authority to effect real and immediate change in a situation or organization, nurses must often reveal confidential medical information for the purpose of reprimanding, reining in, or otherwise causing a negative action to take place on a peer or superior (Lachman 2008). This is, of course, the very essence of whistle-blowing, but the privacy concern is of especial importance in the nursing world, and the disruption in operations that many whistle-blowing incidents lead to can also have an immediate and negative impact on care for a number of individuals, making whistle-blowing in nursing something of a special case.

Effects on Individual Nurses

Whistle-blowing can have extreme emotional and practical effects on nurses involved in whistle-blowing incidents, and these in turn can have an effect on nursing care and patient health outcomes. In many ways, nurses that become whistle-blowers are already better equipped to handle these effects than other nurses, according to one study; there are specific coping mechanisms used in response to job stress and decision-making that nurse whistle-blowers were found to possess as traits in larger numbers than non-whistle-blowers (McDonald & Ahern 2007). These coping mechanisms not only allow these nurses to become whistle-blowers, but can also mitigate the emotional effects of whistle-blowing (McDonald & Ahern 2007).

An earlier study by the same authors that focused on the professional consequences of whistle-blowing for nurses that engaged in whistle-blowing vs. those in similar situations that did not found severe and definite negative impacts were visited upon the whistle-blowers (McDonald & Ahern 2000). These included both official and unofficial consequences, the latter of which were observed by many more whistleblowers but both of which had extreme negative effects on job performance and confidence (McDonald & Ahern 2000). From demotions, reprimands, and psychiatric referrals to experiencing pressure to resign positions and even receiving threats, nurses that reported misconduct by other personnel were often marked for ongoing punishment and intimidation (McDonald & Ahern 2000). This can cause nurses to leave positions, which has the effect of lowering the level of advocacy and accountability that exists in a given unit and is thus completely counterproductive.

Outcomes for Patients

When whistle-blowing is engaged in or even considered by a responsible nurse, the well-being of a patient and potentially multiple patients is always the foremost concern held by that nurse (Jones 2005; McDonald & Ahern 2007). It would thus follow logically that the outcomes for patients in whistle-blowing incidents is generally positive, and at least more positive than had the whistle-blowing not occurred (Jones 2005). While this definitely occurs at least some of the time, there are also some potentially negative effects of whistle-blowing on patients and on the patient's family members that are unintentional but very real.

While whistle-blowing can prevent unsafe care from being provided to a patient or other misconduct leading to a reduced quality of care being acted out, thus saving the patient from harm and fulfilling the essential function of nursing to improve the quality of life, whistle-blowing can also have harmful effects. Whistle-blowing reports are usually a method of last resort, and tend to indicate an organizational culture that is already secretive and/or permissive, but the actual act of whistle-blowing can heighten feelings of mistrust and damage overall communications in a given hospital or other medical facility (Jackson et al. 2010). This can lead to a reduced quality of care in the hospital overall, and can also create greater concerns among patients and their family members as a result of reduced communication and discernible tensions amongst the medical staff (Jackson et al. 2010). Still, in most cases whistle-blowing leads to more positive patient outcomes as it leads to improved care provided under greater scrutiny.

Impact on the Nursing Profession

It has been noted by several nurse practitioners and academics that whistle-blowing hurts the nursing profession and the medical community as a whole, as it exposes problems that could potentially be dealt with effectively without showing the public the level of disarray that can exist in some facilities (Fritko & Jackson 2005). It can also create a larger divide between nurses and physicians in general,… READ MORE

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