WHISTLE BLOWING IN NURSING

Whistle Blowing in Nursing

Whistle Blowing in Nursing

Introduction

At some time during the course of their professional practice there will come a time when nurses must take a stand on what they consider, after careful thought and critical reflection, to be morally important. Taking a stand can involve either individual or collective action. Individual action may involve a nurse refusing conscientiously participate in a controversial medical or nursing procedure; reporting an error, adverse event or some other troubling incident to a supervisor, an oversight unit or to some other authority (including an external statutory authority); seeking advice from a clinical ethics committee or some other decision- making committee; or speaking out in either a conference or some other public forum. On rare occasions, a nurse might decide to approach media outlets to have his or her concerns aired. Collective action, on the other hand, may involve groups of nurses embarking on an organized lobbying campaign aimed at particular target groups. Or, as has become increasingly common around the world, it may involve strike action — particularly in situations involving substandard working conditions that are placing patient safety at risk.

Whatever action is taken, it is never free of moral risk. There are many examples in the nursing, legal and bioethics literature (too numerous to list here) of nurses having suffered both personally and professionally because they took a stand on what they deemed to be an important professional or moral issue. For example, nurses conscientiously refusing to participate in certain morally controversial medical procedures have sometimes lost their jobs or have been made to resign 'voluntarily'.

Despite the associated hazards and risks, nurses have a moral obligation to take a stand on important ethical issues. Nevertheless, there are some misconceptions about the nature of this obligation, the options open to nurses for taking a stand, and even about whether it is right to take a stand at all. Some nurses even fear that some of the options open to them are incompatible with their broader professional obligations as nurses and are therefore 'unprofessional'. For some nurses this has caused enormous personal conflict, and has served more to compound the moral problems they face in the work place than to help resolve them.

Discussion and Analysis

Health care systems around the world are adopting and implementing new models of clinical governance and clinical risk management as part of a global strategy aimed at improving safety and quality in health care and reducing the incidence and impact of human error. To this end, it is being increasingly recognized and accepted by all concerned that:

“Safety is everyone's responsibility. Almost everyone working in health care cares about patient safety, in the sense of wanting to do their best for patients. However, patient safety needs to be embedded in the culture of health care, not just in the sense of individual high standards, but of a widespread acceptance of a systematic understanding of risk and safety and the need for everyone to actively promote patient ...