Whistleblowing in Australian Nursing: Ethics and Outcomes

Introduction

The world is growing ever smaller, as interconnections between previously disparate people and groups become ever tighter and more common. There are now fewer degrees of separation between all individuals and the broader events and features of modern life. 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 established or discovered in recent years. What happens to one individual, or in one particular circumstance, is now recognized as having much wider and more profound implications for others and for the world in general than ever before. This creates a responsibility for everyone involved in virtually any act — and certainly any act that is already known to have broad, far-reaching implications — to ensure that these effects are made as positive as possible.

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

Ethics in Healthcare

Whistleblowing 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 corruption. The nursing world is also in need of whistleblowers, however, and though nurse whistleblowers may receive less media attention, their effects 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 whistleblowing experience for patients, nurses, and other stakeholders in Australian healthcare are examined. Purely ethical issues as well as directly practical aspects of whistleblowing will be discussed, and the wide-reaching implications of whistleblowing 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 whistleblowers will emerge, and convince others to be louder advocates for ethical nursing practices.

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 principle: "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 bear greater responsibility to prevent harm, precisely because patients place greater trust in them (Lachman 2008).

Whistleblowing in Nursing

For nurses, then, the provision of ethical care must include monitoring other care features — such as those administered by physicians or other nurses — and 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 the sense 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 quality of life as much as possible. A nurse's ethical duties are therefore not limited to their training and defined role in given institutions and situations, but extend further to include an awareness of care patterns and individual behaviors that might influence their patients' health.

"Blowing the whistle on" someone stems from a literal practice in which a whistle would be used to call the immediate attention of the public and law enforcement to a crime or danger. As mentioned above, the term "whistleblower" has recently gained renewed popularity in the business world, and it is far more widely used and familiar as a term of business organizations. 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 whistleblower still persists in medical and nursing contexts: a whistleblower is someone within an organization who calls attention to dangers in its operations (Robinson 1993).

Effects on Individual Nurses

There are certain specifics of whistleblowing in nursing practice that must be identified before a meaningful exploration of its effects and implications can be conducted. In order to bring important issues to the attention of those who have the authority to effect real and immediate change, nurses must often reveal confidential medical information for the purpose of reprimanding, reining in, or otherwise prompting a corrective action against a peer or superior (Lachman 2008). This is, of course, the very essence of whistleblowing — but the privacy concern is of especial importance in the nursing world. Furthermore, the disruption in operations that many whistleblowing incidents cause can have an immediate and negative impact on care for a number of individuals, making whistleblowing in nursing something of a special case.

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

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

Conclusion

There are many factors and issues that need to be considered in the larger question of whistleblowing in the nursing profession. The space constraints of this analysis allowed only the briefest discussion of many of these points, but it is hoped that the role and importance of whistleblowing in the nursing profession has been made clear. It is only through following patient advocacy to such extremes that this advocacy has any real meaning or merit.