1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 16 Whistle-Blowing in Nursing

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Whistle-Blowing in Nursing Action by a nurse going outside organization for public’s best interest when organization unresponsive to reporting danger through organization’s proper channels Two types: –Internal: reporting concerns via chain of command –External: reporting concerns outside organization

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Groupthink & Whistle-Blowing Groupthink: inappropriate conformity to group norms –Going outside with significant personal, professional risks –Cases involving Enron, WorldCom, Morgan Stanley, federal prison in California –Awareness of problem; ignore until crisis occurs or problem becomes public –Reality: professionals torn between what they believe they should do, what they actually do

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Examples in Nursing Multiple cases of whistle-blowing by nurses –Nursing home abuse, neglect –Inadequate, inappropriate care –Unsafe nurse staffing –Unprofessional physician conduct

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Examples in Nursing (cont.) Primary reason for not raising a concern: nothing would be done Whistle-blowing never first solution; need to follow chain of command Guidelines for whistle-blowing (see Box 16.1)

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Whistle-blowing involves adhering to groupthink.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Groupthink refers to an inappropriate conformity to group norms. Whistle-blowing involves going outside the norm.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Background Cultural background possible influence—reluctant due to being raised to respect clear chain of command and hierarchy English-as-a-second-language nurses—reluctant due to problems with communication Higher stakes; fear of retaliation

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Personal Risks Negative reactions from coworkers Loss of job Employer retaliation Legal retaliation Personal effects (distress, acute anxiety, flashbacks, nightmares, disturbing thoughts) Effects on family life

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Personal Risks (cont.) Whistle-blowers never assume doing right thing will protect from retaliation Need to determine legal duty for reporting; research specifics of protection under law; anonymous reporting if possible; preparation to defend claim Attempt to solve problems internally before going public Pros and cons (see Box 16.2)

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Ethical Dimensions Conflict between commitments to principle and duty –Loyalty to employer vs. patient protection (major reason for delay) –Advocacy, group loyalty, and “saving face” –Consequentialist view: maximize benefit; minimize harm –Deontological view: duty to keep promises or protect patients ANA Code of Ethics for Nurses and other ethical codes: role of patient advocacy

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? A consequentialist views whistle-blowing in terms of maximizing the benefit while minimizing the harm.

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Whistle-blowing is viewed by a consequentialist as focusing on changing a situation for the better, that is, maximizing the benefit while minimizing the harm.

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Whistle-Blowing as Failure of Organizational Ethics Organization as failing to address accountability for patients’ safety and welfare Nurses encouraged to speak up and be supported when doing so Reality: if person willing to go to the trouble and risk repercussions, then concerns need to be taken seriously.

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Whistle-Blowing as Failure of Organizational Ethics (cont.) Suggestions: –Ethics committee chaired by nurse with biomedical issue experience –Nurse manager promotes values of patient advocacy –Organizational support of individuals willing to take risk

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Legal Protection No universal legal protection for whistle-blowers Federal protection –1st, 14th Amendments to U.S. Constitution –Title VII of Civil Rights Act or Fair Labor Standards Act State protection: 21 states with whistle-blower protection (see Box 16.3) Variable standards for proving retaliation

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Legal Protection (cont.) False Claims Act: for fraud committed against federal government –Exhaust internal chain of command –File complaint with DHHS –If considered valid, litigation proceeds –Whistle-blower receives percentage of damages awarded

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Legal Protection (cont.) Cases: –Four health care professionals of home infusion company in Florida Keys (Ven-A-Care) –Tennessee nursing home employee and Medicare and Medicaid fraud Some state versions of FCA

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Legal Protection (cont.) Other federal legislation –Whistleblower Protection Act of 1989 –Whistleblower Protection Enhancement Act of 2007 –National Labor Relations Act –Sarbanes-Oxley Act of 2002 (best protection for nongovernmental employees)

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The False Claims Act provides protection for fraud committed against the state.

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Although there are state versions of the False Claims Act, the Act was passed to encourage whistle-blowers to come forward regarding fraud committed against the federal government.

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Whistle-Blowing as an International Issue United Kingdom’s Public Interest Disclosure Act –Whistle-blower disclosures to employers, regulatory bodies, media protected from retaliation; if retaliation, subject to unlimited compensation in fines –Whistle-blowers viewed as witnesses acting in public interest –Burden of proof on employee to show disclosure was protected and reason for dismissal Royal College of Nursing: dedicated telephone line and website

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation