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This research examined the stress-induced health effects of whistleblowing and non-whistleblowing on nurses in Western Australia. A descriptive survey design was used to explore the physical and emotional problems experienced by nurses who did and did not blow the whistle on misconduct in the workplace. A questionnaire based on Lazarus and Folkman's Model of Stress and Coping was developed and posted anonymously to general and mental health nurses. Ninety-five nurses responded to the questionnaire, and 70 were identified as whistleblowers and 25 were identified as non-whistleblowers. Results indicated that 70% of whistleblowers and 64% of non-whistleblowers experienced stress-induced physical problems from being involved in a whistleblowing situation. The most common physical problems experienced by nurses were restless sleep, fatigue, headaches, insomnia, and increased smoking. In addition, 94% of whistleblowers and 92% of non-whistleblowers suffered stress-related emotional problems, the most frequent being anger, anxiety, and disillusionment. Whistleblowers and non-whistleblowers suffered a similar percentage of physical health problems, whereas non-whistleblowers suffered a higher percentage of emotional health problems, especially feelings of guilt, shame, and unworthiness. These findings suggest that whistleblowing situations are stressful and may cause physical and emotional health problems whether one blows the whistle or not.
BACKGROUND: Patient advocacy and a desire to rectify misconduct in the clinical setting are frequently cited reasons for whistleblowing in nursing and healthcare. AIM: This paper explores current knowledge about whistleblowing in nursing and critiques current definitions of whistleblowing. The authors draw on published perspectives of whistleblowing including the media, to reflect on the role of the media in health related whistleblowing. CONCLUSION: Whistleblowing represents a dilemma for nurses. It strikes at the heart of professional values and raises questions about the responsibilities nurses have to communities and clients, the profession, and themselves. In its most damaging forms, whistleblowing necessarily involves a breach of ethical standards, particularly confidentiality. Despite the pain that can be associated with whistleblowing, if the ends are improved professional standards, enhanced outcomes, rectification of wrongdoings, and, increased safety for patients and staff in our health services, then the ends definitely justify the means.
Whistleblowing - the public exposure of organizational wrongdoing - presents practical and ethical dilemma for nurses, and needs to be seen as part of a spectrum of increasingly confrontative actions against miscreant organizations by their employees. The ethics of whistleblowing can only be understood in relation to its moral purpose, whether that is to achieve a good outcome (a consequentialist view) or fulfil a duty (a deontological view). The consequentialist perspective is unable on its own to resolve problems arising from the balance of good and harm resulting from the act of whistleblowing (where considerable harm might be caused) or of responsibility for that harm. A deontological approach provides an analysis of these problems but raises its own problem of conflicting duties for nurses. However, a strong argument can be made for the precedence of the nurse's duty to the patient over her duty to the employer. Although both duties are based on an implicit or an explicit promise, the promise to a person (the patient) must take precedence over the promise to an organization. It can even be argued that duty to the employer may in fact justify whistleblowing by nurses in some circumstances. However, the consequences of whistleblowing are forced upon nurses in a different way by the fact that the danger of reprisals acts as a deterrent to whistleblowers, however justified their actions may be. A more robust approach to the protection of whistleblowers is needed on the part of the government and the National Health Service (NHS) to remedy this situation.
OBJECTIVE: To examine the response of organizations to "whistleblowing" and the effects on individual whistleblowers. DESIGN: Questionnaire survey of whistleblowers who contacted Whistleblowers Australia after its publicity campaign. SETTING: Australia. SUBJECTS: 25 men and 10 women from various occupations who had exposed corruption or danger to the public, or both, from a few months to over 20 years before. RESULTS: All subjects in this non-random sample had suffered adverse consequences. For 29 victimization had started immediately after their first, internal, complaint. Only 17 approached the media. Victimization at work was extensive: dismissal (eight subjects), demotion (10), and resignation or early retirement because of ill health related to victimization (10) were common. Only 10 had a full time job. Long term relationships broke up in seven cases, and 60 of the 77 children of 30 subjects were adversely affected. Twenty nine subjects had a mean of 5.3 stress related symptoms initially, with a mean of 3.6 still present. Fifteen were prescribed long term treatment with drugs which they had not been prescribed before. Seventeen had considered suicide. Income had been reduced by three quarters or more for 14 subjects. Total financial loss was estimated in hundreds of thousands of Australian dollars in 17. Whistleblowers received little or no help from statutory authorities and only a modest amount from workmates. In most cases the corruption and malpractice continued unchanged. CONCLUSION: Although whistleblowing is important in protecting society, the typical organisational response causes severe and longlasting health, financial, and personal problems for whistleblowers and their families.
Medical school curricula and postgraduate education programmes expend considerable resources teaching medical ethics. Simultaneously, whistleblowers' agitation continues, at great personal cost, to prompt major intrainstitutional and public inquiries that reveal problems with the application of medical ethics at particular clinical "coalfaces". Virtue ethics, emphasising techniques promoting an agent's character and instructing their conscience, has become a significant mode of discourse in modern medical ethics. Healthcare whistleblowers, whose complaints are reasonable, made in good faith, in the public interest, and not vexatious, we argue, are practising those obligations of professional conscience foundational to virtue based medical ethics. Yet, little extant virtue ethics scholarship seriously considers the theoretical foundations of healthcare whistleblowing. The authors examine whether healthcare whistleblowing should be considered central to any medical ethics emphasising professional virtues and conscience. They consider possible causes for the paucity of professional or academic interest in this area and examine the counterinfluence of a continuing historical tradition of guild mentality professionalism that routinely places relationships with colleagues ahead of patient safety.Finally, it is proposed that a virtue based ethos of medical professionalism, exhibiting transparency and sincerity with regard to achieving uniform quality and safety of health care, may be facilitated by introducing a technological imperative using portable computing devices. Their use by trainees, focused on ethical competence, provides the practical face of virtue ethics in medical education and practice. Indeed, it assists in transforming the professional conscience of whistleblowing into a practical, virtue based culture of self reporting and personal development.
BACKGROUND: Nursing codes of ethics bind nurses to the role of patient advocate and compel them to take action when the rights or safety of a patient are jeopardized. Reporting misconduct is known as whistleblowing and studies indicate that there are personal and professional risks involved in blowing the whistle. AIM: The aim of this study was to explore the beliefs of nurses who wrestled with this ethical dilemma. DESIGN: A descriptive survey design was used to examine the beliefs of nurses in Western Australia who reported misconduct (whistleblowers) and of those who did not report misconduct (nonwhistleblowers). METHODS: The instrument listed statements from current ethical codes, statements from traditional views on nursing and statements of beliefs related to the participant's whistleblowing experience. Respondents were asked to rate each item on a five-point Likert format which ranged from strongly agree to strongly disagree. Data were analysed using a Pearson's correlation matrix and one-way ANOVA. To further explore the data, a factor analysis was run with varimax rotation. RESULTS: Results indicated that whistleblowers supported the beliefs inherent in patient advocacy, while nonwhistleblowers retained a belief in the traditional role of nursing. Participants who reported misconduct (whistleblowers) supported the belief that nurses were primarily responsible to the patient and should protect a patient from incompetent or unethical people. Participants who did not report misconduct (nonwhistleblowers) supported the belief that nurses are obligated to follow a physician's order at all times and that nurses are equally responsible to the patient, the physician and the employer. CONCLUSION: These findings indicate that nurses may respond to ethical dilemmas based on different belief systems.
The purpose of this article is to discuss an external whistleblowing event that occurred after all internal whistleblowing through the hierarchy of the organization had failed. It is argued that an organization that does not support those that whistle blow because of violation of professional standards is indicative of a failure of organizational ethics. Several ways to build an ethics infrastructure that could reduce the need to resort to external whistleblowing are discussed. A relational ethics approach is presented as a way to eliminate the negative consequences of whistleblowing by fostering an interdependent moral community to address ethical concerns.
The protracted and costly investigations into Camden and Campbelltown hospitals (New South Wales), The Canberra Hospital (Australian Capital Territory), and King Edward Memorial Hospital (Western Australia) recently uncovered significant problems with quality and safety at these institutions. Each investigation arose after whistleblowers alerted politicians directly, having failed to resolve the problems using existing intra-institutional structures. None of the substantiated problems had been uncovered or previously resolved by extensive accreditation or national safety and quality processes; in each instance, the problems were exacerbated by a poor institutional culture of self-regulation, error reporting or investigation. Even after substantiation of their allegations, the whistleblowers, who included staff specialists, administrators and nurses, received little respect and support from their institutions or professions. Increasing legislative protections indicate the role of whistleblowers must now be formally acknowledged and incorporated as a "last resort" component in clinical-governance structures. Portable digital technology, if adequately funded and institutionally supported, may help to transform the conscience-based activity of whistleblowing into a culture of self-reporting, linked to personal and professional development.
When nurses encounter misconduct in the workplace, their ethical codes of conduct bind them to the role of patient advocacy and compel them to safeguard the patient from harm. However, reporting misconduct can be personally and professionally risky. The aim of the research was to examine the professional consequences of whistleblowing and nonwhistleblowing in nursing. A descriptive survey design was used to examine the professional effect of reporting misconduct (whistleblowing) and not reporting misconduct (nonwhistleblowing). Ninety-five respondents were included in the study; 70 were self-identified as whistleblowers and 25 were self-identified as nonwhistleblowers. Results indicated that there were severe professional reprisals if the nurse reported misconduct, but there were few professional consequences if the nurse remained silent. Official reprisals included demotion (4%), reprimand (11%), and referral to a psychiatrist (9%). Whistleblowers also reported that they received professional reprisals in the form of threats (16%), rejection by peers (14%), pressure to resign (7%), and being treated as a traitor (14%). Ten per cent reported that they felt their career had been halted. These findings suggest that when nurses identify and report misconduct in the workplace, they may experience serious professional consequences.
The media perpetuates the stereotype of the whistleblower forced to go outside his or her organization and risk his or her career to bring wrongdoing to public awareness. In fact, NHS trusts should all have a whistleblowing policy in place which encourages people to raise genuine concerns about wrongdoing, and offer protection to those who do this. This article aims to help health workers understand the whistleblowing process and so assist them in raising concerns within their organization.
While it is widely known that strict regulations protect nuclear workers who raise safety-related concerns, few are aware that the riling of a claim for radiation-related injuries has been interpreted to constitute a "protected activity" under the Energy Reorganization Act, which endows the claimant with "whistleblower" status. This means that negative employment-related actions taken against a radiation injury claimant can result in detrimental, even draconian, consequences for the employer involved. The case of In re McCafferty illustrates this vividly. The claimants in McCafferty were six contract insulators who filed lawsuits for emotional distress they claimed to have suffered due to exposures they received at Centerior Energy's Davis-Besse nuclear plant. Because of the pending lawsuit and claim for emotional distress, Centerior denied all six claimants access to Centerior's plants, which resulted in their being terminated by their employer. The claimants brought an action with the Department of Labor, succeeded in convincing the Administrative Review Board that Centerior's actions constituted retaliation under the ERA "whistleblower" provision, and were afforded nearly full relief on their claims. This article explains how Centerior's actions ran afoul of the Energy Reorganization Act's "whistleblower" provision. It also describes what licensees and their subcontractors can do if faced with similar circumstances.
Health-care providers throughout the United States face litigation and the threat of litigation on a daily basis due to claims of patient abuse. Hidden within the costs associated with defending patient abuse claims are the wrongful termination filings made by employees who claim they were retaliated against for their whistleblowing activity. The purpose of this paper is to demonstrate why an employer would resort to retaliatory acts in the shadow of a patient abuse filing and to discuss what steps are currently taken to prove and investigate the validity of a retaliation claim. Included within the body of this paper are court decisions on the topics of whistleblowing protection and violation of public policy. These examples are illustrated so that recommendations can be provided that assist the employer in avoiding a wrongful discharge claim and help to conclude that retaliation against the whistleblower is a costly mistake even with the employment at-will principle as a defense.
Although medical centres have established boards, special committees, and offices for the review and redress of breaches in ethical behaviour, these mechanisms repeatedly prove themselves ineffective in addressing research misconduct within the institutions of academic medicine. As the authors see it, institutional design: (1) systematically ignores serious ethical problems, (2) makes whistleblowers into institutional enemies and punishes them, and (3) thereby fails to provide an ethical environment. The authors present and discuss cases of academic medicine failing to address unethical behaviour in academic science and, thereby, illustrate the scope and seriousness of the problem. The Olivieri/Apotex affair is just another instance of academic medicine's dereliction in a case of scientific fraud and misconduct. Instead of vigorously supporting their faculty member in her efforts to honestly communicate her findings and to protect patients from the risks associated with the use of the study drug, the University of Toronto collaborated with the Apotex company's "stalling tactics," closed down Dr Olivieri's laboratory, harassed her, and ultimately dismissed her. The authors argue that the incentives for addressing problematic behaviour have to be revised in order to effect a change in the current pattern of response that occurs in academic medicine. An externally imposed realignment of incentives could convert the perception of the whistleblower, from their present caste as the enemy within, into a new position, as valued friend of the institution. The authors explain how such a correction could encourage appropriate reactions to scientific misconduct from academic medicine.
This article takes a look at how whistleblowing has changed over the last 25 years highlighting some well-known cases and focusing on the areas of health and safety, health services and social services. The article also covers government legislation and the lead taken by professional bodies to encourage and support whistleblowers.
What should you do when you see another dental professional's substandard work? What dental professionals are most likely to encounter whistleblowing dilemmas? Generic components of whistleblowing that apply to dentistry and factors to consider when choosing to report are discussed.