One of my least favorite activities as a chief nursing officer was reading and responding to patient and family complaint letters describing a disturbing event or significant gap in meeting their expectations. Following due diligence to gain insight about each situation, I found some reconciliation was always necessary. Once I’d addressed specific issues, I typically concluded my letter with something like this: “Thank you for your willingness to let us know how we could have provided a better experience for you. We take these issues seriously and work to improve care.” I was sincere and truly valued their willingness to take the risk of sharing their complaints.

But sharing complaints shouldn’t be risky for patients in the first place. All too often, patients tell us they feel too intimidated to ask a healthcare provider about their care, and fear retaliation if they’re perceived as confrontational or complaining. As protectors, we can’t imperil
patients by reacting poorly to negative feedback. As providers, we’re expected to check any dour attitudes at the door and find a way to deal with having a bad day.

A colleague with extensive expertise in patient education and engagement recently shared a disturbing family healthcare experience where she felt helpless and compromised. Her octogenarian aunt fell down a flight of stairs; in the emergency department, she was diagnosed with a foot fracture and received a temporary cast. Discharged to a skilled nursing facility, she didn’t improve—and she fell again. After a great deal of wrangling, the family obtained her medical records and learned to their horror that the temporary cast had been placed on the wrong foot. When she returned to the same hospital after her second fall, her blood work revealed elevated cardiac enzyme levels. Although she lacked symptoms and had no history of cardiovascular disease, she underwent a cardiac catheterization and an intensive care unit stay without being diagnosed with a cardiac problem. My colleague’s most distressing comment was her admission that her family was evaluating what steps to take with the hospital but feared caregivers might retaliate.

Say it isn’t so—that this is an isolated and unfounded fear. Unfortunately, though, the blogosphere and other reports confirm otherwise. On an “I hate dialysis message board” (http://ihatedialysis.com/forum/index.php?topic=26399.0), patients complain their dialysis caregivers (including nurses) are indifferent to them and deny their dignity, and say they fear caregivers might compromise their care if they complain about them. Comments on other sites reveal patients’ beliefs that nurses withhold or delay pain medication, talk negatively about them or write false information to impugn their integrity, and even delay or ignore call lights of petulant patients. In nursing homes, patients perceive what seem like subtle forms of retaliation, such as delaying delivery of hot meal trays until they’re cold or neglecting to charge an electric wheelchair. Congress acted to curb blatant abuse in nursing homes by enacting the Nursing Home Reform Act in 1987. Many states have since adopted laws protecting those submitting complaints, confirming the right to be free from retaliation (www.nursing-home-abuse-
resource.com/care_center/complaints.html).

For more than a decade, we’ve been encouraging patients to speak up for their safety and know their rights, using such tools as The Joint Commission’s award-winning “Speak-Up” campaign. But more often than not, the more vulnerable the patient, the less likely he or she is to speak up or complain.

Nurses and other caregivers also have been on the receiving end of retaliation. Expected to speak up when any breach of patient safety occurs, such as failure to follow infection-control procedures, unsafe staffing, or disruptive coworker behavior, nurses fear retaliation if they report incidents to authorities. Whistleblowers and nurses who’ve reported unprofessional conduct have lost their jobs. A lesser-known provision of the Affordable Care Act aims to curb such oppression by providing additional whistleblower and retaliation protection for healthcare workers and patients.

We have a responsibility to protect patients (as well as our moral integrity) and not feign ignorance when we observe others acting improperly. As we advance a culture of safety, we want to know how we can improve. We ask why something happened, not whom we should blame. In turn, we should thank patients and families for what today we might view as bravery for coming forward—and help make such reporting an expected, shared, and welcomed responsibility in the future.

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN

Editor