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Critical Care / Emergency / Trauma

When nurses speak up, they pay a price

One of the greatest philosophers, Eeyore the donkey (a character from Milne’s Winnie the Pooh) published a book of wise sayings, one of which was: “No matter how good your friends are, and no matter how right you are, they may not stand behind you in a work-related confrontation, and you have to forgive them for that.” This is a one-sentence lesson in corporate culture! Eeyore adds two more: “Being right doesn’t mean you’ll win,” and “Blowing the whistle always is painful.” He is both right and wise.

Unfortuately, Eeyore doesn’t tell us what to do about any of these morally charged observations. This is especially distressing because there is no protection from retaliation. Yes, legislation has been passed, and courts have often found in favor of whistleblowers, but even though the whistleblower gets compensation, he or she will still pay a price—at the very least loss of friendships, loss of harmony in work relationships, or even “blackballing,” which can sabotage the whistleblower’s future.

“The impact of being a whistleblower can be divided into professional effects, physical and emotional effects, and effects on the whistleblower’s personal life. The professional effects include loss of reputation, reprisals, and loss of job security,” McDonald and Ahern write. While there may be positive outcomes for blowing the whistle, McDonald and Ahern found that “…they were overshadowed by the negative outcomes, which could include being referred to a psychiatrist or demoted, suspended, or transferred from their usual place of work. Being a whistleblower may impact on personal life and cause physical and emotional symptoms.”

All of which helps explain why, despite legislative whistleblower protection, it is so very hard to blow the whistle even when you know to the very core of your being that what is happening is wrong, and that reporting it to the proper authorities is right.

Take, for example, a Texas case in which emergency department nurses Stephanie Hohman, RN, and Lisa Lippert Gray, RN, reported to the Texas Board of Nurse Examiners that trauma teams under the physician director of trauma services were performing unnecessary and often painful procedures on patients who had “exercised their legal right to refuse” them. Their employer became aware of their complaint when the Texas Board of Nurse Examiners followed up on it. Retaliation followed: At any rate, that is what a jury of 8 women and 3 men determined when they heard the case. Subsequently, the jury awarded Hohman $35,000 in lost wages, $10,000 for the loss of future earnings and benefits, and $300,000 in compensatory damages. Moreover, the jurors fined the nurse administrator who enabled the retaliation $50,000 for violating the Texas Nurse Practice Act, which, in fact, requires nurses to report harm, or even potential harm, done to patients.

Why do we routinely and unfairly punish whistleblowers? The answer is complex:

  • Often the whistleblower makes others who have not blown the whistle feel uncomfortable.
  • The team mentality almost demands that you protect the team rather than the patient.
  • People quickly learn that you have to “go along to get along” with others.
  • The impact of authority: Several studies, beginning with “The Auschwitz Effect,” which Mansson wrote about in 1972, demonstrate that average people will do something they think is wrong if instructed to do so by someone in authority.
  • In everyday life, people tend to judge themselves by their own good intentions rather than by the outcomes of their actions — even when the facts are contrary to what we ourselves believe to be right.
  • By putting things in survival terms, otherwise unacceptable behaviors are tolerated and even encouraged.
  • An overemphasis on expediency “justifies” conduct that otherwise would be condemned as unethical. Group pressure to conform, the pull of team affiliation, and the “all or nothing” attitude of group think leads otherwise moral people into, at the very least, the complicity of silence.

I have only scratched the surface of the complexity: fear of rejection, fear of self-incrimination, the desire to get ahead, and many more motives impinge on the moral dilemma of blowing the whistle. And, of course, there are always credible reasons for one’s behavior if one needs badly enough to find them, no matter what your position in an organization.

Why take the risk of speaking out? Advocacy is a valued and widely accepted role of nurses. Whistleblowers believe that they are acting with integrity and promoting patient safety. However, while they perceive themselves as patient advocates, few want to be known as whistleblowers because the term carries with it a lot of negativity and even a stigma. Nonetheless, they often became whistleblowers because they had been unable to gain support for their concerns any other way.

Concomitantly, nurse whitleblowers experience systems and organizations that conspire to create and enforce a culture of silence. One example is the infamous Miofsky case in California:

At first Nurse Sandra Doll Neri could not believe her eyes. She was a nurse in the operating room at Sutter Memorial Hospital, Sacramento, Calif. Dr. Calvin O’Kane, one of Sacramento’s most respected surgeons, had opened the abdomen of a 50-year-old woman and was working. The anesthesiologist, Dr. William Miofsky, stood less than two feet away but in relative isolation, behind a semicircular screen that separated him from the operating team. Nurse Neri saw that Dr. Miofsky had his groin in the woman’s face. He was moving gently, forward, then back.

The two nurses notified Allyne Waters, the chief OR nurse. She took a look and saw twitches in the patient’s toes, a sign that the anesthesia was wearing off. Ms. Waters told Miofsky about this, and he gave his patient more anesthetic. Dr. O’Kane dismissed what the nurses said as nonsense. Meanwhile, the RNs chafed and simmered at their powerlessness to prevent the anesthesiologist’s weird pleasures.

The nurses finally organized, making notes and conducting their own investigation. They witnessed and documented Miofsky in action on a 12-year-old girl. They submitted a three-page report to William Schaeffer, the hospital administrator, who took no action. Eventually, the nurses testified at the preliminary hearing in superior court that commenced Miofsky’s prosecution on seven counts of sex perversion involving six patients.

Nurse whistleblowers often report that their working lives become unbearable following the whistleblowing episode. Not only management, but also their nusing colleagues subtly (and sometimes not-so-subtly) harrass the whistleblower. There is a climate of fear that may extend beyond the workplace into the nurses’ home life.

One young nurse whistleblower (who reported a physician for routinely ordering huge overdoses of drugs on patients, and who went unheard until the phsycian killed a patient) found that her schedule changed everyday, and she often worked two shifts consecutively or doubled back on shifts. One morning she was driving home after 18 hours on duty when her brakes failed. She narrowly escaped an accident by steering her car into a vacant field until the vegetation stopped the car; later it was determined that her brake line had been deliberately cut. In justifiable fear, she resigned and with the help of a courageous nurse manager who advised her to have any request for references sent to her at her home address, eventually found another job—for lesser pay, but still she was grateful to be working.

Is everyone who does not blow the whistle morally wrong? I think not, but depending on circumstances, they may be complicit. Clearly nursing leadership was complicit in all these cases. Perhaps we nurses never learned the true causes and the purposes for colleagiality.

What is amazing is that nurses speak up at all. But, even then, few nurses will go outside the system if no one inside the system will act. Despite the price, nurses are more likely to speak out than any other healthcare provider. So, is it any wonder that the public trusts them more than any other professional?

Leah Curtin is Executive Editor, Professional Outreach for American Nurse Today.

Selected references

Gallup Poll. Honesty/Ethics in Professions. Available at: http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx Accessed September 16, 2013.

Jackson D, Peters K, Andrew S, et al. Understanding whistleblowing: qualitative insights from nurse whistleblowers. J Adv Nurs. 2010;66(10):2194-201.

Mansson H. Justifying the Final Solution. Omega. 1972;3(5):84.

Milne, AA. Eeyore’s gloomy little instruction book. 1996; Dutton Juvenile.

McDonald S, Ahern K. Physical and emotional effects of whistle blowing. . 2002;40(1):14–27.

Miofsky v. Superior Court of State of California, 703. F2d 332, 338 (9th Cir 1983)

UTMB v. Hohman, No. 01-98-01382-CV. Available at: http://www.leagle.com/decision/19997736SW3d767_1713 Accessed September 16, 2013.

7 thoughts on “When nurses speak up, they pay a price”

  1. Either it matters to you or not. Is your first duty to your patient? Or do you keep the cult of silence. Use this safe place to tell your story. About the patient you advocated for and the obstacles that stopped you. Was it your charge nurse who told you that’s how it is here, or the Director who set fear in your heart for causing waves, or the Physcian who yelled at you and attacked you verbally. Your attempts failed….the patient died and now you can’t stop obsessing

    Nurses what more is it going to take to stop the cover

  2. psynurs says:

    Why the Board of Directors? They hire the administrators that cause problems for pt advocates. And why do other nurses side with management over the nurse who has done the reporting? Management pays their salaries.

  3. Anonymous says:

    I strongly think that every hospital needs an ethics officer who is accountable only to the BOD. in addition I think that the before every senior administrator is hired they undergo personality testing to make sure they are not a sociopath. A culture of caring and support would go far in healthcare to raise the profession. This starts in nursing education programs with ethics programs and is supported by Boards of Nursing. I also think top executives need regulatory accountability.

  4. Mary says:

    Yep. I have been in the fight of my life to protect my license over the past 15 months. I have been placed on administrative leave after being told to hide a fractured vertebrae and multiple sexual assault allegations at a federal training center where I am a Health Center Manager. I also have had a gag order on me for more than a year. I understand fully and would not do anything differently, no matter what the toll on my personal and work life and my health

  5. Anonymous says:

    sometimes even minor concerns that are voiced can cause major trouble. I can’t say much because I am in the middle of arbitration currently!

  6. Anonymous says:

    I agree that nurses could help other nurses, but in my experience nurses tend to align themselves with management…

  7. Anonymous says:

    Perhaps the answer to “group-think” is to replace the workplace group with a culture of the nurse group. If we as nurses gather around the whistle blower, perhaps the consequences to the whistle blower would not be so profound.

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