When nurses speak up, they pay a price

Author(s):

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.

11 COMMENTS

  1. I have just experienced two unbelievable retaliatory events. Yes what I have read is all true of the physical, psychological, mental, and punitive damages effects of speaking up as a mandated reporter. I did. My philosophy is if I do not then I am no different than the offender. Thankfully I have not suffered any loss spiritually, only gain. I was protected by my LORD who orchestrated the events and letters to prove the incompetence of a state hospital. I had chosen to forgive. I still forgive! AND now in my forgiveness I plan to file suit against the hospital for defamation of character, harassment, constructive discharge, discrimination, and more. I am also filing criminal charges as it is a Class IV misdemeanor to make dishonest reports of a practitioner in any capacity. To protect herself my supervisor has the floor staff make up many lies of my practice AFTER I reported her actions and what she was condoning to take place on the floor she managed. When the report of me was sent to the BON, the DON had no idea of the truth. She had no idea of the number of emails I had sent asking for the hostility to stop, and asking otherwise to be moved to a different unit. I sent so many messages via email. And yes my supervisor did say “”Well, it’s just the _____.______ way. Do what I do and send messages to yourself in case anything happens!!” WHAT?

  2. I reported a prestigious hospital for violating patient civil rights, false imprisonment, and negligent care. All founded. I warned the hospital for a year about what they were doing while being summarily ignored and labeled as “negative”. I finally reported to the Joint Commission. They stopped the practices. In the follow up I was than targeted, retaliated against, and eventually suspended for “threatening” when I was kept out of ratio at the expense of patient care. This was reported by a surgeon who was caring for one of the patients as well as 2 other nurses. regardless I was suspended, Had to hire a lawyer, Lost everything, Had to declare bankruptcy and am now looking for a job outside of nursing.

    After I found out and have, in writing, proof that the hospital lied to the Joint Commission. Sent that evidence to the Joint Commission and they took NO action. The state was notified and they took NO action. I called my local representative and sent 8 emails to the governors office including calling and speaking to someone on his staff.

    Not only is the manager who I reported for retaliating against me still there but there has been no discernible action taken against the organization. Every single person I spoke to from the Joint Commission, to the ANCC (regarding their magnet status) and the state have dragged their feet in doing anything whatsoever.

    My local and state representatives all the way up to the Governor of California couldn’t have cared less about what the hospital was doing or what was done to me. And just for clarity when the targeting started I went to the vice president of regulatory compliance and filed a complaint against the manager for retaliation. next meeting I had was with that manager. Filed a complaint with Human Resources and met with the CEO and filed a complaint. No investigation was done. No action was taken. When I was finally suspended for stating I was reporting the unsafe conditions this same manager is the only name who appears on the suspension.

    Not making this up. So don’t believe for a minute that there is a culture of safety or accountability all the up the chain of command. The joint commission does nothing because they get money from the hospital. The State is bogged down in red tape and incompetence, the ANCC couldn’t care less since they get money from the hospital and the state and local government couldn’t care less about the unsafe practices or nurses being thrown under the bus for reporting unsafe actions. So don’t fool yourselves people. There is no REAL investment in giving nurses or anyone else a voice. The system is set up for the appearance of accountability and safety not to actual provide those things.

    If I decide to stay in this field I will look the other way like everyone else from this day forward as I would recommend to anyone else. You will NOT be supported. The only goal is to protect the status quo. There is no investment in actually providing safe conditions. If there were nursing ratios would be the law of the land, not just one state that doesn’t enforce them.

  3. Thank-you for this article. Not that this has made me feel better as a professional but certainly solidifies my thoughts about injustices sought towards whistleblowers. What are your recommendations for those readers as far as recommending legal advice or links for legal advice where one can consult with attorneys specialized in employment law specifically to the medical field.

    thank-you in advance,
    ED

  4. I reported a coworker (hospital social worker) for reading the medical chart of a child, solely for the purpose of gossiping about the child’s obesity. My harassment was coordinated by the Director of our department (Case Management/Utilization Review) and culminated in me receiving the head of a cat in the mail, with at least 6 cats in the feral colony I care for being killed/dismembered in the last year and a half. I quit my job when I received the head of the cat, as I also had multiple break-ins to my condo, a nail in my tire, “air freshener” to which I was highly allergic sprayed repeatedly in my workspace “but nobody knows where it’s coming from,” my electronics hacked, etc. I am now blacklisted from employment (I can’t even obtain a volunteer job.) Would I be a whistleblower, knowing then what I know now? Yes, in a heartbeat. Our patients deserve better. There is so much more going on at that hospital than I ever suspected! Kathleen Maynard, RN

  5. 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

  6. 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.

  7. 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.

  8. 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

  9. 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!

  10. 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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