Should Nurses Blow the Whistle or Just Keep Quiet?

Carolyn Buppert, MSN, JD


June 24, 2014

In This Article

So, Don't Report?

Am I recommending that nurses adopt the "see nothing, hear nothing, speak nothing" attitude? No. I am saying that under current law, it is safer for a nurse not to report than to report. That surprises me, and it may be right- or wrong-minded, but it's the way it is.

To argue the hospital or facility's side, a facility can't have every nurse they fire come back and say he or she was fired because the nurse complained about a patient safety issue. Hospitals will lobby legislators for laws that protect the hospital. And a hospital is going to defend itself against allegations of breach of patient safety, even if that means firing a nurse and discrediting the nurse. In all fairness, with every safety issue that a nurse might identify, there usually is an opposing argument that it isn't a safety issue or is a necessary risk. And some nurses are vulnerable to being discredited because they don't have spotless records.

My purpose in this article is to inform nurses of the things they must do to protect themselves, before complaining, both within their company and to outside agencies.

First, check your state's Nurse Practice Act for any law on reporting patient safety issues. Also check the state's Board of Nursing Website for any direction on this.

Then, look at the whistleblower laws for your state, if there are any. If you decide to blow the whistle, follow the dictates of the law, exactly. Gather your evidence. Keep detailed records.

I urge nurses to conduct a safety analysis on themselves before blowing the whistle on safety problems in the workplace, and even before complaining. I don't like to see nurses get nowhere with their patient safety concerns and also suffer personal setbacks. It is smart to consult an attorney who is experienced in whistleblower cases before complaining. (I am not an expert on whistleblower cases.) It may be best to line up your next job before complaining to higher-ups.

Think before you act. Spend some time thinking about how to raise the issue, and with whom to raise it. Read some of the many books about the ins and outs of workplace communication. Watch and listen, and observe individuals in your workplace who seem skilled at working with others to effect change. It may be best to frame complaints as volunteering to help solve a problem. I don't know of a "charm school" for nurses, but if there is one, I would enroll and would encourage others to do so.

Consider your risk. Be sure that your own practice is in order. If you complain about a policy or practice at your facility and someone wants to get back at you, what would they say? What are your vulnerabilities?

Assess the gravity of the problem. If the problem you have identified is putting a patient or employee at imminent and serious risk, you may need to put all thoughts of yourself aside and report it. If the risk isn't so serious or isn't so imminent, then perhaps volunteering to problem-solve is in order.

Assess the administration and your supervisors. Is there someone you can talk to in confidence whom you trust? Is there a financial reason why the problem is present? If so, be prepared for a struggle, unless you can suggest a legal, more cost-effective alternative.

Taking a big-picture view, I recommend that nurses, throughout their careers, safeguard their ability to find another job, if they need to. Cultivate people who will give you positive references throughout your career, and do the same for them. This means treating colleagues professionally, not sharing personal dramas at work, keeping up with the latest developments in the field, handling disagreements in a way that doesn't leave others feeling bruised, and going up the chain of command when necessary. Conduct periodic self-assessments to identify your own vulnerabilities, and make a plan to minimize them.

The bottom line is: It's always better to prevent problems, in law as well as healthcare.


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