Hollywood has tapped into the whistleblower storyline on numerous occasions. Who could forget The Insider with Russell Crowe, the star-studded cast of The Post, or Erin Brockovich? While these examples are based on true events, the cinematic application provides a sense of intrigue, drama and deserved retribution.
In real life, whistleblowing is a very serious path to venture down. In healthcare, it often deals with "life or death" scenarios.
What Does "Whistleblowing" Actually Mean?
The National Whistleblower Center (NWC) defines a whistleblower, at the simplest level, as "someone who reports waste, fraud, abuse, corruption, or dangers to public health and safety to someone who is in the position to rectify the wrongdoing." In many cases, the individual reporting the wrongdoing works within the organization — but that is not required. The key characteristic is that the whistleblower discloses information that otherwise would remain unknown.
Medscape further defines whistleblowing in nursing: "The action taken by a nurse who goes outside the organization for the public's best interest, when [the organization] is unresponsive to reporting the danger through the organization's proper channels."
Whistleblowing & Patient Safety
Regarding patient safety, the National Institutes of Health (NIH) and its sub-division, National Center for Biotechnology Information (NCBI), outline four common situations that serve as the underlying foundation of whistleblowing within nursing:
- Reporting on the systemic failure to provide adequate nursing resources
- Requesting review of the clinical outcomes of a whole department
- Reviewing poor clinical outcomes involving a single individual over a period of time
- Anticipating and reporting a single catastrophic event
These may overlap in certain scenarios. For example, a lack of resources would almost certainly lead to poor clinical outcomes.
More specifically, take one publicized case in which registered nurses Stephanie Hohman and Lisa Lippert were employed by the University of Texas Medical Branch emergency room. They began to notice a pattern after Dr. William Mileski was hired to improve the quality of procedures performed in the ER. Patients were increasingly declared "trauma evaluation" cases and subsequently forced to undergo painful, unwanted and unnecessary procedures.
This is just one example of a threat to patient well-being. Ultimately, any time a process or procedure is seen as a threat to a patient's health and safety gives cause for employees to at least begin the internal reporting protocol.
Whistleblowing & Fraud
Whistleblowing is not exclusive to patient care. In fact, many cases involve fraud, including:
- "Up-coding" of services or improper use of laboratory tests to increase payments
- Billing for doctors' services when those doctors did not perform the procedures
- Creating claims for services (e.g., home health visits) that never occurred
While not necessarily responsible for putting patients at risk, these examples are important to report nonetheless.
What Consequences Might Nurses Face?
Unfortunately, even the best intentions can put nurses in a very precarious situation. In Hohman and Lippert's case, both were subject to a barrage of harassment, which eventually led to their resignation. Nurses are routinely subject to retaliation from their superiors. This became even more prevalent during the pandemic when the incidence of retaliation cases against employees spiked as healthcare workers voiced concerns about workplace safety.
To mitigate the negative consequences of whistleblowing, nurses should follow certain steps — from the time they witness the wrongdoing until they report to an external organization. Here are some key points to consider:
1) Documentation is everything. Record all interactions related to the whistleblowing situation — but make sure your notes are objective. Keep copies for your personal file, ideally in both digital and physical form.
2) Enlist the counsel of a trusted individual (preferably someone outside of the situation) to optimize the objectiveness of your reporting.
3) Turn to your state nursing association, or an attorney, if you are able, to get assistance in documenting your concerns.
4) "Blowing" the whistle involves reporting your concerns to the national and/or state agency tasked with regulating the organization for which you work. This is important because private groups (e.g., The Joint Commission, National Committee for Quality Assurance) do not provide protection.
5) If criminal activity is involved, you should also bring your complaint to law enforcement agencies.
6) Follow the "chain of command" as much as you are able. Inability to document internal attempts of broaching the problem may work against you. That said, the threat to patient safety might be so immediate that it cannot wait.
One critical aspect to remember is that you are not protected from retaliation by your employer until you blow the whistle — reinforcing the value of seeking aid from outside resources while navigating precursory actions.
A Heavy, But Often Necessary, Weight to Bear
Critics of whistleblowers paint them as "troublemakers." Yet, nurses who bring serious issues to light can literally save lives. The more nurses know about the ramifications and processes involved in whistleblowing, the more prepared they'll be to bear this weight should it become necessary. This knowledge is just as important as the clinical skills nurses develop throughout their training and career.
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