By Tom Clegg via Nurse.com 

Whistleblowers fear retaliation and the chance that nothing will be done with the information they've provided. An organization's culture should make it's employees feel safe when reporting something. But, there are still times when Nurses refrain from whistleblowing because their work culture has encouraged them not to do so. This delicate area of policy and ethics is a work in progress. As a healthcare worker, what steps do you think would help the process of reporting questionable practices?

A 2015 revision to the ANA Code of Ethics strengthened the wording of its policy that “nurses have a responsibility to assist whistleblowers who identify potentially questionable practices.” Further, New Jersey’s Conscientious Employee Protection Act protects those who report such practices from retribution.

That’s all well and good, but as nurse leaders stressed at the Organization of Nurse Executives New Jersey Research Day Conference in June in Princeton, the best way to ensure nurses and other healthcare workers feel confident they can blow the whistle is by creating the proper work environment.

That was the conclusion of a research committee study at ONE NJ to replicate work done by University of Nevada researcher Lisa Black in 2011, which identified workplace factors that influence nurses’ willingness to report.

“If you have a culture in your organization where people felt safe to report things, they would report it and have less fear of retaliation,” said Patricia Steingall, MS, RN, NE-BC, vice president of patient care services and CNO of Hunterdon Medical Center in Flemington, N.J., and president of ONE NJ.

Steingall said the biggest fears of those considering blowing the whistle are retaliation and that nothing will be done with the information provided. Nurse leaders can alleviate some of those concerns by establishing a culture of openness and by educating “staff on what are the policies about whistleblowing, assure them that there are protections in place for them and let them know what those protections are,” Steingall said.

She also stressed the importance of being sure of the facts, a point echoed by Lucille Joel, EdD, RN, APN, FAAN, Distinguished Professor, Rutgers University School of Nursing, Newark. Joel, who presented “Speaking Up: A Dimension of Professional Practice in an Ethical Context” at the conference, added blowing the whistle never is easy and always has some ambiguity.

“In regards to whistleblowing, it’s an ethical decision that runs contrary to an employer,” Joel said. “You have to be sure of the data. You have to be relatively sure, although you can’t be absolutely positive, that whistleblowing or calling governmental attention to a situation is going to be better for the client than allowing the incident to continue uncontested.”

Attorney and nurse Kathleen Gialanella, RN, JD, LLM, Esq., spoke at the conference on the legal and ethical considerations of blowing the whistle. She encourages anyone considering reporting a potentially unsafe practice to seek guidance, which may include legal counsel. She also said that although certain situations allow whistleblowers to report an incident directly to an outside body, “normally the process needs to unfold within the organization, and the organization needs to be given an opportunity to correct whatever concern the employee has.”

Gialanella said progress has been made by healthcare organizations in making staff feel more comfortable reporting incidents, but not everyone is on board.

“Some organizations are ahead of others in adopting that kind of culture,” she said. “There are many situations where nurses still are not comfortable bringing a concern to the attention of their supervisor, and it’s because of a culture (in which) they’re not really encouraged to do so.”

Tom Clegg is a freelance writer.