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Blowing the whistle
What leads a nurse to make the call?
By Sonja Cleary
A number of human factors influence the way managers within organisations address patient safety concerns. One is wilful blindness.
The phenomenon of wilful blindness has been described by Heffernan( 2011, p. 3) as“ shirking” the“ opportunity for knowledge, and a responsibility to be informed”. When faced with unsettling reports about substandard care and / or patient safety breaches, some health service managers prefer ignorance to knowledge.
The human tendency to favour positive news and avoid conflict is powerful. Managers deal with these reports by filtering and editing the information received, preferring that which supports a previously held belief, while conveniently filtering out that which unsettles( Heffernan, 2011).
This human reaction to avoid reports of unprofessional and unethical conduct that results in adverse clinical events can lead to whistleblowing.
In Australia, there have been two high-profile cases where wilful blindness
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contributed to nurse whistleblowing: Bundaberg Base Hospital in Queensland and Macarthur Health Service in NSW( Davies, 2005; HCCC, 2003).
Both whistleblowing incidents resulted in widespread media attention and the establishment of commissions of inquiry.
The proceedings from these cases provided a unique opportunity to examine questions related to factors influencing whistleblowing and were the focus of a PhD study( Cleary, 2014).
In these cases, nurses who reported patient safety concerns were hampered by the misguided belief( false consciousness) that organisational processes would be‘ on their side’ and action would be taken to address their concerns.
The nurses mistakenly believed that reporting through internal channels would result in censure of individual practitioners and / or a change in processes that would mitigate the risks of patient injury or death.
Instead, the nurses experienced retaliatory responses to their internal reporting which contributed to a“ social crisis” and the rare act of whistleblowing( Cleary & Duke, 2017).
Examination of the two cases uncovered the conditions under which nurses who reported failure felt morally compelled to report outside their organisations.
This was particularly so when the observational gaze and consequent sanctions were turned back upon the whistleblowing nurses, rather than upon the inadequacies and transgressions that they had uncovered.
Retaliation against whistleblowers has been well documented and involves managers who attempt to deal with the disclosure by discrediting the whistleblower, rather than dealing with the information disclosed( Attree, 2007; Jackson et al, 2014; Jackson et al, 2010).
When the attention is focused more on the messenger than the message, the ability to capture and learn from the concerns raised is hampered.
Whistleblowers report incompetent, unethical or illegal situations in the workplace to an authority who has the power to stop the wrong( McDonald & Ahern, 2002). In healthcare, this authority is someone outside the healthcare organisation, as internal reporting is not considered whistleblowing but an essential component of clinical governance and the first essential step in the identification of systemic gaps and weaknesses to improve patient safety( World Health Organization, 2005).
However, in order to prevent external reporting – that is, whistleblowing – a feedback loop that provides constructive, responsive communication back to those who report is essential. Repeated inaction, or a culture of blame and retaliation, will contribute to the difficult decision to either remain silent or escalate the concern, first to a higher authority within the organisation, and, if unresolved, outside the organisation.
Researchers have repeatedly found that internal inaction and a lower level of trust in, and support from, management can be a significant motivating factor to report to an external body that may be able to affect action( Hunt, 1995; Miceli, Near & Dworkin, 2008; Wortley,