Should nurses blow the whistle?

More and more nurses are speaking out about unsafe healthcare practices despite the potential risks to their careers.

Should nurses blow the whistle?

With the various corporate scandals of recent years, we've seen plenty of headlines about whistleblowers in the business world. Now, the nursing industry is bringing us its own front-page cases that could see more medical watchdogs come to the fore.

Legal experts say the number of whistleblower cases in the healthcare field has been on the rise since 1999, when the Institute of Medicine of the National Academies reported that medical errors are the nation's leading cause of death and injury.

"Nurses are becoming more vocal about concerns that healthcare organizations are using unlicensed assistant personnel and not employing enough nurses on a shift," says attorney LaTonia Denise Wright, RN, of the Healthcare Risk Aversion Group in Cincinnati. "This is a real concern, because these practices lead to medical errors."

Nurses Speak Out

Nurses are also blowing the whistle on questionable practices. Cindy Moore, RN, got vocal about the way Florida's Duval County Health Department diagnosed people with sexually transmitted diseases. She complained that health officials were not notifying infected people in a timely manner and was subsequently fired for her accusations.

Likewise, Stephanie Hohman, RN, blew the whistle on the University of Texas Medical Branch (UTMB) emergency room when she became concerned about patients' rights and possible abuse. Hohman was also fired. And psychiatric nurse Stacie Neldaughter, RN, was fired after reporting alleged misuse of shock therapy treatment at a Wisconsin hospital.

Despite the career risks, healthcare attorneys say nurses have a responsibility to blow the whistle on such activity.

"Everyone has a moral obligation to blow the whistle on unsafe practices," says attorney Joanne Sheehan of Friedman, Newman, Levy, Sheehan and Carolan in Fairfield, Connecticut. "A nurse may be disciplined by the state licensing board for participating in unsafe practices that can harm patients."

Employer Retaliation

While this is certainly true, Wright advises nurses to understand the potential backlash before speaking out.

"You could be terminated, and even if you decide to file suit, it could be years before you get your job back -- if you get your job back," she says. "The statutes are normally very narrowly worded, and they vary from state to state. It's not a decision that you should make lightly."

More than 50 percent of workers who flagged incidents of unlawful conduct in 2002 were fired, according to a study by the National Whistleblower Center, a nonprofit educational advocacy organization dedicated to supporting employee whistleblowers. Many others said they faced unfair discipline.

The protections are limited even where a whistleblower statute is applicable, since statutes of limitation often force employees to learn of their rights and file a complaint within 30 days of being fired or disciplined.

Steve Lee, RN, says his career nose-dived after he blew the whistle on alleged unsafe practices at a Texas hospital. He launched Nurseprotect, a grassroots effort to support nurses who face retaliation for whistleblowing.

"Don't blow the whistle unless you are willing to give up your career for it," says Lee. "Whistleblower laws are symbolic and largely ineffective."

While many agree with Lee, more nurses are finding protections and remedies under new state whistleblower laws, say experts, especially since the Health Insurance Portability and Accountability Act came on the scene with federal provisions built in.

Mixed Outcomes

In August 2003, a jury decided that the Duval County Health Department fired Moore in retaliation for making accusations about unsafe departmental procedures. The two sides settled and Moore got her job back.

Hohman won her four-year battle against UTMB when a jury ruled that the facility retaliated against her for whistleblowing. The jury also awarded her wages and damages totaling $500,000.

But in Neldaughter's case, even though the Wisconsin Coalition for Advocacy found that her hospital's procedures for obtaining informed consent for shock therapy were coercive, she did not get her job back after taking court action.

"If you are thinking about blowing the whistle, then you need to make sure you are protected by whistleblower statutes," advises Wright. "If not, then address it through your management or through your union. Court battles could take years to resolve and winning is not automatic."