1 Truth Telling… Blow the Whistle“A man does what he must – in spite of personal consequences, in spite of obstacles and dangers and pressures – and that is the basis of all human morality.” - Sir Winston Churchill Truth Telling… Blow the Whistle A man does what he must - in spite of personal consequences, in spite of obstacles and dangers and pressures - and that is the basis of all human morality. Sir Winston Churchill Our Presentation today is on Truth Telling and whether or not to blow the whistle. NURS 350: Professional Development II Presented by: Jennie Hoover, Andrew Rhodes, Laura Schwartzer, Amanda Sikora, and Lindsay Snyder

2 What is a Whistleblower?We have a quick video for you from a law office perspective of what a whistleblower is. So take a look. Did you want me to cut this down at all? -Laura

3 Definition Whistleblowing is defined as “the disclosure by organization members (former or current) of illegal, immoral, or illegitimate practices under the control of their employers, to persons or organizations that may be able to effect their action.” (Near & Miceli, 1985, p. 4) Read definition

4 Whistleblowing The term “Whistleblower” comes from the action the referee uses in sports to indicate when a foul is committed. In the 1970s Ralph Nadar coined the phrase to avoid negative connotations associated with words like informant or snitch. The term “Whistleblower” comes from the action the referee uses in sports to indicate when a foul is committed. It has also been referenced to that of a police officer blowing a whistle when they see a crime being committed and want the criminal to stop...he blows the whistle and calls them out. In the 1970s Ralph Nadar coined the phrase to avoid negative connotations associated with words like informant or snitch. Ralph Nadar actually wrote an entire book about whistleblowing and the punishments of those who blow the whistle. This book gives several examples of people who have blown the whistle on different organizations and their stories. Most of them did not have positive outcomes or experiences. The book takes the standpoint that whistleblowing can be dangerous and costly but it is still the ethical thing to do. If you are going to blow the whistle you should not be stupid or naive about it but you should follow a set of rules that are outlined in the book. This book was written in the 1970s and has some accuracy but some of the laws and protection provisions for whistleblowing have since changed.

5 Four Types of WhistleblowingThe Government Accountability Project lists four ways to blow the whistle: Reporting wrongdoing or a violation of the law to the proper authorities, such as a supervisor, a hotline or an Inspector General Refusing to participate in workplace wrongdoing Testifying in a legal proceeding Leaking evidence of wrongdoing to the media (Nadler, Schulman, 2006)

6 Significance to Practice & Society94% of whistleblowers and 92% of non-whistleblowers reported suffering from stress related emotional problems. (McDonald, Ahern, 2002) According to an article in the Journal of psychosocial nursing and mental health services 94% of Whistleblowers and 92% of non whistleblowers suffer from stress related emotional problems. These problems include physical problems related to energy, sleep disturbances, headaches, smoking increase, weight loss or gain, digestive system problems, cardiac problems, just to name a few.

7 Applying the Ethical Decision Making Model to A Case StudyVA Whistleblower Valerie Riviello Ethical Decision Making Model: Articulate the Problem Gather Data Explore Strategies Implement the Strategy Evaluate Outcomes

8 Case Study

9 Ethical Decision Making Model: Articulate the ProblemCurrent Situation: An argumentative female sexual assault victim had been placed in restraints for 7 hours After assessing the patient, Valerie felt the restraints were no longer necessary Valerie advocated for the patient The physician disagreed and insisted that the patient was being “combative” Ideal Situation: Collaborative nurse-physician relationship Agreement upon the most appropriate action based on good clinical judgment Use of evidence-based practices when utilizing restraints Current Situation: Valerie Riviello was a nurse manager on the inpatient psych unit at the VA in Albany, NY. She had been employed there for 28 years. During her shift, a female sexual assault victim had been placed in restraints for 7 hours. Valerie removed the restraints from the patient and, after her assessment, felt that the restraints were no longer necessary for that patient so she did not place the patient back in the restraints. The physician disagreed and felt that the patient was being “combative”. Additional case study background info: •Riviello said it was her job as a nurse to continually evaluate the patient and get her out of restraints as soon as reasonable. •VA policy calls for keeping people in the “least restrictive environment”. •Patients should only be kept in restraints if they are an imminent threat to themselves or others. •2 years prior to this incident, many physician and administrative changes took place in the hospital. •In the 2 years after this change, restraint hours increased from 20 to 150 hours annually. •If a patient is removed from restraints, then needs to be placed back in the restraints, the physician needs to come to the facility and re-assess the patient within 1 hour of restraint application. •Valerie believes that physicians want the patients kept in restraints because it is inconvenient for them to come in to re-assess the patient. References: https://www.youtube.com/watch?v=M_r16deYrbY

10 Ethical Decision Making Model: 2. Gather DataKey Participants: Valerie and the VA administrators The patient, the physician, Valerie’s coworkers, … Conflicting Obligations: Loyalty to the patient vs. duty to the institution How is This an Ethical Dilemma? “A problem that requires a choice between two options that are equally unfavorable and mutually exclusive” Involves conflicting moral claims, obligations, or principles Ethical Principles Involved: Autonomy, non-maleficence, veracity, fidelity, justice, … An Example of Moral Distress… “The reaction to a situation in which there are moral problems that seem to have clear solutions, yet one is unable to follow one’s moral beliefs because of external restraints”

11 Ethical Decision Making Model: 3. Explore StrategiesShould Valerie Blow the Whistle? What to Consider: Pros (Benefits) and Cons (Risks) of Blowing the Whistle Professional, Institutional, and Legal Considerations Literature Review

12 Literature Review 1 Greene & Kantambu-LattingIdentified characteristics of whistleblowers Altruistically motivated and intend for their actions to be beneficial to those being wronged Utilitarian possess a high level of moral development and are driven by their sense of integrity and social responsibility to speak out Allow their own attitudes and beliefs to guide them and “won’t lie to cover up”

13 Literature Review 1 (Cont.)Greene & Kantambu-Latting Identified characteristics of whistleblowers Seem uninterested in tailoring their behavior to conform to particular situations and behave consistently across situation Often are well-educated, hold managerial or professional positions, and keep well-documented records of what they perceive to be abuse and waste

14 Literature Review 2 Herdegen-RohrANA code of ethics does not specifically state which values should be upheld ANA Code for Nurses reads “Nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.” was fired from her hospital job Freedom for nurses to report a physicians unsafe medical practices is non-negotiable

15 Literature Review 2 (Cont.)Herdegen-Rohr Winkler County Nurse Trail in TX Charged with misuse of official information Texas Nurse Association Justice prevailed for Anne Mitchell. “If anything was to be gained from the absurdity of this criminal trial, it is the reaffirmation that a nurse’s duty to advocate for the health and safety of patients supersedes all else” was fired from her hospital job Freedom for nurses to report a physicians unsafe medical practices is non-negotiable

16 Pros Boosts credibilityCo-workers value your opinion Know you are willing to do what it takes to make sure patients are safe Eradication of wrong doings/Improves quality of care Patients will no longer be subjected to possible dangerous or adverse practices

17 Pros Promotes change Performed ethical duty Trust in legal systemBrings harmful and detrimental practices into the light so they can be addressed and changed Performed ethical duty Trust in legal system Precedence shown in previous legal cases Support from others In one aspect of our literature review

18 Cons Leaving and returning to workSome institutions require the person to leave while the investigation is ongoing After the period of leave there was still hostility Matters that required the leave of absence are not often resolved before returning to work Mistrust of co-workers upon return

19 Cons Spoiled professional relationships Bullying and exclusionColleagues not understanding why you become whistleblowers Treated with suspicion Colleagues acted as though they had to watch their backs due to fear of having something said about them Bullying and exclusion Open hostility over prolonged periods

20 Cons Breakdown of trust Between medical providers and nursesDon’t treat each other as professionals Lack of trust and confidence in their medical decision making Anxiety and nervousness around doctors especially if they were the cause of the whistleblower’s complaint

21 Case Study (Cont.)

22 Ethical Decision Making Model: 4. Implement the StrategyValerie reported the incident to her supervisor who said “not to worry about it” and subsequently reported the incident to the patient safety officer.

23 Case Study (Cont.)

24 Ethical Decision Making Model: 5. Evaluate OutcomesAfter the physician complained, Riviello was reassigned to a “special project” to develop a nurse educator program. Her title of “nurse manager” was removed. She took a $6,000 cut in pay. She spent 8 hours per day at a desk and no longer had contact with patients.

25 Case Study (Cont.) Riviello filed two claims with the Office of Special Counsel: Patient abuse Whistleblowing These claims put disciplinary action on hold. The investigation is still ongoing.

26 Whistleblowing: What to Consider...How serious is the problem? Is it life threatening? Is your nursing license in jeopardy if you do not report? What type of problem is this? Is the law being violated? What evidence do you have about the problem? What are the potential costs of blowing the whistle?

27 Whistleblowing: Steps to Take...Determine if you are ready, both personally and professionally, to take action. Consult a lawyer. Contact your state nurse’s association for information about whistleblower legislation in your state. Use a journal to document instances. Speak only the truth, state only the facts, and follow the institution’s chain of command before contacting an outside agency.

28 Post-Test Question #1 An RN has just gotten off of her shift and she sees another RN from her unit walking through the parking lot. They stop and talk and the outgoing RN notices that the incoming RN’s breath smells of alcohol. What should the outgoing RN do? Do nothing to avoid being called a “whistleblower” Ask the oncoming RN if she wants to hit up happy hour after her shift Give the oncoming RN a breath mint so no one suspects anything Immediately report the incident to their supervisor

29 Post-Test Question #2 A nurse is thinking about blowing the whistle. Which of the following is NOT a step that the nurse should take? Blow the whistle only if the nurse knows he/she will win the lawsuit Decide if he/she is personally and professionally ready to take action Consult a lawyer Contact the state nurse’s association to determine the status of whistleblower legislation and obtain guidance in the whistleblowing process

30 Post-Test Question #3 A nurse is unsure whether or not he wants to blow the whistle. Which of the following is a reason why he might refrain from blowing the whistle? He wants to promote change within the hospital system He wants to create a safer environment for his patients He fears retaliation from his institution He knows there is no legal protection for whistleblowers

31 Post-Test Question #4 To ensure that her voice is heard, the nurse should share her personal feelings and opinions in addition to facts when whistleblowing. True False

32 References Burkhardt, M. A., & Nathaniel, A. K. (2007). Ethics & issues in contemporary nursing (3rd ed.). Clifton Park, NY: Cengage Learning. CBS6 Albany News. (2014, August 7). Albany VA nurse alleges safety concerns [Video recording]. Retrieved from https://www.youtube.com/watch?v=9uTAguAo3g0 Grant & Eisenhofer False Claims Litigation Group (2011, December 2). What is a whistleblower? [Video recording]. Retrieved from https://www.youtube.com/v/EDr_yqk9wAk Greene, A. D., & Kantambu-Latting, J. (2004). Whistle-blowing as a form of advocacy: Guidelines for the practitioner and organization. Social Work, 49(2), Retrieved from docview/ ?accountid=13158 Hannigan, N. S. (2006). Blowing the whistle on healthcare fraud: Should I? Journal of the American Academy of Nurse Practitioners, 18(11), doi: /j x Herdegen-Rohr, L. (2008). To blow the whistle… or not. Virginia Nurses Today, 18(2), 6. Retrieved from Jackson, D., Peters, K., Andrew, S., Edenborough, M., Halcomb, E., Luck, L., …Wilkes, L. (2010). Trial and retribution: A qualitative study of whistleblowing and workplace relationships in nursing. Contemporary Nurse: A Journal for the Australian Nursing Profession, 36(1-2), doi: /conu Kao, L. (2001). Student’s corner. Nurses and whistleblowing: Is it worth it? The Maryland Nurse 2(3), Retrieved from cin20&AN= &site=nrc-live

33 References Katz, Marshall, & Banks, LLP. (2015). Dodd-Frank Act whistleblower incentives. Retrieved from and-whistleblower-protections-for-financial-services-employees/ Klimas, J. (2014, June 29). 50 VA hospital workers claim retaliation for blowing whistle on the horrors they saw. The Washington Times. Retrieved from 50-va-hospital-workers-claim-retaliation-for-blowi/?page=all McDonald, S., & Ahern, K. (2002). Physical and emotional effects of whistle blowing. Journal of Psychosocial Nursing & Mental Health Services, 40(1), Retrieved from ?accountid=13158 Nader, R., Petkas, P. J., & Blackwell, K. (1972). Whistle blowing: The report of the Conference on Professional Responsibility. New York: Grossman. Nadler, J., & Schulman, M. (2006). Whistle blowing in the public sector. Retrieved from Near, J. P., & Miceli, M. P. (1985). Organizational dissidence: The case of whistle-blowing. Journal of Business Ethics, 4(1), Retrieved from accountid=13158 Philipsen, N. C., & Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practitioners, 7(9),