OPINION

'Treat nurses and doctors the same when it comes to whistleblowing'

23 August, 2011

Senior lecturer Bill Whitehead questions why regulators have been given different advice on blowing the whistle on poor care

In light of the events at Winterbourne View care home and Mid Staffordshire Trust, it is hardly surprising that the recent Commons health committee (2011a) annual report on the Nursing and Midwifery Council recommended that: “The NMC needs to send a clear signal to nurses and midwives that they are at as much risk of being investigated by their regulator for failing to report concerns about a fellow registrant as they are from poor practice on their own part.”

Similar recommendations were made for doctors, however, the committee softened its approach in the report on the General Medical Council by noting that: “Doctors and other practitioners who have raised concerns [about] other staff have sometimes been subject to suspension, dismissal or other sanctions. The committee therefore intends to examine this issue in more detail in due course” (Commons health committee, 2011b).

Is this lack of consistency just an oversight on the part of the health committee or are we again facing the familiar oppression of nurses when compared with medical staff?

“Clearly, if doctors are subject to unfair discrimination when they blow the whistle this is equally likely to happen to nurses”

Clearly, if doctors are subject to unfair discrimination when they blow the whistle this is equally likely to happen to nurses. A recent article in The Independent highlighted that a range of NHS whistleblowers had been “hung out to dry”, including radiographers, nurses, senior managers and medical staff (Lakhani, 2011).

The committee is right to be careful with their advice to the medical regulator and they should be equally considerate with advice to the NMC regarding potential reprisals against nurses.

Our research, which was conducted last year into nurses’ concerns about the “risk of reprisal” when blowing the whistle on poor care, highlighted this issue. We found in that: “Reprisal for whistleblowing remains a major concern for nurses. Future research should concentrate on developing an environment where nurses feel able to report incidents safely. Confidentiality should be given priority, thereby reducing the fear of reprisal or future repercussions” (Whitehead and Barker, 2010).

This would go a long way towards making nurses feel more confident to speak up, facilitating a more effective and safe healthcare environment for patients and healthcare professionals alike.

I’m not saying there is no room for consequences when nurses fail in their duty to protect patients from harm. However, if this is pursued further, it should be the case for all health professionals, including doctors, and it is unfair for any regulator to knowingly put their registrants into a dilemma where they are likely to be punished by employers for upholding their professional standards. Before making nurses accountable for failing to report bad practice, we must ensure that whistleblowers are supported by both their regulator and the NHS.

Bill Whitehead is senior lecturer in nursing and healthcare practice at the University of Derby

References
House of Commons health committee (2011a) Annual Accountability Hearing with the Nursing and Midwifery Council: Seventh Report of Session 2010-12. London: Stationery Office.
House of Commons health committee (2011b) Annual Accountability Hearing with the General Medical Council: Eighth Report of Session 2010-12. London: Stationery Office
Lakhani N (2011) Hung out to dry: scandal of the abandoned NHS whistleblowers. The Independent, 4 July 2011
Whitehead B, Barker D (2010) Does the risk of reprisal prevent nurses in the NHS from blowing the whistle on bad practice? Nursing Times; 106: 43, 12-15.

Readers' comments (13)

Anonymous | 23-Aug-2011 5:23 pm
I happen to know for a fact 11 consultants at Stafford are under investigation by the GMC for failing to whistleblow.
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Anonymous | 24-Aug-2011 0:14 am
Damned if you do and damned if you don't
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mike | 24-Aug-2011 11:49 pm
It's a wonder any of us bothers doing the job at all!
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Anonymous | 25-Aug-2011 4:09 pm
I was involved in raising concerns about two doctors with the GMC. They made me spend literally weeks of my time giving statements and preparing notes and then both doctors were allowed to retire without the cases being heard.

These cases were covered in the nursing times 5 November 2010. "Registration system for doctors and nurses inequitable" .

The cases I reported did not happen in isolation - if the allegations which the GMC conspired not to hear had been upheld, then there were potentially serious failures of governance. All this was swept under the carpet.

I have seen first hand what happens to NHS whistleblowers how despite the Public Interest Disclosure Act 1998, the most likely outcome is having to leave a job or giving up career prospects.

Whilst the medical establishment protects its own - which it undoubtedly does, it is unjust and unfair for the Nursing and Midwifery Council to give this advice to nurses. Those public spirited and courageous enough to raise concerns will soon learn to their cost how things really work.
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Anonymous | 25-Aug-2011 4:32 pm
it seems that nurses need to settle down and accept their lot and just do the job they trained for without getting mixed up in politics or with the medical profession. our path has been cut out for us and will not change and we need to accept that and follow it quietly for the benefit of all concerned and especially the patients!
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Anonymous | 25-Aug-2011 4:33 pm
there is little point in putting up this constant fight which is leading nowhere.
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Tanya Little | 26-Aug-2011 9:03 am
I find it disturbing that practicing professionals continue to place possible personal discomfort ahead of the protection of vulnerable adults.
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mike | 26-Aug-2011 4:51 pm
Tanya you have missed the point entirely, it is not about comfort! It is about still being able to BE a practicing professional after speaking up for patients!
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DH Agent - as if ! | 29-Aug-2011 11:14 am
Tanya Little | 26-Aug-2011 9:03 am
mike | 26-Aug-2011 4:51 pm

You are both right: patients clearly expect bad behaviour to be addressed, but it is also very clear that reporting bad behaviour often leads to unacceptable consequences for the person who reports it.

Everyone KNOWS this - these endless reports, seem to be pointless, as others have commented.

But I suspect there is an element here of 'nurses are supposed to do what they are told' and 'doctors make the decisions' - this is, I am told, out-of-date as an attitude, and no longer present in the NHS. But it seems to be present here, because nurses are apparently being given something close to an instruction, with much less 'you should consider the consequences of obeying it' than appears in the guidance for doctors. However, it is almost invariably true, that the guidance for doctors stresses the complications of decision-making, while the guidance for nurses in similar areas seems to highlight 'answers' (and not the subtler issues) - there is, whatever is claimed to the contrary, a 'sort of assumption' in guidance, that within the NHS 'the doctors do more thinking'.

That is wrong - everyone should think ! - but I can see, that within organisations it leads to chaos if people are rowing in different directions, which is probably where this comes from (and it does indeed seem 'patronising' - mind you, the stuff for patients seems even more patronising !).
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Anonymous | 29-Aug-2011 11:34 am
Professor M. Stone pronouncing his judgement yet again but not to be taken seriously. thought you had gone on holiday!
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bill whitehead | 30-Aug-2011 12:21 pm
The point of all this is to improve patient care. If staff feel supported in blowing the whistle on unsafe care, this goal will be easier to achieve.
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DH Agent - as if ! | 3-Sep-2011 11:53 am
Anonymous | 29-Aug-2011 11:34 am

No, not on holiday, but spending my limited online time exchanging e-mails with other, more useful than you, parties, such as the RCGP.

Do you have a problem with reading ? I have told you that I have a doctorate, so Dr Stone works for me if you insist on using irrelevant titles - how come you seem happy with Nurse Stone (inaccurate) or Professor Stone (similarly inaccurate) ? Is this because you are attached to flawed beliefs ?

Bill Whitehead has got this right, and expressed the point clearly: the idea is to improve patient care, and treating 'whistle-blowers' in a way which inhibits staff from raising valid concerns is therefore 'bad': not that I would expect you (anonymous) to grasp that point, based on the lack of logic in your posts.

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Anonymous | 3-Sep-2011 12:56 pm
RCGP.

it would be helpful if one could even understand your posts without having to google all your abbreviations each time. i suppose you think it big to talk in riddles all the time so that others do not understand.
using simple english is a sign of good education!

I am more attached to your ideas of self-importance!

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