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Are nurses who fail to blow the whistle on bad practice protecting themselves?

  • 6 Comments

Nigel Jopson and Ian Pierce-Hayes discuss the issues surrounding whistleblowing.

Yes

Nigel Jopson

It is never easy to blow the whistle but, at times, it is the only way to move things forward. We surely did not come into nursing to tolerate seeing people abused or damaged, deliberately or by neglect.

We need to be fully prepared to stand up for our patients. It is easier to stop an individual who is causing harm intentionally or by a lack of training than it is to change the way an institution behaves.

The death and suffering caused by institutional abuse and neglect makes Shipman look like an amateur. The damage caused by a lack of training and updating, understaffing, a lack of resources, outmoded practices and procedures, and staff’s willingness to let them continue should be a source of shame to us all.

We know that working understaffed and with insufficient nurses on duty damages outcomes. We know that we need to be constantly updated if we are to deliver the best care.

Why then are staff working overtime without being paid and staying at the end of shifts to catch up on paperwork? Why are staff paying for their own training or doing it in their own time?

If we are not willing to stand up for ourselves, will we stand up for our patients? We are very privileged to do our job and, with privilege, comes responsibility. If we see something wrong we simply must do something to put it right. While we have the NMC code of conduct to guide us, surely we know that as responsible human beings we cannot condone abuse or neglect?

If you have concerns about anything that you consider constitutes unsafe practice, it must be raised with a line manager. If there is no resolution, then the matter should be taken higher.

It is not always easy to do the right thing but patients must be protected and that is our job. Always put things in writing and keep copies. If nothing seems to be happening, don’t be put off – keep asking what progress has been made.

It may not be a comfortable thing to do, and it may cause you worry, but think how you would feel explaining to relatives that the reason they are grieving is that you knew something was wrong but you did not want to cause yourself any discomfort by speaking out.

Nigel Jopson is the manager of a nursing care home for people with dementia in Surrey

No

Ian Pierce-Hayes

As nurses, our first consideration must be the interests and safety of patients. However, the whole notion of whistleblowing is often far from clear-cut and the recriminations for those who have been brave enough to raise their concerns can be so severe and bitter that it can lead to an atmosphere of fear and intimidation that prevents any discussion – let alone criticism – of practice.

It is not individual nurses acting in their own interests who are the problem but the failure of managers and employers in preventing honest and open discussion that is letting down patients.

Under the 1998 Public Disclosure Act, workers who disclose information of a specified nature are protected from being dismissed or penalised by their employers. Furthermore, the Department of Health has stated that all trusts must have policies and procedures on whistleblowing. However, in reality, we work in a climate governed by costs and targets. Nothing can stand in the way of meeting targets.

If anyone feels the law has made a difference, the cases of two nurses – Graham Pink and Karen Reissmann – demonstrate how little has changed.

Graham Pink was a charge nurse who wrote a string of passionate letters – to his employers, the health authority, the health secretary and finally the press – about the inadequate care on his elderly care ward at Stepping Hill Hospital in Stockport. He told of elderly patients lying in bed in their own excrement and the chronic lack of staff to care for them. He was sacked for gross misconduct in 1991 after writing his letters.

Karen Reissmann, a community psychiatric nurse, was sacked last November after leading protests against possible cuts to NHS mental health services. She and her colleagues felt that service reorganisation would leave too few staff to deal with a large number of clients. Two months after her initial suspension, the trust accepted that client numbers were higher than it first thought and put in extra staff. Karen is still campaigning against her sacking.

So despite all the talk of open and accountable cultures and ‘listening’ managers, as well as whistleblowing legislation, the reality of raising concerns has changed very little. Until we have a stronger and empowered nurse leadership, it will continue to remain that way.

Ian Pierce-Hayes is cardiac specialist nurse at Wirral University Teaching Hospital NHS Trust

  • 6 Comments

Readers' comments (6)

  • Ian Pierce-Hayes has in fact confirmed the original question, yes...nurses who do not blow the whistle are protecting themselves.

    As a nurse with 20 plus years experience in many fields including agency nursing (nursing homes, hospitals) community nursing, Bank Nursing, private clinic nursing and as Matron at two large Nursing Homes, one with a small unit for patients with dementia, I can confirm I came across many instances of poor and even outright unacceptably bad practice.

    As a bank nurse and agency nurse when I came across bad practice I reported it to the person in charge and advised them I would be reporting on to the local authority, either health or social services. This I always did.

    We are all responsible for our own moral code and practice. I would not want to have my parents or one of my children to receive bad care, and I think if all nurses used this as a measure, they wouldnt think twice about reporting bad practice.

    I think as Europeans, we may find that the European courts will have very different ideas about what is acceptable and would hope that all future cases of nurses losing their employment through whistle blowing take their cases to the European courts.

    We should be thanking these whistle blowers, after all, we may be the next patient in the bed receiving this sub standard care.

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  • The term whistle blowing should be changed to improving care, because as nurses is this what we set out to do - IMPROVE CARE TO OUR CLIENTS. The term whistle blowing is very undignified in itself never mind actually going through the proceedure and the feeling that you are in the wrong when you have complained, due to the amount of paperwork that the manager then needs to do.
    Where is the support for yourself as a professional doing what the NMC state is part of our professional conduct to your client.
    The NHS needs to change due to the amount of areas for improvement that are needed.

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  • In response to Carol Norwell in her reporting bad practice I do admire her views,that she has put into action and reported unsafe practice to the relevant authorities as a bank and agency nurse but is it easier to report bad practice as a bank or agency nurse knowing you do not have to go back to that place again and therefore not worry about any repercussions. When reporting bad in place that you work permanently I think it can be more difficult it can lead to an uncomfortable environment especially if you have to work with colleagues you have reported for bad/unsafe practice. I feel reporting bad practice even though it is strongly encouraged that there is an insufficient amount of support offered to staff to enable them to feel confident in reporting practice that is of a concern. I think it is sensible to ask why do people still feel unable or unwilling to raise concerns?

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  • As an aged care nurse I have seen many nursing homes that should be closed down, yet they are left open and are running under staff.
    At first - when I was new to the industry - I was too scared to speak out for fear of what the other nurses would say.
    Now I have my say, but nothing changes. We are working understaffed, under trained and under pressure. When will the deaths of residents finally change the industry?
    Nurisng Issues.

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  • "...we work in a climate governed by costs and targets."

    management of healthcare has fashions and cycles. can we not now drop this notion of culture and emphasis on meeting targets and replace it with what is important instead such as focusing on the purpose of the organisation, which for the unenlightened is the patient, and on humane and high quality care which we have been trained to carry out.

    another point is that the chief of the NMC on the webchat yesterday said managers of health services, unlike the healthcare professionals, are not regulated. they carry a large part of responsibility for the delivery of safe and high standard care to patients so could there not be formal training and a statutory professional register for healthcare managers to prevent them from working in a healthcare organisation unless they are on this register?

    Most of our administrative managers were well separated from the care teams so we never got to meet them but only received their directives from their remote offices on the top floor on unrealistic and impractical ways of carrying out our work and even some nursing procedures! True remote control! These were filtered down to us via circulars or through our floor manager or by word of mouth (and by the by ...this meant that if there had been a recent change of which we were not informed because of days off or other leave and we carried out an old procedure on our return we were usually severely reprimanded and treated as an ignorant idiot as we did not know, which was especially irksome if you had just come on duty and had carried out some familiar but now suddenly obsolete procedure. The newly qualified took special delight in informing nurses who had spent years on the ward of what had very suddenly outmoded and dangerous practices!)

    I just wonder if there is a rivalry and competition between managers and professional staff and these former feel in some way inferior in terms of their perceived 'power' of knowledge and their authority over staff and patients, so feel a need to manifest this in other ways such as adopting attitudes of superiority to cover their lack of professional knowledge and other deficiencies, commanding and trying to assert who is in charge, higher salaries, and self-preservation of 'their jobs'. Maybe this could explain much of their attitudes towards patients and staff such as their 'deafness', apathy and even bullying.

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  • michael stone

    The answer is probably 'yes'.

    The problem is the complaints process itself.

    This is already well understood !

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