Whistleblowing has become synonymous with bullying and harassment. Praising nurses not pillorying staff for reporting incidents will empower them to challenge practice, says Jane Reid
For many healthcare professionals, challenging practice has become synonymous with whistleblowing. Unfortunately, due to a number of high profile cases where whistleblowers have been badly supported or openly victimised, whistleblowing is often viewed negatively, leaving people anxious and reticent to speak out. Over the years “whistleblower” has also become a pejorative term, resulting in the negative labelling of individuals, rather than reinforcing the notion that speaking out is fundamental to exercising a person’s professional accountability and ethical duty.
Despite the Public Interest Disclosure Act that came into effect in July 1999 to protect whistleblowers, too many have endured isolation and paid a high personal price for raising their concerns, including loss of employment, financial hardship, divorce, and a host of mental and physical health problems. In cases where nurses have sought to highlight that patients were at risk due the incompetence and poor performance of senior medical staff, too many have found themselves diminished by oppressive hierarchies and collusions of silence, as well as bullying, harassment and even physical assault.
When faced with the need to challenge practice I have found the phrase “not on my watch” has proved invaluable. Over the course of my career I have relied on this phrase to frame my position when choosing to escalate a professional concern, speak up about an issue, or question the practice or professional conduct of a colleague. These short but powerful words emphasise the importance of doing what is right - however uncomfortable - and the need to exercise professional accountability to ensure patient safety.
Reflecting on my career, many of the situations that have resulted in my speaking out were not easy. My attention was not always well received, particularly if the challenge concerned individual behaviour or risky practice. In my experience, in order to depersonalise the situation it is important to focus on patient safety as the driver for raising concerns.
Highlighting a concern can be difficult and is rarely easily resolved because the systems we work in are complex and working with people is inherently unpredictable. However, in our pursuit of safety and quality difficult conversations, although unpleasant, should be seen not as the exception, but the norm.
To enhance care we need to create a “safety culture” where teams feel they are working in an environment where it is safe to speak out about poor practice. Staff are more likely to feel empowered to speak up if they are praised rather than pilloried for doing so.
Although speaking up is challenging and we cannot predict the outcome and impact of our actions, if we have the patient’s best interests at heart, and are motivated by the ethical principle of beneficence, we will increasingly find ourselves supported and heard by our peers, medical colleagues and managers.
Given the evidence that the Public Interest Disclosure Act has failed to protect whistleblowers working in the NHS, I welcome the public consultation announced last month to amend the NHS Constitution. The consultation will examine how to make clear the rights and responsibilities of health service staff and their employers in respect of raising concerns about practice. This consultation is necessary because legislation can only work if organisations have systems in place that give people the confidence to voice concerns and then support them for doing so.
However, amendments to the NHS Constitution will not be a panacea. Affecting real change is dependent on creating the right conditions and culture at a local level. We need transparency to be able to qualify the scale of harm within our organisations, to take steps to learn from error and to be able to disclose the truth arising through serious untoward incidents. This will require the executive leadership of NHS Boards to set the tone for ethical caring and the support of the entire NHS. In this way we can ensure that patient safety comes first.
JANE REID,CoPMRE, BU, is clinical advisor for the National Patient Safety Agency and president of the International Federation of Perioperative Nurses