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Christy Lyon In fact, state law and the Nursing Practice Act require it. A nurse who stands by and lets a patient be harmed—in any way—without doing anything about it could be in big trouble with the BRN and face severe legal sanctions. According to the California Code of Regulations, a nurse "acts as the client’s advocate … by initiating action to improve health care or to change decisions which are against the interests or wishes of the client." If you notice anything that keeps you or your colleagues from giving your patients the care they deserve, you have an obligation to do something about it, say healthcare experts. Whether it’s another nurse with a substance abuse problem, a physician who doesn’t listen to patients, or staffing levels that are unsafe, nurses must do something to fix the problem. First things first What should you do if you feel your patients’ health and safety are being jeopardized? First, find out whether the situation qualifies as a reportable problem or whether it’s simply a policy you don’t agree with, said Laura Mahlmeister, PhD, RN, president of Mahlmeister and Associates and a staff nurse in the birthing center at San Francisco General Hospital. If in doubt, call the BRN, the California Department of Health Services (DHS), or the Joint Commission on Accreditation of Healthcare Organizations. Once you’re sure of your facts, make sure you go through the appropriate channels at your facility, Mahlmeister said. "We encourage nurses to report any [action] against the patient," said Gerard Brogan, RN, a nursing practice representative for the California Nurses Association. Nurses should go to their immediate supervisor and make an oral report when they first observe the incident, then follow up with a written communication, Brogan said. Particularly tough It can be especially hard to report a co-worker. But it’s crucial to let your supervisor know about a possible problem with a colleague, especially if it reflects incompetence or an illegal or unethical act, Mahlmeister said. "You may think this is an isolated event, but you don’t know that. There’s no way to know how many times it’s happened," she said. In addition, professional courtesy demands that you tell your colleague what you’ve seen and what you will report, Mahlmeister said. If you can’t face the idea of bringing up your concerns in person, many hospitals have anonymous reporting lines you can use to report problems with a colleague or the facility, said Susan Harris, MPA, RN, senior vice-president of Pacific Health Consulting Services, which is part of the California Healthcare Association. While nurses always have the option to go to the BRN or DHS with problems, "I would hope issues could be resolved without that type of punitive action," Harris said. Others agree that it’s best to start by going through the proper channels at work. "I know it’s a tough call, but nurses need to bring [problems with colleagues] to the attention of the facility and hope it will be resolved," said Susan Brank, the BRN’s assistant executive director. But just as important, Brank said, "if they feel that it isn’t being addressed, they should alert the BRN so we can look into it." Truth and consequences That’s easier said than done, Mahlmeister said. "My experience is that to simply tell nurses to go to the BRN may be inadequate. Whistle-blowing has huge ramifications for nurses: ostracism and disapproval by peers, termination, and long courses of legal action," she said. If the administration does not appropriately address the issue when nurses report problems to hospital authorities, nurses should act by "quietly letting things settle down and then surreptitiously reporting [to an outside agency]," she said. Any nurse who blows the whistle on a colleague or a facility needs to be prepared for the fallout. "You should consider whether you should look for another job before you blow the whistle," said Phyllis M. Gallagher, JD, RN, an attorney in Wrightwood in San Bernardino County. In addition, you might also want to consult an attorney who can help you navigate the twists and turns of the review and legal system. "Before you make your final move, speak to a lawyer," Mahlmeister said. "It behooves any nurse today … You sometimes don’t consider all the ramifications." Protecting your anonymity Most times, nurses have the option of reporting problems anonymously, giving them an opportunity to protect their privacy—and their jobs. "We encourage anyone who sees a problem that they believe is not being corrected after they’ve notified the appropriate facility personnel to contact us. They can do it anonymously," said Ken August, spokesperson for the DHS, which regulates hospitals. The DHS investigates anonymous complaints the same way it handles those made openly, August said.
The BRN also accepts anonymous complaints, although they’re often more difficult to investigate, Brank said. "If someone sends us an anonymous letter with sketchy information, we may not have enough to follow up." However, the BRN does everything it can to "make this an open process for the individuals who feel they need to report, and hopefully they feel they can approach us," she said. Backup material If you’re going to make an accusation, have enough information to back up your claim. "We want to know as much as possible—the nature of the problem, how often it occurs, where and when it occurred, and the circumstances surrounding the problem," August said. Some experts suggest keeping a log of incidents so you’ll be able to refer back to it. The most effective complaints are those that contain firsthand, verifiable information, according to the BRN. The agency asks nurses to give as many specific details as possible, including dates and times and a list of witnesses and telephone numbers. But regardless of the amount of information you have, any agency you report a problem to will have to conduct its own independent investigation.
Protecting yourself Federal legislation on the horizon could brighten the picture for whistle-blowers. The Patient Safety and Healthcare Whistle-Blower Protection Act of 1998, sponsored by Rep. Mark Foley, R-Fla., includes a provision to protect healthcare workers from retaliation if they report unsafe care, according to Sapin. The bill would protect healthcare workers who advocate for patients or initiate, cooperate with, or participate in any government investigation or proceeding regarding care, services, or conditions of any healthcare entity. Although Congress failed to pass the bill this year, it will be reintroduced in the next session, which starts in January. Regardless of how much protection whistle-blowers may have under the law, they will always face the difficult decision of whether—and how—to disclose unsafe care. But experts agree that blowing the whistle on unsafe care is part of being a nurse. "The role of the nurse in patient advocacy in nonnegotiable," Mahlmeister said. "Nurses cannot stand by and let patients die." |
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