Nurses and Whistleblowing in Healthcare

Our current featured article is titled “Hypervisible Nurses: Effects of Circulating Ignorance and Knowledge on Acts of Whistleblowing in Health” authored by Amelie Perron, PhD, RN; Trudy Rudge, PhD, RMHN, RN; ´ Marilou Gagnon, PhD, RN. In this timely and important article, the authors examine whistleblowing and the failures it brings to light.  The article is available at no cost while it is featured on the ANS website.  Here is Dr. Perron’s message that provides background on this work:

This paper brings together two seldom discussed subject matters in nursing: whistleblowing and nonknowledge. Publishing this paper on whistleblowing turned out to be very timely in light of the numerous nurses and other healthcare professionals who have spoken up about serious covid-related concerns, in particular with regards to the prevention and management of coronavirus infections and the lack of personal protective equipment made available to care providers. Yet nurse whistleblowing is not limited to crisis and unprecedented situations such as the one we are currently experiencing. Whistleblowing is a constant in nurses’ worlds. Nurses regularly alert their organizations to unsafe, unethical or illegal practices, in the hopes that such situations will be corrected. However, while in some cases, positive reactions ensue, many nurses’ reports are instead met with indifference, suspicion or hostility.

There are many reasons for this. Managers can already feel overwhelmed with various pressures (e.g. budget cuts, staffing issues, patient turnover, the need to implement a new directive with minimal support, etc.) and have limited head space or time to take on additional concerns; they may feel their performance as manager is called into question and become defensive; they may agree with the reported concern but feel powerless to communicate it to their own superiors; their own reading of the situation may be different and they may feel they have a better or a more complete understanding of it. Whichever is the case, these reactions often lead to a lack of decisive action and therefore the perpetuation—and, in some cases, the worsening—of the original issue. Concerns can become lost and forgotten unless nurses persevere. Insistence often leads to nurses becoming overly and precariously visible in the organization: that is, they may be increasingly perceived as the ‘problem’ to be ‘fixed’, rather than the issue they are reporting. This is even more likely to occur if nurses decide to leak their concerns outside the organization (e.g. health ministry, patient safety office, integrity commissioner, health and safety agency, police, media, etc.) in the hope that something will be done to prevent or stop the wrongdoing.

Our paper delves into the reasons why nurses’ knowledge about critical situations or wrongdoing does not necessarily translate into organizational knowledge that can lead to corrective measures. Using the Sociology of ignorance as a framework to deepen this understanding is novel: it is the first time the (anti)epistemic underpinnings of whistleblowing are teased apart in any discipline. This perspective provides insights into the way “not knowing something” (for example through uncertainty, doubt, denial, censorship, forgetting, etc.) becomes a feature of organizational life; how it shapes the way people think and act; how it produces interests, meanings and priorities; and how it positions various individuals in the process.

The literature on whistleblowing emphasizes how the conscious or accidental interruption of critical knowledge is the main driver of critical events or wrongdoing in healthcare settings, and how lack of corrective measures is the main trigger of external whistleblowing.  Through mechanisms of ignorance, knowledge that could have prevented or stopped harmful events becomes unavailable, unusable or unconvincing. Pockets of ignorance form, that translate into organizational blind spots. Experts agree that whistleblowers are critical to the identification and elimination of these blind spots in order to safeguard patients’ and workers’ safety, the quality of care processes, the integrity and the reputation of the organization, and the public interest more broadly. Dissecting the organizational positioning of nurse whistleblowers through the Sociology of ignorance provides new insights into the phenomenon and allows us to reconsider the role of whistleblowing policies and legislation meant to protect whistleblowers.

This work follows a concept analysis on whistleblowing published previously (Gagnon, M. & Perron, A. (2019). Whistleblowing: A concept analysis. Nursing & Health Sciences, doi: 10.1111/nhs.12667). It is part of our work within the Nursing Observatory (https://nursingobs.com/), the first observatory of its kind in the world. It sets the stage for a federally funded study we are currently conducting on nurse whistleblowing in Canada.