What Do Nurses Get for Being Ethical? The Boot!

This article cautions nurses to think hard before blowing the whistle on their employers' unsafe/unethical practices because they will likely suffer retaliation, most notably termination. This is really interesting in light of yearly studies that consistently place nurses at or near the top of the most ethical professions according to the public.


Nurses are indoctrinated in our schooling and by licensing boards on our "duty" to report harmful situations. The safety of patients is paramount, and our role is to advocate for their best interests, not those of the employer whose goal is to make money in the most efficient manner possible. Employers pay lip service to quality care and customer service, but it's the individual nurses who bear accountability for errors and adverse events. Employers are more than willing to fire a "troublemaking" nurse, rather than admit an institutional problem and actually implement steps to correct it. You see that costs money ,time, and extra paperwork for management. It also means admitting a problem and risking your reputation as a quality healthcare provider.


I read a lot in nursing journals about employer initiatives to encourage nurses to report more freely unsafe practices and errors they witness in an effort to reduce said practices and errors--tons of blathering about creating an environment of mutual trust among nurses and administration, among nurses and physicians. Puuuhlllleeeaaasssse! Most nurses, especially those doing full-time acute bedside care, need their jobs. They have bills to pay, families to support, and retirements to fund. Unless they find a practice or error truly egregious, they aren't likely to report it for fear of increased scrutiny of their work, which leads to comments in their personnel file, which leads to an even punier raise, if at all, at review time or the implicit threat of termination, which makes it even harder to come in to work every day in a hostile environment knowing they aren't appreciated when they're trying their best to do the right thing, which leads to burnout and attrition.


Tell me again how the nursing shortage is supposed to be solved by increasing access to education and allowing for more flexible work schedules. The problem runs so much deeper. But, I suppose the nurse academics who formulate these initiatives realize the futility of trying to change a for-profit employer's perspective on quality care (i.e., that it can be bought for pennies, and if not, well, we'll just do without and pretend all is well, thank you, please contact our attorney), so they putter around with ideas about communication and trust and other cumbaya bullshit and call it a much needed paradigm shift. WTF?


Many years ago, I started working for a national dialysis provider. I was still in the orientation phase when I witnessed licensed staff leaving the facility while patients were dialyzing leaving unlicensed personnel to supervise patients whose condition can deteriorate rapidly. The staff was also eating in the dialysis area. And, there was such a rush to get patients on and off the machines for the next shift, that infection control protocols were compromised, as well as treatment times. I resigned two days later and stated in writing that I had witnessed numerous breaches in safety protocol and that I could not put my license at risk by continuing to work for the organization. I received a terse letter in response demanding payment of $5000 for my "free training" and failure to fulfill a two-year work commitment. I responded with a certified letter cc'd to all management up to regional director pointing out the fact that repayment of the $5000 was contingent upon my completing the training phase (which I didn't do) and that I was not capable of working independently as a dialysis nurse for them or any of their competitors. I went on to detail the specific events I witnessed, making sure to notate explicit violations of the Texas Department of Health and CMS regulations. Without making a direct threat, I implied that if pushed, I would file formal complaints with the aforementioned agencies, which would automatically trigger, at least in the case of the TDH, an investigation. I guess the employer decided $5000 wasn't worth risking a governmental probe because I never heard from them again.


I suppose that like the nurses in the article mentioned, you have to be ready to give up your job, maybe even your profession, if you plan to blow the whistle because the laws aren't necessarily on your side. And, even if they are, achieving justice can take years, and most people can't go years without gainful employment. Then, there's the emotional toll of fighting a system that is completely backassward in its priorities. It's enough to make you throw up your hands and yell, "Why bother?" I suspect the public has no clue when they fill out those yearly surveys just how difficult it is for nurses to be ethical. Maybe, they expect nurses to be martyrs. Employers certainly do.