IN NOVEMBER 2002, in what stands as one of the most significant whistleblowing cases in the history of the Australian health care system, four nurses went public with concerns they had about the management of clinical incidents and patient safety at two hospitals in Sydney, New South Wales. The handling of this case and its aftermath raises important moral questions concerning the nature of whistleblowing in health care domains and the possible implications for the patient safety and quality of care movement in Australia. This paper presents an overview of the case, the moral risks associated with whistleblowing, and some lessons learned.
The International Council of Nurses (2000) Code of Ethics stipulates that nurses have a stringent responsibility to "take appropriate action to safeguard individuals when their care is endangered by a co-worker or any other person". Other local and international nursing codes of ethics and standards of professional conduct likewise obligate nurses to take appropriate action to safeguard individuals when placed at risk by the incompetent, unethical or illegal acts of others - including the system. Despite these coded moral prescriptions for responsible and accountable professional conduct, taking appropriate action when others are placed at risk (including making reports to appropriate authorities) is never an easy task nor is it free of risk for nurses. As has been amply demonstrated in the literature, taking a moral stance to protect patient safety and quality of care can be extremely hazardous to nurses (Johnstone 1994, 2002, 2004; Ahern & McDonald 2002). In situations where nurses report their concerns to an appropriate authority but nothing is done to either investigate or validate their claims, nurses are faced with the ethical dilemma and 'choice' of whether to: do nothing ('put up and shut up'); leave their current place of employment (and possibly even the profession); or take the matter further ('blow the whistle') by reporting their concerns to an external authority that they perceive as having the power to do something about their concerns.
It is rare for nurses to 'blow the whistle' in the public domain. When they do, it is usually because they perceive that something is terribly wrong and, as a matter of conscience, they cannot just look on as morally passive bystanders. For those nurses who do take a stand, the costs to them personally and professionally are almost always devastating, with no guarantees that the situation on which they have taken a public stance will be improved. Nurses who blow the whistle often end up with their careers and lives in tatters (see case studies in Johnstone 1994 & 2004).
The Campbelltown and Camden Hospitals case (discussed below) is a rare event. Publicity surrounding the case has had dire consequences for many people, including the nurses who went public with their concerns. However, the case has also provided an unprecedented opportunity to examine the relationship (some might say, tension) between whistleblowing and clinical risk management, and the processes that might be used by nurses and others to promote patient safety and quality of care in highly politicised environments.
This article focuses on the broader issues raised by this case, addressing what constitutes whistleblowing, the conditions under which nurses might decide to blow the whistle, the moral risks of whistleblowing, and why whistleblowing ought to be considered only as a last resort. The ultimate conclusion of this paper is that, contrary to some of the pessimistic views expressed about this case, it has provided a valuable opportunity for lessons to be learned and underscores the pressing moral imperative for establishing what Liang (2001) describes as a "non-punitive, cooperative environment that focuses on systems, not individuals, to reduce errors". In order to advance this discussion, however, some background information on the case is warranted. …