INTRODUCTION AND BACKGROUND
Whistleblowing occurs across health care sectors nationally and internationally, and whilst various definitions of whistleblowing exist, most incorporate the basic concept of promoting advocacy to prevent harm to individuals or groups (Bolsin, Faunce, & Oakley, 2005; Davis & Konishi, 2007). Furthermore, whistleblowing can involve the reporting of poor and unsafe work practices to both internal and external organisations (Ray, 2006). In previous nursing literature, whistleblowing has been more specifically defined as 'a nurse who identifies an incompetent, unethical or illegal situation in the workplace and reports it to someone who may have the power to stop the wrong' (Ahern & McDonald, 2002, p. 305). Whilst whistleblowing in the health care sector can be considered an honourable act (Lachman, 2008), it holds negative consequences for individuals involved (Firtko & Jackson, 2005; Ray, 2006). Despite these consequences, nurses continue to advocate for patient safety and, when their concerns are not addressed, blow the whistle in an attempt to enforce changes in practice (Myers, 2008). Although some difficulties experienced by those involved have been acknowledged, the impact that whistleblowing has on collegial relationships between nurses and other health care professionals remains largely unexplored.
Elsewhere we have argued that whistleblowing is a measure of last resort, and used when other means of drawing attention to issues fails (Jackson et al., 2010). For those who do speak out, 'backlash, backing off, backstabbing and isolation' may result (Attree, 2007, p. 397). In a study to explore perceptions of professional effects of whistleblowing in a sample of nurses, McDonald and Ahern (2000) confirmed previous findings (see Chafey, Rhea, Shannon, & Spencer, 1998; Dempster, 1997; Hunt, 1995; Mohr, 1996) that reporting misconduct often results in organisational reprisals and can negatively impact working relationships (Firtko & Jackson, 2005).
Any factor that negatively infl uences working relationships between nurses is a matter of concern. Effective professional relationships in nursing results in job satisfaction and decreased staff turnover (Duddle & Boughton, 2007), which benefits workforce recruitment and retention (Jackson, Mannix, & Daly, 2001). In contrast, ineffective relationships can lead to bullying or physical and psychological confl ict, in what has been termed lateral or horizontal violence (Duffy, 1995; Farrell, 2001), which has been found to be more distressing for nurses than aggression from other sources such as patients (Farrell, 1997).
The need for effective and strong professional relationships is not simply to engender work satisfaction among staff, but also to foster patient care (Mahlmeister, 2009). In fact, patient safety is dependent on health professional staff being able to speak up about any matters of concern and adopt an advocacy stance for patients (Firtko & Jackson, 2005). A workplace culture that views whistleblowing as 'telling tales' is not conducive to raising issues of patient safety (Harrison, 2003, p. 12).
The literature suggests that within healthcare organisations, whistleblowing is frequently perceived as a 'breach of loyalty and betrayal by those who conform' (Ahern & McDonald, 2002, p. 304), and as evidence of not being a team player (Faunce & Bolsin, 2004). This sense of betrayal can result in colleagues losing their trust in each other (Dunbar, Reddy, Beresford, Ramsey, & Lord, 2007), and Ahern and McDonald (2000) note a belief that the decision to take action could place whistleblowers in 'direct confl ict' with the rest of their colleagues (p. 314). However, given the fact that nurses are implicated in whistleblowing (Firtko & Jackson, 2005), there is little in the literature that explores the impact of whistleblowing on workplace relationships in nursing, and no literature could be found that includes the perspectives of the major stakeholders-whistleblowers, bystanders to whistleblowing events and subjects of whistleblowing complaints. …