What is Whistleblowing in Nursing? (With Examples, How-To, Consequences, & Protection)

Written By: Darby FaubionDarby Faubion RN, BSN, MBA

Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Darby lives in Louisiana and loves exploring the state’s rich culture and history. Darby has a passion for caring for veterans and a special interest in those affected by post-traumatic stress disorder. In her quest to make a difference for veterans, she founded a non-profit called “Operation Battle Buddy.” Read Full Bio »» RN, BSN, MBA

Nurses are patient advocates and the eyes and ears of doctors and, as such, are often the first people to witness unethical behavior, violations of patient care standards, and unsafe practices. When these situations arise, nurses are faced with the tough decision of whether to report it, often referred to as whistleblowing. Many people have heard the term whistleblowing but may wonder, “What is whistleblowing in nursing?”

In this article, we will discuss the complexities of whistleblowing in nursing. I will share information with you about things to consider if you are thinking of whistleblowing, possible consequences you could face, and the appropriate steps to take to protect yourself and others.

What Exactly Is Whistleblowing In Nursing?

Whistleblowing in nursing is the reporting of unsafe practices or misconduct that could violate ethical standards or harm patients. Whistleblowing has become an essential tool used to uphold the integrity of the healthcare system and to protect patient rights and safety.

Can Nurses Be Good Whistleblowers?

Yes! Nurses can be good whistleblowers. Nurses are on the front line of patient care, which gives them direct access and view of practices and conditions associated with patient care. Also, because nurses are bound by an ethical code that prioritizes the well-being and safety of patients, they often feel driven to speak up when something appears wrong.

What Are Some Examples Of Whistleblowing In Nursing?

(The following are 3 good examples of whistleblowing in nursing.)

Example #1: Unsafe Nurse-Patient Ratios

Having adequate ratios of nurses available to provide care to patients is essential to patient safety. One of the top examples of whistleblowing in nursing occurs when nurses report unsafe nurse staffing ratios, which could jeopardize patient care. For example, nurses may report their hospital or healthcare facility for having consistently low nurse-patient ratios, which leads to an increased risk of errors and patient safety issues.

Example #2: Fraudulent Billing or Upcoding

In some cases, nurses blow the whistle when they become aware of healthcare providers engaging in upcoding, which means billing for more expensive services than what they actually provided. This practice is a type of fraud aimed at increasing the reimbursement providers receive from insurance companies or government-funded healthcare programs, such as Medicare and Medicaid.

For example, I recently attended a conference about medical billing and coding where I met a nurse who was formerly employed by a large healthcare organization, and part of her job was to perform chart and billing reviews for accuracy. After finding several patient bills that were grossly inaccurate, she reported her findings to the administrators of the organization, who conducted an internal review. It was discovered that one of the providers was billing patients for services that he did not perform, but that could typically easily be overlooked...until her review, that is. As a result of this nurse blowing the whistle, the provider was terminated from his job, and several patients had to be reimbursed for their overpayments for services.

Example #3: Improper Patient Care or Abuse

Another common example of reasons for whistleblowing in nursing is the improper care or abuse of patients. While abuse or inadequate care can occur in any healthcare setting, it is most common in cases where vulnerable populations are recipients of care. For example, state-run hospitals and nursing homes are common places where this occurs.

5 Important Things Nurses Should Consider Before Blowing The Whistle In Nursing

Whistleblowing in nursing is not something to be taken lightly. There are several things to consider before blowing the whistle. The following are five important things you should think about before whistleblowing.

Thing #1: Whether the Issue Can Be Resolved Through Internal Channels

Before whistleblowing in nursing, it is important to consider whether the issue can be handled within the organization where the problem exists. Many hospitals and healthcare organizations have policies and procedures in place that allow nurses to report concerns within the organization. Handling problems within an organization is typically the way most people prefer to address situations instead of escalating them to external sources. However, if you feel you cannot talk to the appropriate people in leadership and there is no way to make an anonymous report, you may not have an option other than external escalation.

Thing #2: What Evidence Do You Have to Support Your Claim?

Whistleblowing in nursing is something serious that should be carefully considered. Before you blow the whistle, ensure you have objective, clear, and well-documented proof of the unsafe practices or misconduct that need to be reported. Good evidence includes the dates and times of any incidents and specific details about what happened.

Thing #3: Know Your Rights as a Whistleblower

As a nurse, you have an ethical and legal obligation to protect patient rights and safety. However, it can be scary if you feel threatened or believe you may lose your job or be reprimanded for whistleblowing. I worked as a consultant for a company that owned several large nursing homes and assisted living facilities years ago. One day, I was asked to visit a facility where an employee had reported a nurse for falsifying medication records. When I got there, I was immediately faced with nurse managers and administrators who wanted to know who sent the report to the home office, but the report was confidential. As I conducted the investigation, I discovered that many nurses had concerns, but no one wanted to come forward. I had to call a mandatory in-service for all nursing staff and educate them about their rights as a whistleblower, during which they received printed information with ways of contacting me either personally or anonymously.

It is important for you to know that whistleblowers in nursing are protected by several laws designed to protect your rights as an employee to be free from retaliation. A few examples of laws and statues designed to protect whistleblowers include the Occupational Safety and Health Act, the False Claims Act, and the National Labor Relations Act.

Thing #4: Any Personal or Professional Consequences that May Occur

Although your rights as a whistleblower in nursing are protected by law, those laws cannot ensure that your personal or professional relationships or your emotional well-being won’t be affected. Before whistleblowing in nursing, I recommend thinking about the situation carefully and weighing whether you are prepared to handle any consequences of your decision.

You must be prepared for any possible repercussions from reporting. Some nurses feel extremely guilty or overwhelmed after whistleblowing. If colleagues are aware that you are the whistleblower, it could negatively impact your professional relationships and career. I am in no way discouraging you from blowing the whistle. In fact, if you are aware of unsafe or illegal practices, I encourage you to report it to the appropriate people. Just keep in mind that you may face personal or professional conflicts afterward.

Thing #5: Who Can You Trust for Guidance or Support?

Having a good support system to provide emotional support and guidance through the process of whistleblowing in nursing is important. Think about trusted colleagues and mentors you can confide in and seek their advice. It may also be necessary to seek legal counsel, especially if this is a situation that you feel has the potential to end up in a lawsuit or with criminal charges against the person or people you report.

How To Blow The Whistle In Nursing?

If you are considering whistleblowing in nursing, it is important to have a well-planned and structured approach. Following a structured plan can help ensure all your concerns are appropriately addressed and that you are protected from any negative repercussions or retaliation.

Step #1: Get the Facts!

The first step in whistleblowing is to ensure you have all the facts. Collect clear evidence of any unsafe practice or misconduct from an objective point of view. Keep records of any interactions related to the incident, including conversations with supervisors and coworkers, as well as any responses you receive.

Step #2: Consult Legal Counsel

Before submitting your complaint, it is wise to seek advice from either legal counsel or your state nurses’ association. Your nurses’ association or legal counsel can provide guidance on how to document correctly and help you navigate through the process while protecting your rights as a whistleblower.

Step #3: Put Your Complaint in Writing

It is crucial that any complaint involving whistleblowing in nursing is submitted in writing. Having your complaint in writing ensures there is a formal record. You may submit your complaint directly to regulatory bodies or through internal channels within your organization. Either way, it is especially important that you keep a copy of any complaint you submit.

Keeping a copy for yourself serves as proof that you submitted the complaint, which may be useful if there are disputes, and you need to prove you made the complaint. Also, in cases where a great deal of time has elapsed, it is natural for details to become fuzzy. Having clear documentation from the time of your report gives you detailed information and a consistent account of what happened, which you can refer to if you need to discuss the matter with others.

Step #4: Follow Internal Procedures, if Possible

Whenever possible, try reporting the issue through your facility’s internal procedures before going outside the organization. Reporting internally does not mean you are trying to hide things or keep things from being handled. Instead, internal reporting gives management the opportunity to address problems and remedy them without involving people not associated with the organization.

Step #5: Report to Appropriate Regulatory Agencies

Of course, there will be times when you feel internal reporting may be to no avail. If the problem has been persistent and you or someone else has reported the issue with no response or resolution from management, then reporting to the appropriate state or national regulatory agencies is necessary. These agencies have authority to investigate your claims and take appropriate action.

5 Potential Consequences Nurses Might Face After Whistleblowing

Although there are many reasons that whistleblowing in nursing may be necessary, it is also important to note that there are some consequences nurses may face after doing so. Nurses should consider the consequences before whistleblowing and be prepared for ways to handle them. The following are five potential consequences nurses may face after whistleblowing.

Consequence #1: Professional Isolation

Perhaps one of the worst consequences of whistleblowing in nursing is that colleagues may distance themselves from you. Professional isolation may be the result of coworkers being angry about your decision to blow the whistle. On the other hand, peers may feel worried that others will assume their involvement in the situation and choose to separate themselves so they do not experience any fallout because of the whistleblowing.

Consequence #2: Retaliation

Although there are legal protections in place for whistleblowers, that does not mean that retaliation in these cases is nonexistent. In some cases, whistleblowers experience retaliation, such as being harassed by coworkers or supervisors, demotion, or loss of their jobs.

Consequence #3: Long-Term Career Impact

Unfortunately, whistleblowing in nursing can have a long-term impact on a nurse’s career. Even if the case was justified and the nurse is in the right, if others know who made the report, they could view them as troublemakers. Unfortunately, when this happens, it could not only result in trouble at their current job, but it may also impact future job prospects.

Consequence #4: Financial and Legal Repercussions

At times, whistleblowers can face legal challenges, such as lawsuits from the accused or their employers. With lawsuits comes a financial burden. Nurses may feel it is necessary to leave their jobs, which only adds to the financial strain, compounding the complexity and pressure of an already tense situation.

Consequence #5: Emotional Stress

The simple thought of whistleblowing in nursing is emotionally taxing. The process is more than enough to cause stress and anxiety. Many nurses who blow the whistle experience burnout, which often results in leaving their jobs or the profession.

What Protections Are There For Nurses Who Blow The Whistle?

If you feel you may need to blow the whistle about something in nursing, knowing your rights and what protections you can expect is essential. There are several protections in place to protect individuals who exercise whistleblowing in nursing, including the following.

Protection #1: Healthcare-Specific Protections

Some laws, such as the Patient Safety and Quality Improvement Act, encourage nurses to report unsafe conditions and medical errors by providing protection of their confidentiality. The PSQIA establishes a voluntary reporting system that is designed to resolve patient safety and healthcare quality issues. The Act provides confidentiality protections for patient safety information.

Protection #2: Occupational Safety and Health Act

The Occupational Safety and Health Act protects employees who report workplace safety violations and prohibits employers from retaliating against employees who participate in investigations or file complaints.

Protection #3: False Claims Act

The False Claims Act protects whistleblowers, referred to as “relators,” who report fraud against government programs, such as Medicare and Medicaid. Under this Act, whistleblowers can file lawsuits on behalf of the government and are shielded from any acts of retaliation.

Protection #4: Whistleblower Protection Act

The Whistleblower Protection Act is a law specifically designed to protect federal employees, including healthcare workers, who disclose information they believe proves gross mismanagement, violation of laws, or acts that pose a specific and substantial danger to public health or safety.

Protection #5: State-Specific Whistleblower Protection Laws

Many states have laws designed to provide protection for whistleblowers. Each state’s laws vary, but they offer the same general protections, including protection against retaliation. For example, most states in the United States protect nurses federally through the Occupational Safety Health Act, False Claims Act, and the National Labor Relations Act. Other states, like Montana, have state statutes designed specifically for their states. In Montana, in addition to protection by OSHA, FCA, and NLRA, the state statute 39-2-904 prevents employees from being terminated when they refuse to violate public policy or report a public health or safety issue.

My Final Thoughts

As patient advocates and promoters of good, nurses often find themselves in situations where speaking up for others is necessary, an act often known as whistleblowing. While many people have heard the word whistleblowing, some nurses wonder, “What is whistleblowing in nursing?”

In this article, I answered that question by sharing information about whistleblowing in nursing. You learned what whistleblowing is, found examples of it, and discovered consequences and protections for nurses who become whistleblowers. Although it is sometimes difficult to decide to become a whistleblower, as a nurse and someone who has worked in nursing leadership, I encourage you to remember the lessons you have learned as a nurse and why you chose this profession. Then, if you are faced with a situation where unsafe practices or patient safety are an issue, consider your role as a patient advocate and do your part to help bring awareness and promote safety and quality nursing care.

List Of Sources Used For This Article

1. United States Department of Labor- Occupational Health and Safety Administration
2. “False Claims Act” (U.S. Department of Health and Human Services, Office of Inspector General)
3. “Things to Know About Whistle Blowing” (American Nurses Association)
4. "Patient Safety and Quality Improvement Act of 2005" (U.S. Department of Health and Human Services)
5. “A Guide to the Whistleblower Protection Act for Healthcare Professionals” (The National Law Review)
6. National Labor Relations Board