Organisational factors that prevent nurses from whistleblowing: a review of the literature

This paper is a literature review submitted as part of the academic requirements of the BSc Honours Degree course I am currently pursuing. The topic I chose to review was whistleblowing in nursing, more specifically why nurses do not whistleblow. Because of cases such as the Leas cross Inquiry and the Rostrevor case coming to the forefront of Irish media in recent times, interest for this literature review stems from the author’s belief that nurses must protect patients from harm through advocacy, reporting and if necessary, whistleblowing. This research seeks to answer the research question: ‘How do organisational factors prevent nurses from whistleblowing?’ A manual review of the literature was carried out with the intention of highlighting the organisational factors that exist which prevent nurses from whistle-blowing. A computer search was conducted of databases including: CINAHL, Science Direct, Trip database and the Cochrane Library. The following keywords were used: whistle-blowing, organisational factors, organisational culture, dilemma, raising concerns, barriers and patient safety. Initial search limitations included: literature no more than five years old and Irish and UK journals only. However, this resulted in too little research on the topic and the search was expanded to include non-Irish/UK journals as well as one article dating back to 2005. In-depth analysis of the literature resulted in the identification of twelve articles relevant to the review. The major theme that emerged was ‘organisational culture’. The definition of whistle-blowing is varied throughout the literature; however the most cited being that whistle-blowing is the act of highlighting and taking a stand against organisational wrongdoing. The overall image that emerges from the literature is negative: closed culture, poor response to the raising of concerns, silence and fear. Findings from this research suggest that organizational culture plays a major role in whether or not nurses will raise concerns. Whistleblowing still appears to be somewhat of a taboo subject. Patient safety is paramount in healthcare and nurses need to put patients’ needs before their own. It is evident form the literature, that a sense that ‘nothing would be done’ in relation to the raising of their concerns was the most commonly cited reason as to why nurses remained silent about wrongdoings in their workplace. However, such negative perceptions appear to stem from the organisational culture in which they work. The literature suggests that it is the leaders in such organisational climates that set the standards for what is accepted as common practice. However, nurses have a duty of care to their patients and cannot turn a blind eye to situations that raise serious concerns. Silence is a cancer which eats away at organisations. Organisational culture plays a major part in the decisions of nurses who contemplate whistleblowing. In reality, facilitating factors, appropriate organisational infrastructures and proper support systems need to be put in place in order to encourage and support whistleblowers. There is a need for authentic change within organisational systems to allow nurses raise concerns and above all the absolute need for disincentives to reporting to be removed.