Registered veterinary nurses (RVNs) in the UK became more directly accountable for their actions (or lack of action) with the introduction of a disciplinary system in April 2011. As a result it has never been so crucial that they are fully aware of their professional, legal and moral responsibilities when witnessing continued or deliberate wrongdoings at work or a colleague's professional malpractice. Being aware of what kind of activities constitute malpractice or professional misconduct is challenging enough in itself, but knowing if and who to tell provides individuals with further dilemmas and challenges which are likely to have long-term effects both to themselves personally and professionally and to the profession in general.
Whistle-blowing is the idiom used to describe an employee voicing their concern about an act or acts of wrongdoing that they believe to be going on in their workplace. The origin of the expression, which is generally reported to have derived from the British police force who in the past, blew a whistle when witnessing a crime, has been transferred to current usage because of its association with alerting others and warning the general public of danger (Isaacs, 2010).
The purpose of this article is to inform readers of their professional responsibility regarding the reporting of incidents of malpractice and misconduct and to identify some of the issues associated with whistle-blowing. The authors found very little literature specifically discussing or researching whistle-blowing in the veterinary industry, and so articles discussing the experiences of other healthcare professions will be reviewed for their comparability and application to this stage of the evolution of a veterinary nursing profession. It is also the authors’ aim that this article provides a resource for any veterinary nurses (VNs) considering blowing the whistle so that he or she is in a better position to make informed decisions about how to go about it and ensure any professional protocols and legal requirements are followed correctly.
Professional responsibilities, professional integrity
It is widely accepted that professionals have responsibility to demonstrate professional integrity and behave in ways which are transparent and deserving of the public's trust (Blass, 2010; Royal College of Veterinary Surgeons, 2010a; Edgar and Pattison, 2011). Many of the activities, attitudes and behaviours expected of professionals are unwritten but the general public expects certain standards to be maintained and to be protected from activities which might be considered unacceptable.
One such expectation is that members of the profession, in demanding a high degree of professional autonomy, prestige, recognition and social status, have a moral obligation to report any acts of misconduct or malpractice that they witness in their place of work in the public's interest. Increasingly, some professional regulatory bodies (e.g. The Royal College of Nursing (RCN), The British Dental Association, General Medical Council to name just a few), have created dedicated whistle-blowing policies to guide and instruct members on what to do in the event of witnessing a colleague's or organization's malpractice (Royal College of Nursing, 2001; General Medical Council, 2010).
In the UK, the regulatory body for veterinary surgeons and veterinary nurses is The Royal College of Veterinary Surgeons (RCVS). While this professional body does not currently provide members with a specific whistle-blowing policy, statements identifying veterinary practitioners’ responsibilities to patients, clients and the general public can be found in each profession's Guide to Professional Conduct (GPC) along with guidance of what to do if they have any concerns about the competence of a colleague:
‘A veterinary nurse or other person who has concerns about the competence of a colleague is encouraged to discuss this through with the appropriate processes in the place of work. If the matter cannot be resolved with such an approach, any concerns should be brought to the attention of the RCVS Professional Conduct Department.’ (Royal College of Veterinary Surgeons, 2010b, S1C (2))
With around 17 000 registered veterinary surgeons and just over 9000 registered or listed veterinary nurses in the UK and millions of veterinary consultations occurring every year (Royal College of Veterinary Surgeons, 2011) it is reasonable to assume that there will be occasions when veterinary staff could find themselves in a situation where they witness some kind of ongoing or repeated wrongdoing at work. Since April 2011, RVNs now have a professional and ethical obligation to report any serious concerns they have about patient safety, acts of malpractice, wrongdoing or misconduct that they are aware of in their place of work.
‘Venterinary nurses must not: ‘speak or write disparagingly about another professional colleague…’ and so it is easy to see how veterinary nurses might be confused about their professional responsibility’.
Why blow the whistle?
Apart from the obligation bestowed on professionals by their professional bodies to report malpractice, one of the primary purposes of blowing the whistle is to protect public interest and improve care to patients and services to the general public (Directgov, 2011). A number of studies in human nursing exploring why nurse practitioners decide to blow the whistle reveal that in most instances, nurses do so with the intention of raising concerns about patient safety and the standard of care being delivered (Attree, 2007; Gallagher, 2010; Jackson et al, 2010). There have been a number of high-profile media cases involving health professionals who have blown the whistle with the purpose of identifying malpractice ultimately with the intention to ensure better systems and standards. Dr Stephen Bolsin's story in the 1990s is perhaps one of the most emotive and high profile examples of how his whistle-blowing actions helped to highlight the high mortality rates of babies undergoing heart surgery procedures at the Bristol Royal Infirmary (BBC News, 1998). In 2005, the nurse Margaret Haywood blew the whistle via a BBC Panorama programme when she secretly filmed poor standards of care being provided to elderly patients on a hospital ward at a Brighton Hospital (BBC Panorama, 2005).
Both whistle-blowers in these examples were willing to take significant risks both personally and in their professional career because they felt so strongly about high-lighting the unacceptable and inhumane activities that they were witnessing. Edgar and Pattison (2011: 95) suggest that those who have the courage to blow the whistle on unacceptable standards of practice may be considered ‘moral heroes, paragons of virtue, and admirable exemplars of integrity…’.
Why not blow the whistle?
Raising concerns about misconduct or malpractice is challenging and possibly one of the most problematical situations any employee can face at work. In some instances concerns may be ignored and result in no action being taken. There is also the potential for some kind of negative personal comeback. Widely reported risks by healthcare professionals associated with blowing the whistle include reprisal, retribution and persecution (Attree, 2007; Isaacs, 2010; Whitehead and Barker, 2010; Edgar and Pattison 2011). Studies have shown that fear of such repercussions and retribution is one of the main reasons affecting nurses’ decision not to blow the whistle (Attree, 2007). Dr Bolsin's story was not straight forward or particularly pleasant for him; his concerns were ignored internally for many years and only came to light after he made the media aware. His whistle-blowing eventually resulted in the largest public inquiry in the NHS’ history and despite this enquiry proving the legitimacy of his concerns, Bolsin claimed that his life was made so unbearable in the UK as a result of his whistle-blowing that he had no option but to leave the country.
‘Veterinary nurses who are concerned about the health of a verterinary surgeon must also take steps to ensure that animals are not put at risk and that the interests of the public, including those of their colleague, are protected. This may mean reporting a colleague to the RCVS’.
In addition, if the whistle-blower does not follow certain protocols, he or she could face disciplinary action for breaching their code of conduct or breaching confidential-ity rights. Margaret Haywood's case demonstrates this; she failed to gain consent from the patients she secretly filmed to expose the neglect and ill-treatment they suffered at the hands of the health workers, and this resulted in her losing her job and being struck-off the nursing register by the Nursing and Midwifery Council (NMC) for breaching her professional code of practice. Although interestingly, the NMC's decision was eventually overturned after a deluge of public support and a petition with more than 43 000 names calling for her to be reinstated was presented to the NMC (Royal College of Nursing, 2009a).
There are further reasons why employees who witness wrongdoing or incidents of malpractice may be reluctant to blow the whistle. Edgar and Pattison (2011) warn that practitioners who lack certain integrity and who make rash decisions to blow the whistle without exploring the other issues and perspectives, risk damaging the functioning of the profession and organizations and it is probably not surprising that members of a profession might consider this action to be in conflict with their professional code. The RCVS Guide to Professional Conduct for Veterinary Nurses (Royal College of Veterinary Surgeons, 2010b, S1F(2a)) provides that ‘veterinary nurses must not: ‘speak or write disparagingly about another professional colleague…’ and so it is easy to see how veterinary nurses might be confused about their professional responsibility. Employees face other moral dilemmas, not least that in such a small profession as the veterinary industry, the person blowing the whistle might be reporting a friend or colleague and this action can lead to loss of friendships, a bad reputation and the whistle-blower can be left feeling disloyal and ostracized (Gallagher, 2010).
A relatively new addition to the guide to professional conduct states:
‘Anyone coming into contact with veterinary surgeons, including other veterinary surgeons, veterinary nurses, members of practice staff, clients and healthcare professionals (for example, medical practitioners) who has concerns that a veterinary surgeon's health may be impairing fitness to practise is encouraged to report those concerns to the RCVS as soon as is reasonably practicable.
In addition, veterinary surgeons and veterinary nurses who are concerned about the health of a veterinary surgeon must also take steps to ensure that animals are not put at risk and that the interests of the public, including those of their colleague, are protected. This may mean reporting a colleague to the RCVS’ (Royal College of Veterinary Surgeons, 2010c).
Uhl-Bien and Carsten (2007) highlighted a number of issues surrounding employees experiencing difficulties reporting colleagues, one of which might be directly applicable to a veterinary nursing/veterinary practitioner situation. They concluded that the hierarchical structure of many organizations can result in ‘obedience to authority’, creating an environment where employees are less likely to report their bosses. Those considered to be ‘lower’ in the hierarchy are more likely to take a submissive role and less likely to question the decisions of those ‘above’ them. It is also thought that employees are also more likely to keep quiet because they fear victimization by their employer and are worried in case they put their current or any future jobs at risk (Krull, 1996; Attree 2007). In small, privately owned veterinary practices, VNs may find themselves in a position where the person they have concerns about is the person they should report the wrongdoing to. This presents a difficult situation and could leave the VN feeling that there is no easy route or outlet for expressing their concerns.
However, individuals who do not blow the whistle on genuine and continued wrongdoing leave themselves in a perilous position both personally and professionally. By turning a ‘blind eye’ to unacceptable standards of care, employees may experience negative and guilty emotions. As summed up by one doctor, recounting an experience as a junior doctor when his seniors closed rank and lied to the husband of a patient about the cause of his wife's death, ‘I missed my chance to blow the whistle and it still haunts me’ (Isaacs, 2010: 213). Ultimately, not doing anything has professional implications for RVNs, who not only have a duty of care to the patients and clients seen at the time, but also to future patients and their owners. As Gallagher (2010: 22) cautions ‘If they do not take action, unethical practice continues and questions may be asked about why they have failed in their professional responsibilities’.
What activities warrant blowing the whistle?
It can sometimes be difficult for individuals to determine what kinds of activities warrant blowing the whistle on, but Jones’ (1991) summary of unethical behaviour in decision making is a good starting point (Gino and Bazerman, 2009: 709), defining an action that is ‘either illegal or morally unacceptable to the larger community’ as one that warrants whistle-blowing. Individuals who have concerns must make the distinction between one of genuine mistakes and continued in-competency and malpractice. Johnstone and Kanitsaki (2006) suggest that, keeping records of incidents and near misses through clinical audits is a way that allows a picture to be built up of the true nature and frequency of incidents, and may be helpful in determining the difference between one of mistakes and continued malpractice.
In the UK, The Public Interest Disclosure Act 1999 came into force with the purpose of encouraging employees to report malpractice and wrongdoings in their workplace to voice their concerns without fear of retribution or dismissal (HMSO, 1998). For employees to be protected by this legislation however, they must follow certain prescribed protocols. First, they must ensure that the wrongdoing they are reporting is one that is classified by the Act as a ‘qualifying disclosure’ (Box 1).
Box 1.Qualifying disclosuresTo be protected as a whistle-blower you need to make a ‘qualifying disclosure’ about malpractice. This could be a disclosure about:
- Criminal offences
- Failure to comply with a legal obligation
- Miscarriages of justice
- Threats to an individual's health and safety
- Damage to the environment
- A deliberate attempt to cover up any of the above
Source: www.direct.gov.uk, 2011
How to blow the whistle?
Once someone has determined to bring some aspect of malpractice to light, they then have further choices to make about who to tell which includes whether to report internally (to a senior member of staff) or externally (e.g. via a professional body or to the media), in confidence or publically. Again, legislation requires that whistle-blowing must be done in the right way and to the right people so that the employee's employment rights are protected (Box 2). In the first instance the whistle-blower should raise their concerns internally to an appropriate staff member. Some employers provide employees with guidance on what to do or specify the procedure in their contracts of employment. When or if reporting internally fails to work and where individuals still feel that their concerns have not been addressed, whistle-blowers may choose to approach external organizations such as their professional body, member's helplines or support services. Very occasionally, when all else has failed, the whistle-blower may decide to go public and involve the media.
Box 2.Making sure you are protected by the lawYou must:
- Make the disclosure in good faith (which means with honest intent and without malice)
- Reasonably believe that the information is substantially true
- Reasonably believe you are making the disclosure to the right ‘prescribed person’
If you make a qualifying disclosure in good faith to your employer, or through a process that your employer has agreed, you are protected. You should check your employment contract to see if your employer has set out a process for whistle-blowing. If you feel unable to make a disclosure to your employer then there are other ‘prescribed people’ you can make a disclosure to. If you are unsure, you should always get professional advice before going ahead.In some circumstances you may be able to make a disclosure to someone who is not your employer or prescribed. To make a protected disclosure to others you must either:
- Reasonably believe your employer would treat you unfairly if you made the disclosure to your employer or a prescribed person
- Reasonably believe that your disclosure to the employer would result in the destruction or concealment of information about the wrongdoing
- Have previously disclosed the same or very similar information to your employer or a prescribed person
Source: www.direct.gov.uk, 2011
Recommendations
It is apparent from some of the findings in the health professions that blowing the whistle on wrongdoings, malpractice and poor standards of care is fraught with professional and personal dilemmas.
From the authors’ experience of teaching professional studies on undergraduate and post qualification courses for veterinary nurses, it is apparent that VNs are unclear of their professional level of responsibility with regard to reporting acts of malpractice and misconduct that they witness, and do not know how or who they should report. To highlight some of the issues faced by human nurses witnessing poor standards, a study of over 5000 RCN members revealed that over half of nurses who highlighted issues about patient safety with their employers, said no action was taken in more than one in three of these reported incidents (Royal College of Nursing, 2009b). At this stage, it is unknown whether a similar experience is happening in the veterinary profession and it may be a pertinent time for the profession to determine first, if there is a significant problem within the profession regarding patient safety, poor standards of care and continued malpractice and second, if there is a problem, do members of the profession fully understand how to deal with this?
Whistle-blowing can be a vital way to drive improvements in patient care and services to the public. Uhl-Bien and Carsten (2007) suggest an upward ethical leadership behaviour style and a training programme for employees to help them take a proactive approach when responding to wrongdoing they have witnessed. In addition it is recommended that organizations should move away from ‘command-and-control’ cultures (Uhl-Bien and Carsten, 2007) and promote an ethical environment through strong ethical codes and strategies for dealing with reporting acts of wrongdoing. These strategies could include providing employees with hotlines or easily accessible information and support services for reporting malpractice similar to The Royal College of Nursing's recent launch of its dedicated telephone support service for members.
Undertaking further professional training, academic studies and relevant continued professional development (CPD) may help to ensure that not only do VNs have a clear understanding of their professional responsibilities but that they have the knowledge of relevant legislation to ensure they are aware of how they can blow the whistle and be protected by the law.
Where to get help and useful contactsBlowing the whistle is a serious matter and if you are unsure, you should get professional advice before making a disclosure.Check your:
- Employment contracts
- Guide to Professional Conduct
- Find a solicitor or advice agency (see below)
- Public Concern at Work website (an independent organization providing free advice if you are not sure if you should raise a concern about workplace malpractice or how to raise your concern)
- Acas (Advisory, Conciliation and Arbitration Service)
- Citizens Advice Bureau
- Directgov — online information about how to blow the whistle and be protected by the law
- British Veterinary Nursing Association (BVNA) — free and confidential members helpline and support service
- Veterinary Defense Society (VDS) — free helpline for members
- Royal College of Veterinary Surgeons (RCVS) — provide guidance and advice notes about the complaints procedure
It is important that VNs can differentiate between genuine ‘errors’ as opposed to malpractice. It is helpful to conduct clinical audits and keep record of incidents that occur. These records will form a database to help to identify the true nature and frequency of incidents and therefore this can help to reveal persistent acts of incompetence or malpractice.
With all of the recent initiatives to drive RVNs towards professional status and fully accountable practitioners, it may be an appropriate time to review current information provided and for the professional body to offer more guidance through clear whistle-blowing policies.
All RVNs should be accountable for promoting ethical practice. RVNs need to establish strong networks within their own profession to provide a source of advice and support for each other and allow them to lessen their sense of dependency and take command of their future profession.
Conclusion
Witnessing a colleague's continued malpractice or misconduct provides anyone with difficult decisions and challenges. There are a number of long-term benefits which should happen as a result of whistle-blowing: these include improved standards of care to patients and the general public; increased levels of professional accountability; and the publics’ respect. Members of a profession have a professional responsibility to maintain a high level of the public's trust and there are a number of reported risks and reasons which can make reporting difficult.
Any VN faced with an issue that warrants whistle-blowing should be aware of the issues and take the necessary steps to follow correct procedure to ensure that they do so in the right way. Some professional bodies provide their members with detailed guidance on what to do when placed in this position and it might be time for the veterinary profession to review the way it guides and support its colleagues through this challenging and emotional process.
Key Points
- Blowing the whistle on malpractice or poor standards of care is vital to help drive improvements in patient care and services to the public.
- Blowing the whistle on a colleague's malpractice creates legal, professional and ethical dilemmas for veterinary nurses.
- Veterinary nurses have a professional responsibility to report malpractice and misconduct.
- Veterinary nurses who blow the whistle must do so in a way that is in line with relevant legislation and does not breach their code of conduct.