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Whistleblowing: a last resort?

The case of Margaret Haywood at the Royal Sussex Hospital in Brighton has raised important issues for nurses and other healthcare professionals who have concerns about patient care.

Margaret, a nurse for 20 years with an exemplary record, was investigated and suspended for whistleblowing, and accused of breaching confidentiality when secretly filming the care of elderly residents. Having initially been found guilty and struck off the Nursing and Midwifery Council (NMC) register, she has now been given a one-year caution.

While the case is complicated, the issues were clear, and similarities with other recent high-profile cases were obvious; so one wonders whether we learn from such incidents. Fundamental aspects of basic care were once again compromised.

A recent survey by the NMC and Nursing Standard, Public Concern at Work, showed that 87% of respondents would blow the whistle even if they had suffered reprisals in the past. This is a reassuring statistic and shows nurses are willing to challenge poor practice; but there is still room for improvement.

Furthermore, 47% still said they felt incidents were handled badly and, clearly, learning can take place from this. Improvements must be made if the quality of care delivered is to be enhanced further under the clinical governance agenda. Simplifying and clarifying the process would be one way of doing this.

Nurses and healthcare professionals are often unsure about what to do and can feel unsupported by managers when they raise concerns; indeed, they can often be made to feel like they are at fault. Even where policies exist, employees are often unsure about them because they are too complicated or they can fear reprisals, particularly where employment issues are affected. However, our NMC Code of Conduct (2008) should support us if we are acting in the best interests of our patients, and nurses need to use this to raise concerns at an early stage and reinforce their actions.

Whistleblowing should be a last resort. There needs to be a change in culture whereby the person raising concerns is not made the scapegoat. As nurses we also need to demand access to the support mechanisms available to us, such as training and development, and resources such as clinical supervision or action learning sets, which can be an important tool in raising standards of care and supporting our professional practice.

Peer support in situations of concern can be crucial in helping you understand and decide how to tackle an issue and clinical supervision provides this, particularly where professionals are working in isolation and there isn't the opportunity to share best practice. Managers need to embrace such strategies if there is to be a change in culture within healthcare.

It may interest you to know that, in 2009, another whistleblower, Graham Pink, who raised concerns about the care of the elderly, was voted one of the most influential nurses of the past 60 years by Nursing Times readers. So perhaps while not supported at the time, he may feel it was all worth it!

Well done to Margaret Haywood for being brave enough to speak up for vulnerable patients, who need nurses like her to improve standards and challenge unacceptable practices. Would you be prepared to do the same I wonder?

Nursing and Midwifery Council (NMC). Whistleblowing Or Escalating Concerns. NMC News 2009;30:16-9.
Public Concern at Work. Available at: