In the pursuit of advocating for patients and promoting safer workplace environments, nurses often find themselves caught in a paradox. On one hand, advocacy is a cornerstone of the nursing profession, rooted in ethical obligations to prioritize patient welfare and challenge injustices. On the other, speaking up against systemic issues or workplace wrongdoings can result in employer retaliation.
I have worked with several nurses who were reported to the Board for some trumped up charge after they “became a problem.” A common scenario is when a nurse refuses to accept an unsafe assignment and accesses the chain of command to get more help. Or when nurses challenge a physician who is asking that something be done that the nurse knows is a violation of the standard of care with the physician becoming offended, angry and reports the nurse to the unit Director.
Nurses have a duty to advocate for their patients. They have a duty to protect patients from harm. And yet they fear retaliation from standing up and speaking out.
The Ethical Imperative of Advocacy
Nurses are bound by professional codes of ethics, such as those outlined by the American Nurses Association (ANA), which emphasize the duty to advocate for patients and the community. Advocacy is not merely a professional expectation—it is a moral obligation. Whether it involves reporting unsafe staffing levels, questionable medical practices, or voicing concerns about institutional policies, advocacy is integral to safeguarding public health.
However, the act of standing up often pits nurses against powerful entities within healthcare systems. Hospitals, employers, and even colleagues may perceive advocacy as a challenge to the status quo, especially when it threatens financial or reputational interests. This environment sets the stage for potential retaliation.
An act of retaliation that may be taken is to report the nurse to her State Board of Nursing. Employers will look for issues and go fishing through charts to find errors or simply blame a nurse for a bad patient outcome that happens and was more related to the failure of the physician to respond to multiple pages.
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Board Actions
Regulatory boards, established to uphold the public’s trust in the profession, wield significant authority. Unfortunately, their power can sometimes be leveraged against nurses who speak out. Reporting a nurse to a Board without good cause is an act of “Bad Faith.” Many Boards of Nursing of have sections within their NPA to address Bad Faith reports made by nurses who are reporting other nurses including Chief Nursing Officers. It is considered a violation of the NPA to report a nurse in Bad Faith and yet it happens more often than one would think. The following scenarios illustrate how nurses may face Board actions that resulted from a retaliatory complaint:
- Baseless Complaints: Employers or colleagues may file unfounded complaints with the nursing board, citing unprofessional conduct or incompetence, as a way to silence or discredit the nurse. Nursing boards often investigate these complaints, even when they are clearly retaliatory, and rarely take action against those who file such reports in bad faith. Boards do not consider the retaliatory nature of a complaint as a mitigating factor. Their sole focus remains on whether the reported incident occurred as described. For instance, if a nurse is accused of failing to administer antibiotics on time to a septic patient, the board will scrutinize this specific lapse, disregarding the broader context. It won’t matter if the nurse was overwhelmed with an acute assignment, simultaneously attending to a patient in cardiac arrest and another requiring intensive care. Nor does it matter if the nurse repeatedly requested additional staffing support from the charge nurse and supervisor, citing an unmanageable workload. These contextual factors are often ignored, leaving nurses vulnerable to punitive actions regardless of systemic issues contributing to the incident.
- License Investigations: Even without clear evidence, boards may initiate investigations, suspensions, or sanctions that tarnish a nurse’s reputation and hinder their ability to practice. The investigation process is often prolonged, leaving nurses without updates or insight into what the board is deliberating. The nurse’s account of events is typically limited to a brief written rebuttal or the responses provided during a required board interview. These interviews often resemble interrogations and are frequently conducted by individuals trained in criminal investigation techniques rather than by nurses. Consequently, the nurse’s fate often hinges on the subjective interpretation of the interviewer, who may lack the clinical context necessary to fully understand the circumstances. This approach overlooks systemic issues, such as inadequate staffing or high-acuity assignments, that may have contributed to the reported incident.
- Emotional and Financial Toll: The process of defending one’s license can be lengthy, emotionally draining, and financially ruinous, discouraging others from speaking out. Nurses often emerge from a Board investigation and disciplinary process no longer wanting to work as a nurse because the process is so discouraging.
The Chilling Effect
The fear of facing board actions creates a chilling effect on advocacy. Nurses, aware of the potential consequences, may choose to remain silent rather than risk their careers. This silence not only undermines the profession’s ethical foundation but also compromises patient safety and workplace improvements.
What is Nursing Patient Advocacy? – Felician ABSN
A Call for Systemic Reform
To address this issue, systemic reforms are necessary:
- Whistleblower Protections: Strengthening legal safeguards for nurses who report unsafe practices is critical. These protections must extend to shielding nurses from board actions that arise as retaliation.
- Accountability for Boards: Nursing boards must implement transparent processes to ensure that complaints are thoroughly vetted and not weaponized. Boards should come under some oversight for they themselves to be regulated and to correct the current structure that allows the abuse of power.
- Support Systems for Nurses: Professional organizations and unions should provide resources for nurses facing retaliation, including legal support and advocacy training.
- Cultural Change: Healthcare institutions must foster a culture that values and rewards ethical advocacy, rather than punishing it.
Conclusion
Advocacy is the heart of nursing, yet the risks associated with speaking out threaten to erode the profession’s moral fabric. The struggles nurses face when standing up for what is right highlight the urgent need for systemic changes that protect those who dedicate their lives to safeguarding others. Until such reforms are enacted, the courageous voices of nurse advocates will continue to echo—a testament to the resilience and unwavering commitment of the profession.