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Tragedy into Policy: A Hepatitis C Outbreak and a Study of Nevada RNs Lead to New Protections for Whistleblowers

June 7, 2011

By Sylvia Foley, AJN senior editor

In 2008, more than 62,000 people who had undergone procedures at one of two southern Nevada endoscopy clinics were notified that “they might have been exposed to bloodborne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices.” As author Lisa Black reports in this month’s CE–Original Research feature, a subsequent investigation by federal and state agencies found multiple breaches of infection control protocols. Indeed, 115 patients were found to be “either certainly or presumptively infected” with HCV through the reuse of contaminated medication vials.

Especially distressing was strong anecdotal evidence that because of a general fear of workplace retaliation, staff at the two clinics had often failed to report unsafe patient care conditions. At the request of the Nevada legislature, a study was conducted to examine Nevada RNs’ experiences with workplace attitudes toward patient advocacy activities. Black was the principal investigator.

The researchers developed a questionnaire and tested its validity and reliability. Then they sent it to a random sample of 1,725 Nevada RNs; 564 RNs (33%) responded. Among the key findings:

  • 34% of respondents indicated that they’d been aware of a patient care condition that could have caused harm to a patient, yet had not reported it
  • the most common reasons given for nonreporting included fears of workplace retaliation (44%) and a belief that nothing would come of reports that were made (38%)

Black writes:

The findings of this study illustrate the importance of a workplace culture based on openness, not fear. . . . That more than a third of RNs in our study indicated that they’d been aware of a situation that might have harmed a patient and had not reported it is of grave concern and must be addressed.

The study findings were presented to the Nevada legislature and, with the support of the Nevada Nurses Association, the Nevada State Board of Nursing, and local labor unions, a whistleblower protection statute (AB10) was signed into law in May, 2009. As Black notes, this marks a positive shift in health care policy. Among other things, the bill

provides the means for supporting nurses in a workplace environment that encourages “good faith” reporting of patient safety concerns; it also supports the employers’ need to protect patients by retaining the means by which employers can discipline nurses whose actions pose a threat to patient safety.

For more on the study findings and the evolution of Nevada’s whistleblower protection law, read the article and listen to AJN’s exclusive podcast with Black.

You might also check out editor-in-chief Shawn Kennedy’s June editorial on the broader ramifications of the case of Texas RN whistleblowers Vicki Galle and Anne Mitchell. A collection of posts related to whistleblowing can be found here.

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2 comments

  1. [...] writes about the Hep C outbreak in Nevada and the subsequent change in the whistleblower laws in that state.  A patient safety centered workplace  is absolutely critical.  Whatever cultural changes that [...]

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  2. It is tragic when we as nurses are afraid to do our job – yes, patient advocacy is part of our job – because we could be fired, prosecuted or ostracized. The Texas example and the Nevada example are chilling in their repercussions in nursing. Kudos for Nevada in enacting whisleblower protection for nurses, too bad it came too late for those infected with hepatitis because the nurses did not speak up. I am pleased to see that there are steps being taken to help prevent the felony prosecution of nurses for reporting unsafe practices such as what happened to the Texas nurses.

    However, it is going to take more than legislation and clarity in the law to open the door to better advocacy. In the cited study, there was also the over-whelming thought that even if reported, nothing would change. The workplace environment needs to be proactive and dynamic in making changes to protect the patients and the nurses who care for them.

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