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Dismissible offence

October 17, 2006 - Today The West Australian reported on an effort by Royal Perth Hospital nurse Diane Harrison to publicize "critical bed shortages," and an apparent government move to "silence" her, despite legal protections for such public sector whistleblowers. Anne Calverley's article highlights (but does not discuss) the particular difficulty bedside nurses may face in pushing for sufficient resources. Nurses spend more time with patients than any other health professionals, and patient advocacy is central to their profession, yet nursing has long been associated with unempowered meekness. Ms. Harrison's decidedly unmeek advocacy is apparently linked to overcrowding in her hospital's emergency department. The piece might have explained how such conditions can affect patients and staff. Even so, we thank Ms. Calverley and the West Australian for coverage of these important issues.

"RPH nurse sparks claims of secrecy" reports that, after Western Australia Health Minister Jim McGinty blamed overcrowding in the ED on poor hospital management, Harrison wrote a letter to the paper that "expressed outrage" at his claim. She argued that the problem was caused by "a critical bed shortage," and also accused McGinty and Health Department director-general Neale Fong of "playing down the problems for their own political reason." (It's not clear from this piece whether this "shortage" is a lack of staff, or physical capacity, or both.) Apparently Harrison also asked the management of the hospital if she could speak to the media, but she "was advised it constituted a 'dismissible offence' under public sector management guidelines." After the West Australian "made inquiries" about "her concerns," the paper says, McGinty "gave permission for Diane Harrison to speak publicly, but by then she was reluctant to do so."

Not exactly pulling punches, the paper says the row is "another example of the Government trying to silence public servants who do not toe the Government line," that it has "spark[ed] claims of a culture of secrecy in the public service," and that health groups say it "cast[s] doubt on the protections available to whistleblowers under public disclosure laws passed in 2003." In particular, the piece reports that Australian Medical Association state president Geoff Dobb fears that "targeting whistleblowers might breed a 'culture of denial' that [] almost proved the downfall of the Queensland health service in the recent Dr Death saga"--a reference to the scandal surrounding efforts by nurses and others to limit the harm apparently caused by Jayant Patel, an allegedly incompetent surgeon. The piece also says Australian Nursing Federation state secretary Mark Olson "condemned the whistleblower laws as weak and self-serving because people faced penalties for seeking help from outside the bureaucratic system." Olson reportedly says the result is that "the public has even less idea now about what is going on in the health system than they did before the laws were brought in."

One thing the piece appears to suggest is that "whistleblower" statutes that limit protections to internal government procedures and forbid disclosure outside the government may not be effective, at least not without strict safeguards to ensure the independence of such procedures. The piece also appears to reflect the difficult situation of bedside nurses, who spend more time with patients than any other group of health professionals, and whose profession includes patient advocacy as one of its central tenets. Such nurses may be in the best position and be strongly motivated to act as "whistleblowers," and so may be most affected when systemic protections are inadequate. Of course, such advocacy runs counter to the profession's enduring lack of empowerment and related culture of silence, which is obviously in tension with its "patient advocacy" principle. However, Ms. Harrison has clearly moved from silence to voice.

The piece might have explained briefly how "bed shortages" can affect patients and staff. A lack of resources, including staff, can have grave negative effects on patient outcomes, as research has shown. And nurses working with insufficient resources are more likely to burn out and leave the bedside, which is the last thing any nation needs during the current shortage.

We thank those responsible for this helpful piece.

See the article "RPH nurse sparks claims of secrecy" from the October 17, 2006 edition of the West Australian.


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