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Background: Whistle-blowing is an ethical activity that tries to end wrongdoing. Wrongdoing in healthcare varies from inappropriate behaviour to illegal action. Whistle-blowing can have negative consequences for the whistle-blower, often in the form of bullying or retribution. Despite the wrongdoing and negative tone of whistle-blowing, there is limited literature exploring them in healthcare. Objective: The aim was to describe possible wrongdoing in Finnish healthcare and to examine whistle-blowing processes described on the basis of the existing literature in healthcare as perceived by healthcare professionals. Research design: The study was a cross-sectional descriptive survey. The data were collected using the electronic questionnaire Whistle-blowing in Health Care and analysed statistically. Participants and research context: A total of 397 Finnish healthcare professionals participated, 278 of whom had either suspected or observed wrongdoing in healthcare, which established the data for this article. Ethical considerations: Ethical approval was obtained from the Ethics Committee of the University (20/2015). Permission to conduct the study was received according to the organisation’s policies. Findings: Wrongdoing occurs in healthcare, as 96% of the participants had suspected and 94% had observed wrongdoing. Regarding the frequency, wrongdoing was suspected (57%) and observed (52%) more than once a month. Organisation-related wrongdoing was the most common type of wrongdoing (suspected 70%, observed 66%). In total, two whistle-blowing processes were confirmed in healthcare: (1) from suspicion to consequences occurred to 27%, and (2) from observation to consequences occurred to 37% of the participants. Discussion and conclusion: Wrongdoing occurs in healthcare quite frequently. Whistle-blowing processes were described based on the existing literature, but two separate processes were confirmed by the empirical data. More research is needed on wrongdoing and whistle-blowing on it in healthcare.

It sometimes seems that we expect our regulators to be superheroes. We expect them to predict, detect and punish wrongdoing. We expect them to protect the rights and interests of vulnerable citizens. We expect them to provide guidance on exemplary ethical behaviour for every eventuality. We expect them to weigh benefits and harms wisely and bestow penalties on offenders that all agree are fair and appropriate. We might even find ourselves wishing that, like Wonder Woman or Spiderman, our professional regulators will be ‘the champions of right and good against evil and injustice’. Whatever we might expect or wish, the track record of regulators of health and social care professionals is much more limited and contested. The care contexts and conduct these regulators are concerned with are much more complex than the generally more straightforward domains of superheroes. In the terrain of the superheroes, villains are wholeheartedly welcomed villainous and interventions to protect vulnerable citizens are unanimously welcomed (by good people at any rate). Superheroes’ decision-making is generally more black and white with few shades of grey and with little of the messiness, ambiguity and complexity of the ‘swampy lowlands’ of contemporary health and social care practice. I was reminded of this last week, as I attended an excellent conference on the theme of ‘Regulating for positive outcomes’. The conference brought together UK health and social care regulators and academics engaged in regulation-related research. Reassuringly, there is now a good deal of activity developing a stronger evidence base for regulatory practice with collaborative interdisciplinary initiatives relating to questions such as ‘How are we to understand and prevent unethical practice?’ ‘What role might patients and the public play in regulatory activities?’ ‘Which factors contribute to different judgements regarding sanctions for misconduct?’ ‘Why, for example, might members of the public view a dentist’s tax evasion more leniently than the regulator?’ And which approach to regulation is most appropriate for 21st century purposes: Right-touch regulation? Relational regulation? Values-based regulation? Or some combination? The conference also included discussion of the potentially detrimental impact of regulators’ interventions relating to responses to complaints and management of ‘warnings’. One speaker referred to doctors’ increased vulnerability to self-harm and mental distress following complaints. The discussion focused on the potential of regulators to be viewed as adversaries rather than as humane and objective investigators charged with public protection and fairness in relation to professionals. Reaching consensus on what it means to be a ‘good regulator’ is challenging. A recent report from the Professional Standards Authority stated that ‘Health and care regulation is incoherent and expensive and there is little evidence for its effectiveness; if it was going to improve care it would have done so by now. It’s time to rethink regulation’. Is it reasonable to expect regulators to improve care? Can we know what care would be like without regulation? We might speculate as to what regulatory success might look like and

In Israel, whistleblowing in the nursing profession has been largely ignored. This topic is neither part of the professional—ethical discourse nor a subject for research. Focusing on the divide between internal and external whistleblowing, this article presents a study that explores nurses’ willingness to disclose an act that could jeopardize the rights or safety of patients. Internal disclosure entails reporting wrongdoing to an authority within the organization. External disclosure involves reporting the offense to an outside agency, such as a professional organization or the press. The study’s findings indicate that the nurse respondents viewed both the harmful misconduct of a colleague and that of a manager as being very serious. In such dilemmas the nurses reported a desire to correct the wrongdoing and a concomitant willingness to act. They were, however, much more likely to whistleblow internally rather than externally. This study revealed a pattern of nurses’ progressive retraction as the circle of disclosure widened.

This study aims to unveil the process of whistleblowing. Two nursing staff members who worked in a psychiatric hospital convicted of large-scale wrongdoing were interviewed. Data were analyzed using a modified grounded theory approach. Analysis of the interviews demonstrated that they did not decide to whistleblow when they were suspicious or had an awareness of wrongdoing. They continued to work, driven by appreciation, affection, and a sense of duty. Their decision to whistleblow was ultimately motivated by firm conviction. Shortly after whistleblowing, wavering emotions were observed, consisting of a guilty conscience, fear of retribution, and pride, which subsequently transformed to stable emotions containing a sense of relief and regret for delayed action. It is necessary for nurses to recognize that their professional responsibility is primarily to patients, not to organizations. Nurses should also have professional judgment about appropriate allegiance and actions.

This article, written from research data, focuses on the possible meaning of the data rather than on detailed statistical reporting. It defines whistleblowing as an act of the international nursing ethical ideal of advocacy, and places it in the larger context of professional responsibility. The experiences, actions, and ethical positions of 24 Japanese nurses regarding whistleblowing or reporting a colleague for wrongdoing provide the data. Of these respondents, similar in age, educational level and clinical experience, 10 had previously reported another nurse and 12 had reported a physician for a wrongful act. These data raise questions about overt actions to expose a colleague in a culture that values group loyalty and saving face. Additional research is needed for an in-depth understanding of whistleblowing, patient advocacy and professional responsibility across cultures, especially those that value group loyalty, saving face and similar concepts to the Japanese Ishin Denshin, where the value is on implicit understanding requiring indirect communication. Usually, being direct and openly discussing sensitive topics is not valued in Japan because such behavior disrupts the most fundamental value, harmony (wa).