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Original Research: Tragedy into Policy: A Quantitative Study of Nurses' Attitudes Toward Patient Advocacy Activities

Black, Lisa M. PhD, RN, CNE

AJN The American Journal of Nursing: June 2011 - Volume 111 - Issue 6 - p 26-35
doi: 10.1097/01.NAJ.0000398537.06542.c0
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Background In 2007 and 2008, 115 patients were found to be either certainly or presumptively infected with the hepatitis C virus through the reuse of contaminated medication vials at two southern Nevada endoscopy clinics. A subsequent joint investigation by federal and state agencies found multiple breaches of infection control protocols. There was also strong anecdotal evidence that among clinic staff, unsafe patient care conditions often went unreported because of a general fear of retaliation. At the request of the Nevada legislature's Legislative Committee on Health Care, a study was conducted to examine Nevada RNs' experiences with workplace attitudes toward patient advocacy activities. This article presents the study findings and reviews how one public health tragedy led to the creation of effective health care policy.

Methods A study questionnaire was developed and tested for reliability and validity. Questionnaires were then sent to an initial sample of 1,725 Nevada RNs, representing 10% of all RNs in the Nevada State Board of Nursing database with active licenses and current Nevada addresses.

Results The response rate was modest at 33% (564 respondents). Of those who responded, 34% indicated that they'd been aware of a patient care condition that could have caused harm to a patient, yet hadn't 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%).

Conclusions The study findings underscore the need for a shift in organizational culture toward one that encourages clear and open communication when patient safety may be in jeopardy. These findings were ultimately used to support the passage of whistleblower protection legislation in Nevada.

Keywords Las Vegas hepatitis C outbreak, patient advocacy, whistleblower.

This study underscores the need for an organizational culture that encourages the reporting of unsafe practices without fear of retaliation. Its findings were ultimately used to support the passage of whistleblower protection legislation in Nevada.

Lisa M. Black is an assistant professor at the Orvis School of Nursing, University of Nevada, Reno. Funding to conduct this study was provided by the Nevada Nurses Association and the Arthur L. Davis Publishing Agency; project support was provided by the Nevada State Board of Nursing. Contact author: lblack@unr.edu. The author has disclosed no significant ties, financial or otherwise, to any company that might have an interest in the publication of this educational activity.

© 2011 Lippincott Williams & Wilkins, Inc.