1. Thompson, Elizabeth M. MSN, RN, CNOR

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Recently I read about a nurse in Texas who faced felony charges and a prison term for whistle-blowing. Anne Mitchell, then an RN at Winkler Memorial Hospital, anonymously reported a surgeon's questionable behavior to the Texas Medical Board. The surgeon had been reprimanded by the hospital for improper prescribing and surgical procedures. The hospital administrator reported that the only official reprimand to the surgeon, "who had conducted improper surgeries, wounded a patient, and committed other breaches of care-was telling him not to do it again."1

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Unsatisfied with this process, Anne Mitchell and a coworker reported the behavior to the medical board. The surgeon accused them of harassment, and they were charged with "misuse of official information"-a felony in Texas-because the letter included patient case numbers (although no patient names). Both nurses were also fired from their jobs.1


To protect the public, professional nurses are licensed. Your license dictates your scope of practice according to the legal and ethical guidelines of the state board of nursing. We also have codes of ethics and nursing standards of practice through the American Nurses Association (ANA). Legally, ethically, and morally, we have a responsibility to be patient advocates.


The ANA's code of ethics clearly endorses reporting any inappropriate or questionable healthcare practices, and outlines how to do it, starting with talking to the colleague in question and, if necessary, reporting to a higher authority within the institution or to an appropriate external agency. Organizations should have a defined process for reporting questionable practices. But what if an organization doesn't address or correct questionable practices, and this poses a risk for patients? In this case, the ANA's code of ethics supports contacting the appropriate professional organizations or accrediting agencies-even when this poses a substantial risk to you, the nurse.2 This is what Anne Mitchell did.


As perioperative nurses, we advocate for patients in the OR every day; for example, by reviewing the informed consent and other documentation to ensure patient decisions are reflected accurately, maintaining a safe environment, correcting breaks in sterile technique, and ensuring confidentiality. Cases like Anne Mitchell's are extraordinary, but an example of nurses placing themselves at substantial risk when acting as patient advocates. Had she been convicted, Anne Mitchell could have faced 10 years in prison.


The jury took less than an hour to acquit Anne Mitchell, and the jury commended her concern, saying that nurses serve "as the eyes for the patient."3 (Charges against her coworker were dropped.) Clearly the public sees us as their advocates. According to a Gallup poll conducted in 2009, nursing consistently is voted as the most trusted profession. With that trust comes a responsibility to protect and advocate for patients, even when it means putting ourselves at risk.


Elizabeth M. Thompson, MSN, RN, CNOR

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Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]




1. Health Care Advisory Board, February 11, 2010. As nurse trial concludes, analysts warn of chilling effects on whistleblowers. Daily Briefing. Feb. 11, 2010. [Context Link]


2. American Nurses Association. Code of ethics for nurses with interpretive statements. 2005. [Context Link]


3. Health Care Advisory Board. Nurse whistle-blower acquitted in Texas. Daily Briefing. Feb. 12, 2010. [Context Link]