1. Lehman, Kay MSN, RN

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After the September 11 terrorist attacks many wondered if the government had done everything possible to prevent the attacks. But among those who knew about what may have gone wrong, few stepped forward. One who did was Coleen Rowley, Federal Bureau of Investigation (FBI) special agent and chief division counsel at the FBI field office in Minneapolis. In May 2002, in a detailed memo to FBI director Robert S. Mueller III, Rowley shared her concern regarding the FBI's lack of candidness by claiming, "certain facts [horizontal ellipsis] have, up to now, been omitted, downplayed, glossed over and/or mischaracterized in an effort to avoid or minimize personal and/or institutional embarrassment." A month later, she testified before the Senate Judiciary Committee.


Comparing an FBI agent to a nurse may require a stretch of the imagination. But just as an agent is privy to information on how well the government is protecting its citizens, so too do nurses have knowledge of their institutions' policies regarding patient safety. When they observe policies and behaviors that are hurting-or possibly killing-patients, they can either speak out and risk their jobs, or look the other way.


For Rowley, looking the other way didn't seem like an option. In August 2001 when Zacarias Moussaoui, a French citizen later accused of being "the 20th hijacker," was arrested for overstaying his visa, Minneapolis agents had requested to search his laptop computer, having received information from the French Intelligence Service that Moussaoui was affiliated with radical Islamic fundamentalist groups. Their request was repeatedly denied; the computer wasn't searched.


Rowley expressed her dismay over the Moussaoui case in her memo to Mueller and to the Senate Judiciary Committee. At the proceedings, which were aired on television, she sat poised and confident, never flinching as Senators hammered her with questions about her accusations against the FBI. As I watched, it occurred to me that she demonstrated qualities that would serve nurses well: she had courage, she advocated what she believed in, and she sought the truth.


Perhaps her courage to speak out was fueled by the thought of all the lives that might have been saved had the September 11 attacks been thwarted. Rowley's interest lay in protecting U.S. citizens, and she called to account an agency that existed for that purpose. She also wanted to shed light on the truth: "My only purpose," she wrote in the memo, "is to try to provide the facts within my purview so that an accurate assessment can be obtained and we can learn from our mistakes." She contended that bureaucracy hindered the tasks of those entrusted with the real work of the FBI, and she boldly accused the leadership of risk aversion, "careerism," and not taking action to avoid getting "written up."


In our own workplaces we may recognize policies and procedures that endanger patients but remain in place because "they have always been that way." These may be as substantial as inadequate nurse staffing, which hampers patient care, or as seemingly simple as physicians' handwritten prescriptions, orders, and progress reports, which can not only lead to medication errors but could cause miscommunication regarding a patient's status. As nurses, we may hesitate to bring attention to these problems because we don't feel we can change the way things are done, or because we don't want to be branded as troublemakers. But as the example of Coleen Rowley demonstrates, even someone who isn't at the top of the ladder can help change harmful policies by pointing them out.