from the media) will not be protected. Moreover, the nurse would have to show
that internal disclosure would have been ineffective as leading to the concealment
or destruction of evidence, or victimisation, or because previous, similar
disclosures had been ignored. Where there is public disclosure, a court or tribunal
can take into account a number of factors relating to the seriousness of the
incident, issues of patient confidentiality, the workings of internal proceedings,
etc. in deciding whether the disclosure is protected by the Act.
In the case of exceptionally serious disclosures it is possible to make public
disclosure immediately, without the need to show fear of victimisation, likely
cover-up or previous inaction. However it would be rare indeed for a nurse to be
justified in going immediately to the media, when other options, such as a Member
of Parliament or a professional association are available. Unfortunately there is
nothing in the Act to require internal procedures to deal with complaints by nurses
concerning the inadequacy of patient care. This may mean that disclosure is no
easy matter for a nurse as he or she informs immediate supervisors, then the
employer, only to witness prevarication or inaction. This may drag the nurse into
the uncomfortable territory of increasingly public disclosure, where the nurse is
already unpopular and may fear more subtle forms of prejudice ± such as the
failure to gain promotion.
Nonetheless, increasingly, there are professional demands made upon nurses.
The UKCC Code of Conduct suggests that the nurse must report circumstances
which could jeopardise standards of practice and must also report circumstances
in which an appropriate standard of care cannot be provided. Such reporting
should be to an appropriate person or authority'. Again, the UKCC Code suggests that nurses shoulddecline any duties or responsibilities unless able to perform
them in a safe and skilled manner'. Increasingly it seems that nurses cannot merely
stand by and ignore declining standards of patient care. It is the nurse who is seen
as occupying the role as patient advocate, and arguably nurses find themselves
under a more direct professional duty to take action in relation to resource
shortfalls than do the doctors.
8.9 Case study
Wisanight duty charge nurse on a ward for acutely ill patients. She believes that
the standard of care for those patients has dropped dramatically due to two events:
the withdrawal of one night nurse, on a permanent basis, from ward duty, and the
replacement over time of a number of more experienced nurses by junior staff.
Matters come to a head when a patient dies in distressing circumstances, in a
situation which W believes was largely a consequence of lack of adequate super-
vision on the ward.
Under the UKCC's Code of Conduct, W here should report to an appropriate person or authority, having regard to the physical psychological and social effects on patients and clients, any circumstances in the environment of care which would jeopardise standards of practice'. Similarly it is said that she shouldreport to an
appropriate person or authority any circumstances in which safe and appropriate
care for patients and clients cannot be provided'. W clearly finds herself in this
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