By Lisa M. Black, PhD, RN, CNE
Tragedy into Policy: A Quantitative Study of
Nurses’ Attitudes Toward Patient Advocacy Activities
T he for sTudy findings lead To new legal proTecTions
Background: In 2007 and 2008, 115 patients were found to be either cer tainly 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 condi tion 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 organiza tional 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.
AJN ▼ June 2011
lthough the Centers for Disease Control and Prevention (CDC) reports that an estimated 3.2 million Americans are living with chronic hepatitis C, in southern Ne vada fewer than four cases of acute hepa titis C are confirmed annually.1, 2 So when six people who had recently undergone endoscopic procedures were diagnosed with acute hepatitis C within a six month period (July 2007 to December 2007), alarms were sounded.1 Ultimately, more than 62,000 patients who had undergone endoscopic procedures at either of two southern Nevada endoscopy clinics would be notified that they might have been exposed to blood borne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices.3 In total, seven patients would be confirmed as having clinicassociated HCV infections that were genetically linked to source patients; two more had clinicassociated HCV infections that could not be so genetically linked; and an additional 106 patients were presumptively diagnosed with “possible clinic associated HCV infection.”3, 4 This appears to be the largest nosocomial patient exposure to a bloodborne pathogen in the United States ever documented in the literature. BACKGROUND In January 2008, the CDC, the Nevada State Health Division, and the Southern Nevada Health District be gan a joint epidemiologic investigation. The investiga tors found multiple breaches of infection control and recordkeeping protocols at the two Las Vegas–area clinics, including the reuse of syringes, medication vials, ajnonline.com Vol. 111, No. 6
bite blocks (devices placed in the mouth during upper endoscopies), and other equipment intended for single use.4, 5 At one clinic, the staff reported that “the rule was to reuse singleuse equipment three