Whistle Blowers & Patient Advocates: When the Nurse Stands Alone

oil on unstreched canvas (detail) 2009 JParadisi

A colleague and I discussed the Winkler County Whistle Blowers case and our admiration for Registered Nurses Vicki Galle and Anne Mitchell. They brought the nurse’s role of patient safety advocate into the national spotlight.

My colleague is also a force to reckon with when it comes to patient advocacy. During our conversation she grew quiet and told me once, she had advocated for a patient without the support of her peers or administration.

The event occurred early in her nursing career, before she gained the skill and knowledge, which now empower her ability to act confidently as an advocate. In the end, she followed orders, even though they conflicted with her ethics. Decades later, she still regrets her choice.

I listened to her story, and tried to imagine her as a young nurse, uncertain and faced with a situation nursing school had not prepared her for. I imagined her alone and isolated, the only one in a nursing unit who felt, or more likely, spoke out loud the feeling that what was happening might not be best for the patient.

The Winkler County Whistle Blower case demonstrates that this kind of moral isolation still happens to nurses. However, it also demonstrates that nurses have developed resources for themselves and learned how to access them. These days, many hospitals have ethics committees and safety committees for reporting unsafe systems and behavior. Many hospitals have policies protecting nurses who refuse to administer treatments that conflict with their moral beliefs. Winkler County Memorial hospital fired Anne Mitchell and Vicki Galle when they used the hospital’s safety chain of command to protect patients, but the hospital and the doctor bringing charges against them found out this kind of punitive behavior is no longer tolerated by the court system or a majority of health care professionals. The Texas Nurses Association and the American Nurses Association said, “We are watching,” as did the Texas Medical Board. I’ve heard the conversations of doctors who ask why Dr. Arafile’s colleagues didn’t report his behavior. Why was the responsibility left to nurses? If any of these resources were available for my nurse colleague when she faced her dilemma decades ago, I would be surprised.

My heart breaks for that young nurse, facing an ethical dilemma alone and unsupported, with nowhere to turn. I told my colleague I hope she has forgiven that young, inexperienced, and frightened version of herself, with  her older, more experienced self’s compassion. I suggested that what she learned from that episode long ago has forged her into the warrior nurse advocate she is today, benefiting hundreds of patients during her long career as their advocate.


  1. Thank you for your thoughtful post. I have been following this case as well.

    The events occurring in Texas are disturbing. I am far more concerned with the absence of support from organized medicine. Why were the nursing organizations the only vocal supporters of the nurses? The silence of the rest of organized medicine is damning.

    The entire medical community just told nurses, in the most eloquent way possible, what to expect from organized medicine when nurses stand up for patient safety:

    That silence explains all the problems we see today in patient safety.

    Lee Tilson


  2. Thank you for the story. I have just become the new Patient Advocate in my VA facility and I am trying to create my own style and platform for dealing with patient concerns. Reading about this story empowers me to do the right thing and advocate for patients regardless of the outcome. More power to everyone in the medical field standing up for the patients.


    1. The Texas Nurses Association and the American Nurses Association deserve credit for bringing this case to national attention. I hope every health care professional who reads about Vicki Galle and Anne Marshall takes the same empowerment from the story that you have. I think that’s the best outcome possible for the story’s message. Congratulations on your new position, Schoen!


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