The Reason Hospitals Won’t Let Doctors and Nurses Speak Out

The NY Times today carried this moving and powerful column from our own Theresa Brown. If you, too, are frightened that speaking out will endanger your job, please know that we are committed to protecting the privacy of everyone who joins this Forum and shares his or her experience. Only your first name and last initial will show publicly on the site, along with any personal information you choose to share.

Here's Theresa's experience, as she told it in today's newspaper:

I know what it’s like to face a gag order after calling attention to life-threatening problems.

During the Covid-19 pandemic, it’s not just the risk of disease that has nurses and doctors worried. Across the country, thousands fear that speaking up about shortages of personal protective equipment and staff will lead to disciplinary action and possibly get them fired. Many hospitals have instituted gag orders to make it clear that publicly advocating for safer working conditions could lead to losing one’s job — and as Nicholas Kristof and others have demonstrated, dozens have already been punished.

I am a nurse, and while I am not currently working on the front lines, I know how those nurses and doctors feel. I was one of them: forced out of a job I loved because I wouldn’t agree to stop writing and speaking about the problems in our health care system.

I have never told this story publicly, and even now it is unsettling. I was naïve when I began writing as a nurse, for this newspaper. I thought that everyone involved in health care wanted all patients to receive the best care possible and that drawing attention to problems would lead to their being solved. Instead I was accused by administrators of “making the hospital look bad.” And even though I scrupulously adhered to federal privacy requirements, never named my hospital and de-identified staff members as much as possible, I finally received an ultimatum: If I wrote or spoke further, I would be fired.

The hospital’s chief nursing officer said that my writing was compromising care and that several oncologists — who were never named and supposedly would not meet with me — complained that they could not practice the way they wanted to with me on the floor. This came after a series of intimidating meetings I had with the chief nursing officer and a corporate lawyer. People who haven’t been through a similar gantlet of corporate suspicion have no idea how stressful it is: I was a floor nurse being repeatedly cold-called into meetings, while my job was to care for very sick bone-marrow-transplant patients. By the time I quit, I was having regular heart palpitations.

I kept this story to myself because I didn’t think my individual trouble with my employer mattered much beyond my personal story. I also worried about being branded a “disgruntled former employee,” a label that could have kept me from ever working as a nurse in Pittsburgh again. I simply had too much to lose.

The nurses and doctors being silenced now, though, have too much to lose if they do not speak up. They don’t want to infect their grandparents, spouses or children with the coronavirus. They don’t want to infect their non-Covid-19 patients. They don’t want to lose their jobs, but they also don’t want to lose their lives.

The real question here is, Why do they have to make such a choice? Why are hospital systems issuing gag orders? And why, when complaints about lack of personal protective equipment or poor management of Covid-19 patients come out, does a hospital representative so often deny everything, even when the evidence is damning? Why are hospitals so intent on defending their own images, rather than their nurses, doctors and patients?

One obvious explanation is money. Hospitals could be worried about being sued, by patients or staff members, for negligence during the Covid-19 pandemic. There may also be regulatory issues that hospitals worry about being dinged for that could lead to loss of income or threaten their accreditation.

But my experience suggests that restricting employees’ speech goes deeper and relates to the continuing corporatization of American medicine. Gag orders and representatives who come across like spin doctors waging a political campaign are the product of corporate health care systems focused on their “brand,” outselling the “competition” and making as much money as possible.

Controlling employee speech is the dark side of this branding and spin. The health system I worked in was very hierarchical, not just in the clinical setting, but also in terms of how management related to staffs. Information came from the top down. Questioning of policies and practices was disapproved of, at times even when that questioning addressed patient safety. No surprise, my former employer has issued a gag order for all of the staff during the pandemic. Clinicians who fear the virus and lack sufficient protective equipment must now work in an environment where they fear the hospital administration as well.

The biggest problem with this watertight approach to information and focus on hospital brands is that maximizing health care revenue does not mean patients receive the best possible care. The United States spends more on health care per person than any other industrialized country, but our patients overall do worse.

Silence is golden, I used to hear as a child, implying that holding one’s tongue has social value in and of itself. In some situations that may be true, but not with the Covid-19 crisis. Patients and nurses and doctors are dying. Prohibitions against speaking up about their clinical needs can only make the number of dead increase, because those clinical needs are real. Front-line workers lack adequate supplies, they do not have tests for the virus, and they keep losing staff members to sickness.

But they do have courage, commitment and their voices — of compassion and outrage intertwined. If the richest country in the world cannot care for its hospital workers, can’t we at least protect their speech? Their protest is a stark distress call in the middle of an already terrible emergency.

Theresa Brown is a clinical faculty member at the University of Pittsburgh School of Nursing and the author of “The Shift: One Nurse, Twelve Hours, Four Patients’ Lives.”

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