Factors influencing nurses’ decision to blow the whistle: a systematic review

Background: Nurses play a central role in the entire process of notifying malpractice and unethical behaviour within healthcare facilities. Understanding which circumstances makes them go ahead and whistleblow is vital for ensuring that patient safety standards are maintained and ethical conduct is promoted. Objective: This research aims to provide a comprehensive understanding of various factors affecting nurses’ whistleblowing decisions at the individual, organizational, and social levels. It draws from both empirical and theoretical insights to capture the complexity of this decision-making process. Methods: A systematic review was performed following the PRISMA guidelines. A broad search of PubMed, Google Scholar, and the Cochrane Library was conducted using subject headings and keywords related to nurses and whistleblowing among the selected studies between 2014 and 2024. Two authors independently screened titles, abstracts, and full texts. Methodological quality was evaluated with the Mixed-Methods Appraisal Tool (MMAT). Studies that met the inclusion criteria were chosen, and appropriate data were extracted and analyzed. Results: Six studies, out of a total of 918, satisfied the inclusion criteria and were analysed in this review. Factors that influenced nurses’ decisions to speak up about their observations included personal characteristics, organizational culture, and the nature of social relationships among healthcare team members. The results emphasized the significance of a culture of responsibility and honesty, and support for those who stand for a reason. Overall, these results supported the case for encouraging disclosure. Conclusion: A summary of results reflects the intricate balance of factors that determine whether nurses’ resort to blowing the whistle or not. Encouraging ethical practice, as well as the provision of a safe environment where nurses can voice their concerns about unethical behavior, is a core element of healthcare organizations’ responsibilities. Clinical trial number: Not applicable.