Multiple factors come into play when a nurse is faced with a practice situation that is known to be unacceptable ("Willful Blindness," Editorial, July). Self-preservation is one of them. I can remember once asking my chief nursing officer what would happen if I brought an issue to the attention of the hospital-wide management team. Her answer was, "You'd be right, but you'd be gone."

I think we need some type of staff ombudsman. Ensuring organization-wide acceptance and protection of the work of this ombudsman would go a long way toward freeing RNs from fear of losing their jobs when pursuing an ethical concern.

Francis X. Holt, PhD, RN

Framingham, MA