I am a nurse who was fired after expressing concern for patients at the hospital where I was employed. I and two other nurses who were illegally disciplined filed complaints with the National Labor Relations Board in November 1996. After a two-day trial, a federal judge ruled on our behalf. In his statement, the judge found that I had been treated with "deep-seated animus." He ruled that I was fired in an attempt to "silence the retaliate against me" for speaking up. The hospital was ordered to reinstate me, pay all my back wages with interest, and remove any reference to my "illegal" termination from hospital personnel records.

Various opinions are currently being offered about why nurses are blowing the whistle on unsafe patient care. The harshest critics have questioned the ethics of whistleblower in the health care system, asserting that the real motive is the prospect of financial gain, not patient safety. Others suggest that whistleblowing sterns for nurses' outrage at being overworked and otherwise treated poorly but the system. Recently, the CEO of a national health care association told National Public Radio listeners that he believes nurses are demoralized by an increasingly stagnant job market. On the whole, such suggestions are an overt strategy that's insulting to nurses. Those who suggest that whistleblowing is based on outrage, however, come closest to naming the reason I went public with my story.

As registered nurses, we are educated to determine when a patient is receiving quality care and when a patient may be in danger. Therefore, we know what conditions prevent us from delivering the best possible care. Under state law, we are held directly responsible for the safety of our patients and the quality of care they receive. High-profile media reports on accidental patient deaths and injuries, from around the country, illustrate what whistleblowing are saying.

In Massachusetts we have promises of education reform, changes planned that will hold school teachers more accountable and include fewer students in our classrooms. The Commonwealth recognizes that a favorable student-teacher ratio directly impacts the quality of learning. We need similar reform in nursing. Right now, we are expected to respond, like Pavlov's dogs, in caring for any number of patients of any acuity. We are also expected to perform myriad assessments, monitor outcomes, document them thoroughly, do so obediently, and suffer the consequences should anything go wrong. This is indeed outrageous.

Various opinion polls reveal that the American public trust us. To the public, the registered nurse is the key indicator of quality care. As Alex Pham wrote in The Boston Globe, "Quality-or the perception of quality-matter, and when events cause the public to question that, the punishment can be swift and severe" This, along with the moral responsibility inherent in nursing, is the real reason behind whistleblowing. To passively accept the substandard conditions that negatively affect the quality of patient care not only places your patients at risk, but also demeans your professional contribution. Moreover, it abandons the public's trust. When you participate in changing laws, shaping health care policy, and improving our practice environments, you assure the public that we are here and will be in the future-to provide the safe, dignified, expert care they expect. Part of our responsibility is the blow the whistle when conditions prevent us from doing so. Anything less is negligent.

-Barry Adams, RN, is an IV infusion nurse in Boston. He is currently studying national health policy at Brandeis University.