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Introduction
One of the many professional roles of the nurse is that of the patient advocate. The patient advocate acts in the best interest of the patient, promoting what is best for the patient, ensuring their needs are met and protecting their rights ([13] Kao, 2001). An Bord Altranais (the Irish Nursing Board) state that "any circumstance which could place patients/clients in jeopardy or which militates against safe standards of practice should be made known to appropriate persons or authorities" ([3] An Bord Altranais, 2000). This is supported by the Irish Nurses Act 1985.
Patient advocacy literature draws attention to the requirement that nurses show courage and conviction and maintain an ethical stance by disclosing their concern, even when faced with opposition from physicians or administration (Chafey et al. , 1998; Holly, 1993; Mohr, 1996, Segesten; 1993; Watt, 1997; as cited in [16] McDonald and Aherne (2000, pp. 313-321; [14] Lachman, 2008). A study in the UK by [6] Firth-Cozens et al. (2003, pp. 331-336) identified that the main reasons that nurses do not disclose concerns is due to "fear of retribution, would not be listened to and did not want to cause trouble". The study by [19] Public Concern at Work (2008), indicated the main reason nurses do not blow the whistle "is that it will make no difference, or because of loyalty to colleagues and fear of disapproval by colleagues". There are many other reasons identified in the literature why nurses do not whistleblow; for example, many researchers have found that nurses are reluctant to raise concerns because of fears of reprisal or being the scapegoat ([5] Eby, 1994; [22] Vinten, 1994; [8] Hunt, 1995; [17] Mohr and Mahon, 1996; [16] McDonald and Aherne, 2000; [20] Pyne, 1992; [21] Vincent et al. , 1999; [4] Coles et al. , 2001; [11] Johnstone, 2004; [9] Jackson et al. , 2010). [18] Moore and McAuliffe (2010) conducted a study of 152 nurses in Irish hospitals and highlighted the culture of silence in hospitals and the poor organisational response to whistleblowers as critical issues that need to be addressed in order to encourage whistleblowing. This is a second paper from the same study. [18] Moore and McAuliffe (2010) address the organisational reactions that may contribute...