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11.05.2019 Feature Article

How Nurses And Many Employers Carry Out Surveillance System

How Nurses And Many Employers Carry Out Surveillance System

According to WHO Public Health Surveillance is the continuous, systematic collection analysis and interpretation of health related data needed for planning interpretation and evaluation of public health practice.

Many employers monitor their employees with surveillance equipment, such as closed-circuit television, global positioning systems, or the Internet, in order to collect data to further their business goals. Employers have always had legal justification for electronic workplace surveillance, as the United States (U.S.) courts have consistently ruled in the employer's favor (Ghoshray, 2013). Nurses should be cognizant of issues surrounding workplace electronic surveillance, as they are likely to encounter surveillance, just as do many employees in other industries (Ball, 2010). Surveillance tools, such as radio frequency identification (RFID) tagged to identification badges, and video surveillance cameras that track movement and behavior, have been used in areas where nurses work (Boyce, 2011; Fisher, & Monahan, 2008; Khan & Nausheen, 2017). Although the traditional justifications for electronic surveillance of employees may be less relevant to the nursing workplace than in such industries as banking, insurance, and real estate, this surveillance is being used today in nursing workplaces. This column will discuss both the benefits and the potential negative consequences of electronic surveillance, along with ethical decision-making related to electronic surveillance among nurses, thus helping nurses to identify fair and ethical guidelines related to electronic surveillance in their workplaces.

Employers have been surveilling their workers for centuries (Holland, Cooper, & Hecker, 2015). However, it was not until the 1990s, when electronic surveillance technology was greatly enhanced and became more cost effective, that this practice began proliferating in the workplace. Recent data suggest that approximately 78% of major U.S. companies monitor email, Internet, and/or phone usage of employees (Ribitzky, 2014).

Although employees have voiced objection to the pervasive and intrusive nature of electronic surveillance, civil liberty groups have made little progress in convincing the courts that electronic workplace surveillance has negative implications for employees (Sanders, Ross, & Pattison, 2013). In this column, I will discuss both the advantages of workplace surveillance for employers and the potential disadvantages of workplace surveillance for employees, along with ethical decision-making considerations related to electronic workplace surveillance of nurses. I will conclude by noting that nurses need to be aware of electronic surveillance in their workplace, understand why and when it is justified, and question electronic-surveillance practices that do not appear to be justified.

Benefits of Workplace Surveillance for Employers

Proposals that describe the positive aspects of electronic surveillance often relate to security, risk management, and enhanced productivity. If implemented with consideration of ethical principles, these three factors may benefit both the employer and employee as discussed below.


Employers make a compelling argument for electronic monitoring when they say they need to maintain the security of the business (Ball, 2010). Experts have estimated that businesses in the US report losses, related to employees’ theft and misuse of time, of approximately $600 billion annually (Henle, Reeve, & Pitts, 2010; Weiss, 2014). Furthermore, as Kelly (2001) has noted, electronic monitoring guards against industrial espionage because intellectual capital is a valuable resource of the company.

Risk Management

Employers have an obligation to protect employees from sexual harassment and workplace bullying (Kidwell, & Sprague, 2009). For example, a $60 million lawsuit was brought against Morgan Stanley by some of its employees claiming sexual harassment and a hostile work environment (Kiser, Porter, & Vequist, 2010). Furthermore, employers may electronically monitor their employees to ensure they are complying with safety rules. In such cases, the electronic surveillance works both to deter unacceptable behavior and to provide evidence to solve any breach(es).

Enhanced Productivity

Another purpose for electronic surveillance is to have employees self-regulate their behavior to be more productive (Sewell, Barker, & Nyberg, 2012). Some employees may work harder because of their employer’s ability to assess and take disciplinary action when employees do not work up to expectation. Also, the employer may use electronic surveillance to determine the employees’ work habits for performance improvement. Timely feedback to an employee for ways to improve work performance can be helpful for both the organization and the employee.

Potential Negative Consequences of Surveillance for Employees

In spite of the advantages noted above, electronic surveillance may have negative consequences for employees. Four areas of concern, namely diminished privacy, stress and emotional problems, distrust, and abuse of power, are presented below.

Diminished Privacy

Despite the legality of electronic surveillance, human beings are autonomous, independent agents with a right not to be used by others as a means to an end. Employees are entitled to respect, which includes privacy (Cate, 2010). Moreover, humans need a protected private space to flourish, think, try out risky projects, germinate new ideas, and meet with others without surveillance (Allen, Coopman, Hart, & Walker, 2007).

Stress and Emotional Problems

Studies have shown that electronic monitoring of employees may lead to increased anxiety, fatigue, depression, and other nervous disorders (Schumacher, 2011). Furthermore, the stress associated with electronic performance monitoring can affect the level of satisfaction, motivation, commitment, loyalty, and integrity in the workplace

Ethical Decision Making Related to Electronic Workplace Surveillance of Nurses

Given the complexity of the pros and cons of electronic workplace surveillance, it is critical that such surveillance is guided by ethical principles. Electronic workplace monitoring of nurses should not be indiscriminately deployed at the workplace. Instead, it should be implemented based on necessity. For example, researchers found that a video surveillance system installed in an intensive care unit helped to increase the hand-washing compliance rate from 6.5% to 78% (Armellino et al., 2012) – an important factor in preventing hospital-acquired infections. On the other hand, it would not be justifiable to introduce electronic surveillance of hand washing in all hospital settings without local evidence of similar problems.

The ethical principle most commonly used to justify electronic workplace surveillance is utilitarianism, which is based on the principle that what is best for the greatest number of people is just (Mandal, Ponnambath, & Parija, 2016). With this stance, proponents state that the employer may ethically conduct electronic surveillance of the workers because it is in the interest of everyone, including the employees. Certainly, saving the company from financial loss is in the interest of everyone. Theft, sexual harassment lawsuits, and time-wasting are indeed detrimental to the company’s survival. These problems, however, are not reflective of the nursing workplace; among 22 professions surveyed, Gallup has rated the nursing profession as having the highest ethical standards for the past 15 years (Norman, 2016).

Since the trend of electronic surveillance has reached the nurse’s workplace regardless of this lack of clear justification, a procedural justice approach should serve as a fair, ethical principle for implementation (Chen, & Park, 2005). Procedural justice is a form of fairness-theory that is concerned with the subjective judgment of the fairness of procedures used in making decisions about one’s entitlements (Tyler & Mentovich, 2011). For example, for an individual to attend a court hearing because of a traffic citation, and to have the judge dismiss the case in the individual’s favor without a hearing, may cause the individual to feel unsatisfied because of the lack of opportunity to present his side of the case (Chen & Park, 2005). Procedural justice is underpinned by transparency and fairness – transparency of process and decision-making, and fairness in application from one person to the next.

Using the procedural justice approach, healthcare employers would only introduce electronic surveillance to improve quality in the workplace. If electronic monitoring is found to be appropriate, the procedural justice principle would dictate that the employer begin with a rebalancing of the power distribution between the employer and employees, perhaps by appointing an independent committee comprised of management personnel and employees to handle all data retrieved from surveillance equipment. For example, badges embedded with sensor technology may be used to track how often a nurse leaves a specific patient’s room, then visits the nurse’s station, and then returns directly to the patient’s room. Data from this surveillance could be used to help hospital staff discover that supplies in the rooms were not being stocked adequately, forcing the nurses to spend extra time getting needed supplies. A committee composed of nurses and administrators could collaboratively determine how, as a result of the monitoring, the hospital could improve its supply procedures and became more efficient.

A procedural justice approach requires the surveillance to be fully transparent to the employees. For example, the employer should enter into a contract with the employees about the nature and extent of the electronic surveillance, and how the gathered information will be used. For surveillance of internet use, the employee should be informed of how much time is allowed for personal internet use and if their private conversations are monitored. Also, there should be a clear and fair mechanism for due process when electronic surveillance is the means of identifying unacceptable behaviors among employees. Finally, collateral data that are gathered during surveillance, and that are not material to the employment, should be discarded immediately to guard against blackmail, discrimination, and mission creep. Applied judiciously in the context of a caring environment, the procedural justice approach should also satisfy the principle of the greatest good for most people.


Advancement in electronic surveillance technology has provided employers with unparalleled power to monitor employees’ activities at work. Nurses need to be aware of this surveillance in their workplace, understand why and when it is justifiable, and question the practice if it does not appear to be justifiable. Employers may be able to improve productivity and lessen liabilities with the use electronic surveillance systems, but these systems may also be a source of tension and stress for employees. I personally believe it is unethical for nurses to have to deal with the disadvantages of electronic surveillance if the surveillance activities do not fit the profile of an employee(s) who needs to be monitored. Notwithstanding, if the employer insists on electronic monitoring of the nurse, the procedural justice framework should be the guiding principle for its implementation. Procedural justice is a fair approach to safeguarding each stakeholder’s interest in a controversial matter.


Dr. Kinsley Pereko

Dr. A.T Derrick

Written by

Alfred Okai Sowah

Physician Assistant Student

Level 200

University of Cape Coast

Alfred Okai Sowah
Alfred Okai Sowah, © 2019

This author has authored 1 publications on Modern Ghana. Author column: AlfredOkaiSowah

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