RCN position on incident reporting

Reporting incidents, accidents or near misses is key to the reduction and prevention of work-related occurrences which can result in unexpected and unwanted harm or distress for staff, patients, and others. 

The RCN believes that all work-related incidents and accidents should be promptly reported in line with the employing organisations reporting processes, and relevant legal and professional standards (NMC Code, 2018).  All staff, including student nurses on placement, bank and agency staff should have access to and training in how to use the local incident reporting system and be encouraged, wherever possible, to complete the report themselves so that an accurate reflection of the event is captured. This should include giving staff the time needed to complete all the necessary details within their normal working hours.

The RCN acknowledges that reporting an incident is not always an easy thing to do, but it is always the right thing to do and any concerns, including where being asked to practise beyond role, experience, and training and any/or risks to patient or staff safety must be documented in the incident reporting system as a priority.

Timely and open incident reporting can be viewed as the ‘black box’ of an organisation, in that it provides the ability to identify emerging trends, the opportunity to learn from these and to proactively address these. The emphasis should be on learning from the incident or near miss, rather than apportioning blame, even when mistakes have happened. Learning from mistakes is the foundation of any incident reporting system (Hasanpoor et al, 2022).

Therefore, alongside the knowledge of how to report and the availability of systems and processes to report, the culture of the service/organisation must be one that supports its staff to report. 

Culture 

Staff should feel confident and psychologically safe to report openly. Psychological safety refers to an individual’s perspective on how threatening or rewarding it is to take interpersonal risks at work. When doing so, they should be treated fairly and not subjected to any detrimental treatment (RCN 2021, NHS Resolution 2019, 2023). However, there are reports of incident reporting systems being weaponised, where it becomes the staff member rather than the incident who is being reported. This can undermine confidence in reporting systems and heighten a blame culture (Maxton et al., 2021). 

Fear of blame and subsequent non-reporting can be addressed by developing a just and learning culture; one where individuals can confidently ask for help, raise a concern without fear, and where people and innovation can flourish. Such a culture requires openness and engagement, with service users, their families/carers, as well as with colleagues after an event and during any subsequent investigation, to ensure meaningful learning and improvements.

A just and learning culture is also one where investigators attempt to uncover why failings occurred and how the system led to sub-optimal behaviours. Using the lessons learned as a mechanism to improve safety, guiding behaviour changes or actions needed to prevent future harm, and support improvements to care and service delivery, not simply a method to communicate failings (WHO, 2020). However, a just culture holds people appropriately to account where there is evidence of gross negligence or deliberate acts’ (Williams, 2018).

The NMC is very clear that work environments in which staff are accountable and encouraged to raise concerns about the safety of people in their care, identifies and prevents more problems, thus, will protect the public (NMC, 2019) 

Being asked to cover up any risk, inappropriate behaviour or action is wrong.

RCN members should be encouraged to seek support where issues around submission of an incident report are raised or where they are being discouraged to report incidents. This may be via the RCN Advice Team/using ‘Get Help’ on website or an RCN representative.

The RCN raising concerns toolkit has further information and advice, including decision tree to help make decisions about raising concerns and whistleblowing.

Response and follow up

Feedback to the individual submitting the report should be constructive and provided in a timely manner. This should include updates on progress during any investigation and when the investigation is concluded. Those involved in the incident, accident or near miss must be assured that appropriate action will be taken to find out what went wrong, why it went wrong, and what can be done to prevent it happening again. 

Managers should recognise that the event may result in staff experiencing significant stress and distress. Anyone involved in an adverse event should be assured that they will be supported throughout the reporting and investigation process. Particularly as this is a duty they are expected to fulfil as an employee and, where relevant, a registrant (NMC Code, 2018). 

Whilst the culture within a team greatly influences how effective incident reporting is, managers have a lead role in developing and sustaining this; including making sure there is a prompt and proportionate response to all those involved. Without this response, staff can feel discouraged from completing often lengthy and detailed forms as they see no evidence of change being affected, often with opportunities to improve quality/safety of services being missed.

Summary

All incidents, near misses and accidents should be reported as soon as possible using the organisations reporting system/process. Organisations should actively promote and encourage staff to report any incidents, accidents or near misses. By enabling easy access, time to complete and training on their reporting system for all staff, including students on placement, bank, and agency staff. As well as creating cultures that support individuals to feel safe and confident to speak up and raise concerns. Adopting a just culture ensures that appropriate action is taken when a person has been reckless or clearly negligent in their work. Whilst ensuring there is a focus on learning and understanding how events occur to prevent the same, or similar, events happening again. Making raising concerns and reporting adverse events, not only the right thing to do but also an easier thing to do.

Footnotes

The Health and Safety Executive (HSE 2004) uses the term ‘adverse event’ to refer collectively to all incidents, near misses and accidents.

It defines an incident as a near miss or undesired circumstance:

• Near miss: an unplanned event that does not cause injury, damage or ill health but could do so. 
• Undesired circumstance: a set of conditions or circumstances that have the potential to cause injury or ill health. 

An accident: a separate, identifiable, unintended incident, which causes physical injury.

References

Hasanpoor, E; Haghgoshavie, E; Abdekhoda, M (2022) What are the barriers to nurses reporting incidents? Evidence - Based Nursing 25: 3. Available at What are the barriers to nurses reporting - ProQuest Accessed 25.01.2024

Maxton, F., Darbyshire, P., Daniel, D.J.M. and Walvin, T. (2021) Nursing can help end the travesty of ‘Datix abuse’. Journal of Clinical Nursing 30: e41-e44. Available at https://doi.org/10.1111/jocn.15691 Accessed 25.01.2024

NHS Resolution (2019) Being fair Supporting a just and learning culture for staff and patients following incidents in the NHS. Available at Home - NHS Resolution Accessed 28.05.2024

NHS Resolution (2023) Being fair 2 Promoting a person-centred workplace that is compassionate, safe and fair. Available at Home - NHS Resolution Accessed 28.05.2024
Nursing and Midwifery Council (NMC) (2018) The Code. London: NMC.

Nursing and Midwifery Council (2019) Raising concerns: Guidance for nurses, midwives, and nursing associates. London: NMC.

Royal College of Nursing (2021) Nursing Workforce Standards – Supporting a safe and effective nursing workforce. Available at RCN Workforce Standards | Publications | Royal College of Nursing Accessed 13.03.2024

Williams, N (2018) Gross Negligence Manslaughter in Healthcare. Available at Williams review into gross negligence manslaughter in healthcare - GOV.UK (www.gov.uk) Accessed 25.01.2024

World Health Organization (WHO) 2020 Patient safety incident reporting and learning systems: technical report and guidance. World Health Organization. Available at: Patient safety incident reporting and learning systems: technical report and guidance (who.int) - Last accessed 28.05.2024.