As registered nurses (RNs) we know we have a legal duty to speak-up when we have concerns about care (NMC, 2018). However, as newly-registered nurses (NRNs), in a time when care is often less than what we would want to give, this can be especially difficult.
We may not feel that we have the knowledge and experience to say that something is concerning. This is especially true where guidelines do not exist (Kee and Jong, 2022) and in an environment where NRNs do not feel supported, or are even being bullied (Mansour and Mattukoya, 2019). Even in simulation, nurses close to registration often do not in speak-up about errors, and sometimes claimed that this was due to a lack of confidence (Kuo et al, 2020).
Whilst as students we have heard about how important it is to speak-up, we also hear about whistleblowers who have been bullied, lost jobs, and struggled with stigma. This creates a fear of speaking-up and suggests that whistleblowers are not listened to (Neville, 2023).
As a student nurse I spoke-up twice, with different consequences. In one case I felt that I was criticised for speaking-up when asked to work outside my competencies. In the other I felt I was listened to - although I am unsure what, if anything, was done about the situation. Both experiences added to my anxiety about speaking up; the first made me fear not being taken seriously or being criticised again. The second made me wonder if anything would be done - even though I did feel listened to.
Despite these fears I have spoken up as an RN. There are definitely protective factors to that. I do feel supported in my team and when I have doubted myself, I have spoken to more experienced colleagues who have validated me. At times I haven’t felt listened to by the wider team, but other nursing staff have backed me up. I also try to validate myself, I think about:
- if I might be offering a fresh viewpoint (for example I might have knowledge about the patient which hasn’t been taken into account);
- how I would feel if the patient was myself or a loved one;
- if there might be a better alternative.
I try to use these thoughts to be able to approach an issue in a rational way.
At other times I have used different routes to talk about wider concerns. My links with the RCN have meant I’ve been able to talk about my concerns around the PUSH model. As a single nurse I might not be able to change this, but through speaking to my branch, my region, and at Congress, I have been able to get the power of the union behind me, and the voice of members validating me.
So, if I wanted to give tips on speaking-up, I would say think about support first.
- Do you think your colleagues would support you?
- How open is the person you are coming to?
- If it’s an issue with an individual, will they listen to you or do you need to go above them?
- If you’re unsure about how to approach it, is there someone you trust who can support you and talk things through with you?
If you don’t feel you have that support in your workplace it may be harder, but it isn’t impossible. Document what you have concerns about and go elsewhere. If you feel able to you can go to your matron. Trusts will have freedom to speak up guardians who are there to help you to share concerns.
The RCN is also here for you with:
- resources, such as the Raising concerns toolkit
- the advice team - Contact the Advice Team
References
Kee K and de Jong D (2022) Factors influencing newly graduated registered nurses’
voice behaviour: An interview study., Journal of Nursing Management, 30(7), pp.
3189–3199.
Kuo S.-Y., Wu J.-C., Chen H.-W., Chen C.-J., and Hu S.H. (2020) Comparison of the
effects of simulation training and problem-based scenarios on the improvement of
graduating nursing students to speak up about medication errors: A quasi-
experimental study, Nurse Education Today, 87
Mansour M and Mattukoyya R (2019) Development of assertive communication skills
in nursing preceptorship programmes: a qualitative insight from newly qualified
nurses., Nursing Management - UK, 26(4), pp. 29–35.
Neville S (2023) Why Are Whistleblowers In the NHS Often Ignored? Financial Times Avaliable at https://www.ft.com/content/d830d29b-e42f-40c7-8931-a95d21157f45 (accessed 17/11/24)
Nursing and Midwifery Council (2018) The Code. Available at https://www.nmc.org.uk/standards/code/ (Accessed 12/11/24)
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