Nurses have a duty to report and challenge poor and unsafe practice. Yet while systems and processes should be in place so that staff can highlight concerns without fear of retribution or retaliation, many nurses are reluctant to speak up. Nearly one third of NHS employees said they do not feel secure raising concerns about unsafe clinical practice, according to a recent NHS staff survey.
If you’re thinking about raising a concern, here’s what to consider and what you can expect to happen.
Barriers to speaking up
Raising a concern by reporting it to your manager, or escalating an issue by submitting evidence through a formal process, can be a daunting prospect. Many nurses fear that the process will have a detrimental effect on their health and prospects, while also affecting those about whom they are raising concerns and the patients involved. At the same time, headlines about whistle blowers who have lost their job, suffered bullying, or had their personal integrity publicly questioned, has only exacerbated the problem.
‘It’s a nurse or midwife’s responsibility to prioritise people, indeed this is the first theme of the NMC Code, which in practice means identifying potentially harmful or unethical practices – challenging those and raising concerns when required,’ explains JP Nolan, Head of Nursing Practice at the RCN.
‘Nurses are protected in law from harassment, bullying, dismissal and other detrimental action when raising a concern appropriately.’
Those considering whether to raise concerns about care need to feel confident they will be given respect, dignity and, if necessary, anonymity and confidentiality by their team and organisation.
Making a qualifying ‘protected disclosure’ in the public interest can include: revealing information regarding mistreatment of patients, law breaking, health and safety violations or financial irregularities.
Protected disclosures can be made by ex-employees and current staff, as well as trainees and students.
When to raise an issue
Sometimes, knowing whether a situation should be raised as a concern isn’t always straight forward.
‘Ask yourself, has the situation caused harm or distress or if you let the situation carry on, is it likely to result in harm or distress?’ suggests JP.
‘Your concern must be based on a reasonable belief that you can justify, but you do not always need hard evidence that wrongdoing is happening, has taken place or is likely to happen in the future.’
The revised Nursing and Midwifery Council code states that nurses must “act without delay if you believe that there is a risk to patient safety or public protection” (NMC, 2015).
‘You could be in breach of the code if you wait to take action. If you see poor care or feel you are being prevented from providing safe, compassionate care, start discussing it with your colleagues as soon as possible. Make sure you’re aware of the different approaches you can take to prevent a problem occurring the first place,’ adds JP.
How to raise a concern
Once you have identified who to approach, decide whether to raise your concerns verbally or in writing. Either way, you will need to prepare what you’re going to say.
‘Your organisation should have a local raising concerns and whistle blowing policy, which provides a solid outline of their particular process. Expect to give some background to the issue, the history of your concerns and the reasons for your concern. Keep a detailed record of notes throughout the process, logging what was said, by whom, and on what date,’ advises JP.
You should be able to raise your concern confidentially (unless you’re required to give your name by law). When you raise the issue, make it clear whether you wish to remain anonymous or not.
‘It will be much harder to investigate the concern if follow-up questions cannot be asked. It’s also easier to get protection under the Public Interest Disclosure Act if the concerns are raised openly,’ adds JP.
What happens next?
Your employer should consider your concerns carefully, and without fear of detriment. They then have a responsibility to investigate your concern thoroughly, promptly and confidentially.
Depending on the nature of the issue, and how serious and urgent the risk, your employer will decide whether it’s best dealt with under the organisation’s raising concerns policy. They will also determine whether assistance is required or if referral to senior managers, or a specialist function, is necessary.
‘You should get an answer in writing, summarising your concerns, whether you raised them openly or anonymously, and informing you of the steps that will be taken to resolve the situation,’ says JP.
‘If you do not receive this, the RCN can provide advice and support. Contact RCN Direct (0345 772 6100) for advice or the NHS whistle blowing helpline on: 0800 072 4725.’
Will there be personal consequences for me?
While the majority of employers respect their moral and legal obligations, it can take courage to raise concerns, especially in the face of possible victimisation.
Remember that legislation is there to protect you.
‘Your continued employment and opportunities for future promotion or training should not be affected. If this happens, you can bring a claim at an Employment Tribunal,’ says JP.
If the matter is not resolved?
The majority of cases will be resolved internally. If you have exhausted your organisation’s relevant internal policies and procedures without success, you may choose to disclose your concerns externally.
‘Going to the media should always be a last resort. There may be confidentiality issues and employer policies that you need to be aware of,’ warns JP.
‘Your aim, as always, should be to nurse in accordance with the RCN Principles of Nursing Practice – looking out for problems or issues that may be harmful to patients, and indeed safeguarding issues.
‘The most important thing is to maintain your honesty and professional integrity when raising concerns and see them through to ensure positive outcomes. ’
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