Supporting nurses to speak up for safety
The importance of a safety culture, incorporating psychological safety and encouraging people to speak up, has been identified as critical to safe care for some time. However, achieving and maintaining such an environment can be challenging. This metasynthesis examines 15 studies to “review and synthesise qualitative research on nurses' experiences of speaking up”.
Individual factors also significantly impact nurses' speaking-up behaviours. Personal confidence, experience level, and perceived repercussions influence whether a nurse chooses to voice concerns. Nurses who fear negative consequences, such as retaliation or marginalisation, are less likely to speak up, even when patient safety is at risk.
The study highlights the importance of education and training in fostering a culture where nurses feel empowered to raise concerns. Programs that enhance communication skills and assertiveness can equip nurses with the tools needed to effectively voice issues. Additionally, mentorship and support from experienced colleagues can bolster less experienced nurses' confidence in speaking up.
The role of interdisciplinary relationships in influencing speaking-up behaviours is also noted. Collaborative teams that value input from all members create an environment where nurses feel their contributions are respected, encouraging open dialogue about safety concerns.
The metasynthesis demonstrates a need for systemic changes to support nurses in speaking up. Implementing policies that protect whistleblowers, promote non-punitive responses to reported concerns and foster inclusive leadership can create a safer environment that encourages transparency.
in the real world:
The findings of this study are a critical reminder that ‘safety cultures’, ‘cultures of transparency’ and ‘open communication’ don’t happen just because we want them to. They must be deliberately established and maintained. All human services want to believe that their organisation supports a culture of safety, but a systematic approach to tackling this is less common. Unless leaders and managers at every level desire a safety culture in their service, know exactly what that will look like and how it is achieved, and are supported to achieve it, it is unlikely to become a reality. Training, as noted in the article is an excellent start. But long-term sustainability and support for ‘speaking up’, requires embedding this in the management and systems staff work with every day, so a safety culture becomes business as usual.
All accessed 15/01/2025: