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Nursing Times campaign: protect nurses who speak out

Nurses who speak out about concerns in the NHS are likely to face negative consequences and are often ignored, according to a survey by Nursing Times to mark the launch of a major new campaign.

The survey of more than 800 nurses revealed that many nurses complain of a bullying culture in the NHS, with staff scared they will be labelled as troublemakers if they highlight problems or concerns about patient care.

The findings come as Nursing Times launches its Speak Out Safely campaign in order to help strengthen protection for frontline staff and increase honesty and transparency in the NHS.

The survey revealed that 84% of respondents had previously raised concerns about a colleague’s practice or attitude – of which 23% said they had done so “several times” or “regularly”, and 23% “at least once”.

But of those who had raised concerns, 52% said there had been no appropriate outcome as a result of speaking up and a similar percentage said doing so had led to negative consequences for themselves.

Almost 30% of nurses said being viewed as a troublemaker was the biggest barrier to speaking up, with inaction by managers cited by 23%.

One nurse said: “You cannot make a complaint about staff or standards without losing your job and potentially your whole career.”

“It is always the whistleblower who has to move on and who has their career threatened,” said another.

An overwhelming majority of respondents, 80%, said the ability to raise concerns in the NHS could be a lot better. However, only 22% said they would be prepared to whistleblow to the media if their concerns were not acted upon by managers or regulators.

Nursing Times has today launched a campaign to help tackle some of these problems and hopefully benefit both nurses and patients.

We are calling on the government to implement a statutory “duty of candour” for NHS organisations, as recommended in the Mid Staffordshire Foundation Trust Public Inquiry report. This would make it a criminal offence for any trust or manager to prevent staff raising concerns after a serious injury to a patient or death.

Nursing Times will also seek a pledge from all NHS employers to make an explicit public commitment to their staff that they will not face disciplinary action for raising genuine patient safety concerns. We also want the government to commit to a full review of the Public Interest Disclosure Act to ensure it gives adequate protection for NHS staff.

Nursing Times editor Jenni Middleton said: “I have personally spoken to nurses who, having raised concerns, have been sidelined and ostracised by their employers, bullied and marginalised by their colleagues – and end up feeling ashamed and guilty, as well as concerned that their careers are over.

“This must stop, and we intend to make it stop with this campaign. We must welcome the input of staff and ensure they are heard, without fear of reprisal.”

In last week’s issue, Helene Donnelly, former Mid Staffordshire Foundation Trust A&E nurse and whistleblower, called for “nurses who are bad apples” to be “named and shamed”.     

She has given her support to the Speak Out Safely campaign and said it was “vital” nurses were encouraged and supported to speak up.

“As nurses, we are there all of the time and we are best placed to be see exactly what’s going on and raise concerns,” she said. “If the Francis report is going to be something that’s not just forgotten, then it’s essential for us as nurses to keep ploughing forward and keep speaking out.”

Whistleblowing charity Public Concert at Work and the Mid Staffs action group Patients First have both backed the Speak Out Safely campaign.

Cathy James, chief executive of Public Concern at Work, described the survey results as “shocking”. She said: “We wholeheartedly support Nursing Times. It really is time for change; time for there to be proper action on this issue.”

Dr Kim Holt, whistleblower and founder of Patients First, said: “What most concerns me is the culture of bullying that deters staff from speaking up – we support Nursing Times.”

Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “It is extremely worrying that a large number of nurses still feel their concerns are going unheard, even worse that some have to live with the threat of reprisal.

“Robert Francis’s report clearly spelt out what happens when members of staff are ignored. There needs to be greater transparency in the current system so that nurses feel supported when they do raise concerns,” he said.

“Ultimately it is patients that suffer when staff are ignored. We need senior staff across the NHS to know what is happening on their wards and pledge that no member of staff will suffer victimisation when they do speak out.”

Dean Royles, chief executive of NHS Employers, which represents trusts and other employers, said it was wrong for people to think whistleblowers were always ignored.

But he added: “We don’t get it right all the time and that can be tragic for patients and for staff.

“I support any campaign that shows the positive effects of raising concerns and how important it is.”

Readers' comments (30)

  • Protecting whistleblowers is of course vital. But most of the big problems in the NHS are things that everyone knows about already. Short staffing, pressure to meet targets, outlying patients. These things don't need to be reported to management because its management doing them. Often the press already know too. We need a system that is actually fixed, not just a way of protecting people who complain about the broken system.

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  • Whilst I agree with everything written above, and indeed have first hand experience of it, I believe that an additional part of this work needs to be focussed on changing the culture at ward level, so that we as nurses feel quite comfortable both challenging aspects of a colleagues everyday practice as well as having our own practice challenged. In my experience many nurses will not challenge a colleague directly for fear of being seen as 'confrontational' or indeed being accused of bullying. In the same way, how many of us can honestly say we have never become defensive when (if) a colleague challenges our practice. Until we all accept that challenges to our everyday practice are learning opportunities that should be welcomed, then we will not move away from the situation where the 'bad apples' amongst us are given space to continue to practice, and continue to contaminate our profession.

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  • I have spoken out before, however nothing was done. It's ok managers saying they are listening but if they choose to ignore concerns then the whole process is pointless. I have recently spoken out again as we have had a change of management and have been informed by this management that they will look into my concerns, however if nothing gets done this time, I can't say that I'd speak out a third time - what would be the point?

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  • There MUST be a culture change across all stakeholders in healthcare. Bullying and/or ignoring real concerns about patient care/safety in the NHS is not just isolated to an individual manager, colleague, unit/ward or hospital, it goes beyond ..... Everyone is accountable here.

    I am a very well known whistleblower within the NHS and yes, I was bullied not just by my colleagues, but my employer pursued me all the way to the High Court because they did not consider that their were liable for the actions of employees who bully whistle blowers ... Yes, they did have a whistle blowing policy that said the Trust will not tolerate the bullying or harassment to those who raise concerns .... Now thats the real culture out there that needs to change across many organisations.

    I am Lead Nurse (UK) for Patients First - We have had many nurses and doctors describing an appalling level of bullying and harassment from colleagues and NHS employers ... Interestingly .... the pattern of bullying behaviour being metered out to whistleblowers is remarkably the same .... This has to stop !!

    However, to those nurses that see poor practice or work in unsafe environments that prevent them from working within the NMC Code of Conduct and chose NOT to raise concerns are not helping that change of culture...... If everybody made their patient their first concern ... that Culture change that is so needed now will start

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  • tinkerbell

    Well done NT for taking the survey.

    If it becomes a criminal offence for managers and trusts to ignore concerns raised then one would hope that this will help lead to a change in culture.

    I once left of my job because it became intolerable to work being labelled a 'trouble maker' for speaking out about patient abuse but i would still do the same again.

    Dean Royles comment doesn't help. It is wrong if any concerns raised are ignored not that just 'some' aren't. Every concern raised in good faith without malice should be addressed.

    and the awful name 'whistle blowers' should be changed to something more positive.

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  • Caroline Williams | 3-Mar-2013 9:55 am

    maybe a sharing of views would be more appropriate before there is any need to challenge and become confrontational. staff should feel comfortable in their work and be able to trust one another and the impartial clinical judgement of their colleagues and not feel under constant threat from them and a fear of doing something wrong which carries a guarantee of turning into a self-fulfilling prophecy.

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  • Great that SKY NEWS are reporting on and discussing this article today - it can only help the situations that exist. I can state from a patients' perspective that patients are also treated adversely when they speak out and complain, indeed ive found a culture of lies, spin and cover up that exists in my own NHS mental health team in Wiltshire, and it appears from the Board of management down that despite many hundreds of letters and firm evidence, my own trust would rather spend thousands of pounds covering up the truth rather than putting matters right by actually complying with the Laws, policies and NHS and NICE guidance that is in place to protect me as an elderly disabled mental health patient diagnosed with PTSD. In truth, I am being subjected to abuse as defined in NO SECRETS, that is subjecting me to further harm and damage to my already fragile mental state.

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  • it is scandalous that patients are being abused and betrayed by the very system they are funding to look after them as well as those very vulnerable members of society unable to pay themselves.

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  • michael stone

    'We are calling on the government to implement a statutory “duty of candour” for NHS organisations, as recommended in the Mid Staffordshire Foundation Trust Public Inquiry report. This would make it a criminal offence for any trust or manager to prevent staff raising concerns after a serious injury to a patient or death.'

    I'm with you 100% - I suspect it will take a lot of pressure on the Govt, to get that done, though.

    But as Francis told the King's Fund - this does not REQUIRE a new law, or a new report: all it actually needs, is for EVERYONE in the NHS to adopt the right 'we care for patients, and do not cover things up' mindset. Of course, if everyone already had that attitude, Francis would not have needed to make the point, would he.

    If the result of Francis, is 'We will set up committees to look a this recommendations' then his report will, I fear, not lead to change - it is the change of mindset, which is an individual thing, that underpins Francis' conclusions.

    I applaud NT for its survey and campaign - took a bit long, but 'using Francis' is probably a good plan (I was doing that, in some e-mails I sent out last week: ' ... in the light of the Francis Report, perhaps ...').

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  • michael stone

    Anonymous | 3-Mar-2013 11:01 am

    It is different if the concern is about an individual, as opposed to about 'the system'. The two things need to be handled differently.

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  • Care Home and Private Home Care should be included!

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  • My experience was I was not supported by my manager, I had to work every shift with the person I reported, I was sent to break on my own with this person, from then on I was over looked all the time for training opportunities "your on the back burner" this is how abuse works, the NHS is full of very powerful 'rings' of people protecting their own interests and each other in a closed secretive environment. Often these individuals have posts where they are able to cover up and no one questions, for instance a caldicott guardian "the conscience of information sharing" heaven only knows what information has not been shared.

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  • Can our Jane Cummings our Chief Nurse do something about this, afterall she has the ear of the health ministers. No! I thought not, it would be too much to expect her to do something useful.

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  • My wife Regina Cartmell (a Brazilian citizen) died on the 8th November 2012 in Lewisham hospital after suffering from cancer she was only 39 years old.The cancer was only diagnosed weeks before she died although I suspect she had cancer months if not years before she died.she had attended hospital off and on for at least two years.

    The treatment she received whilst in hospital in Lewisham was at times terrible including lack of pain relief,lack of drinking water,the nursing staff were not even aware at one stage that my wife had not eaten for several days,mistakes were made over and over again resulting in my wife being left in agony for long periods.

    The reason why I am contacting you is because I am making as many people as possible aware about the way my wife was treated by the NHS.I have left it till now because I have been in no condition to write or speak to anyone about this.

    I want to draw as many peoples attention to this as possible in order to prevent further bad treatment to other people,my wife was very religious and would have agreed with this.
    This treatment or lack of care was witnessed by both Brazilian and English visitors to the hospital but was worse at night,my wife was AFRAID to complain because she thought the nurses would KICK,her she told me this and several of her friends before she died
    Most of the nurses were good especially the Macmillan nurses but the few bad ones made my wifes last few weeks of life full of pain and fear.
    I am not of course blaming all the Nurses because most of them did their best,but a few made my wifes last days very distressful at a time when she should have been given the maximum peace and care.

    My wifes full name was:
    REGINA KEIKO MIKARO-CARTMELL

    Regards

    Steve Cartmell

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  • Steve Cartmell

    My sincere condolences on the loss of your wife. However, I hope that you make your complaints known to the hospital concerned.

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  • I agree the term 'whistleblower' needs to change, it's not about whistle-blowing, it's about trying to maintain and improve standards of care from all staff.

    If all these senior nurses, chief nurses, managers, unions, governing bodies all know that bullying goes on why don't they do something about it. if a member of staff is bullied because they raise an issue then the bullies need to be disciplined, not praised, moved sideways, moved into a senior role.

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  • My wife Regina Cartmell (a Brazilian citizen) died on the 8th November 2012 in Lewisham hospital after suffering from cancer she was only 39 years old.The cancer was only diagnosed weeks before she died although I suspect she had cancer months if not years before she died.she had attended hospital off and on for at least two years.

    The treatment she received whilst in hospital in Lewisham was at times terrible including lack of pain relief,lack of drinking water,the nursing staff were not even aware at one stage that my wife had not eaten for several days,mistakes were made over and over again resulting in my wife being left in agony for long periods.

    The reason why I am contacting you is because I am making as many people as possible aware about the way my wife was treated by the NHS.I have left it till now because I have been in no condition to write or speak to anyone about this.

    I want to draw as many peoples attention to this as possible in order to prevent further bad treatment to other people,my wife was very religious and would have agreed with this.
    This treatment or lack of care was witnessed by both Brazilian and English visitors to the hospital but was worse at night,my wife was AFRAID to complain because she thought the nurses would KICK,her she told me this and several of her friends before she died
    Most of the nurses were good especially the Macmillan nurses but the few bad ones made my wifes last few weeks of life full of pain and fear.
    I am not of course blaming all the Nurses because most of them did their best,but a few made my wifes last days very distressful at a time when she should have been given the maximum peace and care.

    My wifes full name was:
    REGINA KEIKO MIKARO-CARTMELL

    Regards

    Steve Cartmell

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  • I have just resigned from an NHS Trust because of new changes to working practice, that I and all my colleagues, feel will leave patients at a high risk of serious harm. We all tried to appeal to managers, HR and even the Clinical Director, without success, some of my colleagues were accused of being 'lazy, obstructive and the most difficult bunch' that this new manager had, had to deal with. Our jobs were threatened if we did not keep quiet. I feel so disappointed in the NHS and its failure to protect our patients, that after 24yrs of practice, I will never return to nursing.

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  • tinkerbell

    Steve Cartmell | 3-Mar-2013 6:11 pm


    Steve,

    I hope your voice is heard, your complaint properly dealt with and actioned and those who had it in their power to help your wife but didn't are sacked and brought to justice.

    To not give pain relief where indicated should be a criminal offence. No excuses.




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  • Serious concerns should be raised and dealt with, minor concerns where a member of staff nitpicks on another member of staff is bullying which is very different. I'm sure we have all heard and seen the bully who constantly finds fault with everything one person does and blows it all out of proportion and deliberately turns it into some sort of 'incident'. Managers are not always fair and unbiased when speaking to staff about their practice or their attitude. Some managers have dreadful attitudes so who are they to criticise others?

    We also need to stamp out false and exaggerated complaints made against innocent staff who have spoken out, raised concerns, don't 'fit in' (to the exclusive ward club?), or who the manager doesn't like. Being told 'you know what it's like when there are lots of women working together blah blah blah' is not an excuse, if you make a malicious complaint then you need to face a disciplinary hearing.

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