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EDITOR’S COMMENT

'Staff must be protected when they raise concerns'

Having the courage to speak out when you notice things are wrong is essential for ensuring patient care and safety. It’s not just something you should do, it’s something you must do.

The Nursing and Midwifery Council code of conduct insists nurses must speak up when they see care failings.

But if you read the papers, you’ll believe that raising concerns means losing your job or being terrorised by your manager and colleagues. In fact nurses are speaking out and making a positive change across the NHS. But sometimes the results are not so good.

Sign our Speak out Safely petition and support an open and transparent NHS. Find out the latest on our Speak Out Safely campaign

In last week’s issue of Nursing Times, Helene Donnelly, who did speak out about the appalling care she was witnessing at Mid Staffs, told us how she was bullied and sidelined as a result.

Gary Walker, former chief executive at United Lincolnshire Hospital Trust, claimed his former trust tried to prevent him raising concerns about patient safety on the BBC’s Today programme on 14 February. Since then, he has become something of a cause célèbre. He says a flood of clinicians and managers have contacted him to talk about the terrible way they were treated when they raised concerns.

We believe that creating a culture of openness throughout the NHS about every aspect of its service and care is the only way to ensure patient safety

There is no doubt the NHS has made mistakes in the way it handles staff who flag up issues. In the 2013 NHS Staff Survey, 55% of respondents say they don’t think their organisation would handle a complaint effectively if they did voice concerns.

So this week, we are launching our Speak Out Safely campaign. We are petitioning the government to implement the Francis recommendations around the duty of candour because we believe that creating a culture of openness throughout the NHS about every aspect of its service and care is the only way to ensure patient safety. You can only improve if you admit where you are getting it wrong - and learn from it, instead of trying to conceal mistakes.

But we want to be sure that staff are protected when they do raise genuine concerns - whether about their own mistakes or those they have seen others make. We are calling on trusts to make explicit that, unless a criminal offence has been committed or it is not safe for a professional to practise, staff will not be subject to disciplinary action and will be protected from bullying by managers or colleagues. We hope the prime minister’s opinion article (page 7) is a sign the government will support this campaign.

● Follow the latest news on our Speak Out Safely campaign on Twitter at

@NursingTimesSOS and nursingtimes.net/SOS

Jenni Middleton, editor

jenni.middleton@emap.com. Follow me on Twitter @nursingtimesed

Readers' comments (26)

  • It's great that NT are running a campaign to support those raising concerns. Lets hope the NHS follows suit!

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  • I think ALL of the health care unions, not only the nursing ones, should back this as well! It is time to stamp out bullying!!

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  • As long as we have managers within the NHS that are too lazy or inept in delivering effective performance management and will support their staff to escalate critical issues raised - I don't hold out much hope of this ever becoming reality. I have raised issues twice in my substantial years as a senior clinician and on both occassions was victimised for it. I was forced to protect myself and move not only jobs but geography!!

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  • As long as there is a culture that requires us to whistleblow there will remain a battle and the need to protect.
    We all have a part to play in dismantling that culture by listening to our colleagues' concerns and enabling a conversation, in numbers where necessary, backed by unions where necessary.
    The kinder we can be to colleagues who respond positively the less we will need such robust boundaries and outside support.

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  • with all the training in the psychology of interpersonal relations and communicating with patients and their families, why do nurses find it so hard to communicate and show empathy to one another?

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  • The training is all theory not application in practice. When you learn a subject with the intellect in isolation it remains there untouched and unchallenged by the emotional self. With little-practised reflection it remains unchallenged further still. When taught by people who have been educated through this same process there is little chance of facillitating aware, emotionally-able people even if it were the desired aim. When people who are emotionally aware challenge who have climbed the ladder and are in a position of guarded investment, is it any wonder there is such denial and for some, hostility?

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  • in short, training in psychology does not beget empathy

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  • Anonymous | 8-Mar-2013 8:14 pm

    many nurses are highly skilled in this and show empathy to their patients but often it seems to be limited to the bedside. is this a sign it is not genuine and can be turned on and off at will with one set of rules for their patients and another for all the rest?

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  • Some nurses will do 9.08, not all nurses are the same! There will inevitably be a proportion that will have potential for development in this to varying degrees. The ability to flick switches on and off is a common ability, I would argue, and dependant on context and environment as well. Rogers talked about creating the environment (core conditions) that encourages a therapeutic relationship, the question is for staff do they feel they are working in an environment to enable this.

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  • Its all about being practical.
    Supposing you know a new fresh-behind-the-ears nurse being victimised by a very senior surgeon, who botches an operation and then frames her. Everybody is scared to speak up, but everybody knows what happened.

    The nurse phones you, in tears, after being suspended and asks for you support. You know supporting her could cost you your job and you know she is being bullied.

    Would you speak up? You have a family to support. You could end up being a hero or you could lose everything.

    And there is the patient to consider. The patient and his/her family have a right to know what really happened in the operating theatre.

    But this surgeon is friends with the hospital CEO and the management who believe everything he says and does. And you know how near impossible it is to get your voice heard in the hospital hierachy

    What would you do?

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  • If it's not likely to go anywhere internally, there's nothing to lose getting external bodies involved. At least they can start investigations, then take it from there.
    If there's a possible child abuse occurring, we'd raise it as a safeguarding issue. We escalate it and generally not tackle it by ourselves. Then others investigate. We nurture our children to promote fulfilling lives and reduce risks that they perpetuate abuse to the next generation. The same must be applied to staff. All staff must be protected and encouraged to do the right thing, via the safest channels they have open to them. The worst thing is nothing is done, then nothing will change, and abuse will continue and will also affect others in the future.

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  • The NT backing a whistleblowers rights I would like to believe them but history shows how hypocritical they are they have had opportunities to highlight circumstances of nurses being unfairly dismissed on trumped up charges because they dared speak up and have done absolutely nothing, until they actually show support to individual nurses its all just hot wind

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  • "The Person of the Year: The Whistleblower"

    January 8, 2013

    http://corruptioncrimecompliance.com/2013/01/the-person-of-the-year-the-whistleblower/

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  • Staff must be protected when they raise concerns'

    And who is going to protect them when they do?

    Certainly not Sir David Nicholson, who ignored Gary Walker, former chief executive at United Lincolnshire Hospital Trust, when he complained of conditions at his hospital. Indeed instead of doing anything, Mr Nicholson sent another of his fellow bullies, Dame Barbara Hakin's along to gag him and to ask him to resign.

    Certainly not David Cameron, who says that Mr Nicholson is doing a good job, and therefore shows that he condones bullying and gagging.

    Certainly not the chief Nursing Officer for England, Jane Cumming's, from whom we’ve had nothing but silence on the matter.

    Who then in these circumstances is going to risk putting their head above the parapet ?

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  • My friend was bullied so much for speaking out that eventually she had a mental breakdown through stress and had to leave. Guess what happened to the manager who bullied her? You've probably already guessed, she was promoted! Says it all.

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  • Anonymous | 9-Mar-2013 1:08 pm

    more importantly, what happened to the patients in their care? no mention of concern for them!!!

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  • Anonymous | 9-Mar-2013 1:04 pm

    Jane Cummings presumably has a contact address where you can write and ask for her views.

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  • Anonymous | 9-Mar-2013 1:08 pm

    Unfortunately, that is an all too common occurrence.

    Anonymous | 9-Mar-2013 1:17 pm

    From reading the original comment (Anonymous | 9-Mar-2013 1:08 pm), I assumed that the nurse concerned was speaking out because of his/her concern for a patient or patients. When nurses speak out, it is usually because of concern for patients. And it appears that this colleague has paid a heavy price for doing that.

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  • Anonymous | 10-Mar-2013 1:17 am

    we presume to understand from the comment that the nurse was speaking out as something was wrong with the organisation and/or the safety of their patients was being jeopardised. she explained the devastating consequences this had on her friend and also the effect it had on the manager (as you point out not uncommon experiences), but as I pointed out there is no mention of the effect this had on the patients.

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  • Anonymous | 10-Mar-2013 8:23 am

    The article is about protecting staff when they speak out. Therefore, it is entirely appropriate for the commentator to write about the consequences felt by staff when doing just that. Well done to the nurse who spoke out because she cared enough about her patients to do so.

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