SPEAK OUT SAFELY WEEK
Roger Kline: ‘Student nurses must be able to speak out freely’
Students should be in no doubt that the Nursing and Midwifery Council expects them to raise concerns, says Roger Kline
A few weeks ago a student nurse was publicly praised by a Judge who sentenced three healthcare workers for ill-treating and neglecting older patients at Whipps Cross Hospital (http://tinyurl.com/student-nurse-Whipps-Cross).
She is not alone. Research evidence shows that it is frequently new staff who question and challenge poor or unsafe care that existing staff think is acceptable.
Student nurses and student midwives I speak to often question practices that existing staff have taken for granted and academic institutions all have systems in place to support students who do.
“I have heard of trusts warning universities whose students raise too many concerns that they might lose valuable training contracts”
Nevertheless we still have a serious problem. The Francis inquiry into Mid Staffordshire Foundation Trust found there were no records of student nurses raising any concerns about shoddy practice there. I have heard of trusts warning universities whose students raise too many concerns that they might lose valuable training contracts.
There is a glaring legal gap too. None of the ministerial speeches about the need for student nurses to have the right values and speak out mention that student nurses and midwives are not yet covered by the Public Interest Disclosure Act if they do raise concerns and are then victimised.
Despite this, students should be in no doubt that the Nursing and Midwifery Council expects them to raise concerns. The NMC guidance Raising Concerns: Guidance for Nurses and Midwives reminds students that the NMC code applies to them and that:
“You must act without delay if you believe that you, a colleague or anyone else may be putting someone at risk (paragraph 32).
You must inform someone in authority if you experience problems that prevent you working within this code or other nationally agreed standards (paragraph 33).
You must report your concerns in writing if problems in the environment of care are putting people at risk (paragraph 34).
The NMC guide explains that “speaking up on behalf of people in your care and clients is an everyday part of your role. Just as raising genuine concerns represents good practice, ‘doing nothing’ and failing to report concerns is unacceptable”.
All universities follow NMC advice that if you do have a concern you should:
“8.1 Inform your mentor, tutor or lecturer immediately if you believe that you, a colleague or anyone else may be putting someone at risk of harm.
8.2 Seek help immediately from an appropriately qualified professional if someone for whom you are providing care has suffered harm for any reason.
8.3 Seek help from your mentor, tutor or lecturer if people indicate that they are unhappy about their care or treatment.”
The NMC guidance explains
“You do not need to have all the facts to prove your concern but you must have a reasonable belief that wrongdoing is either happening now, took place in the past, or is likely to happen in the future.”
That’s the theory. However, the 2013 Nursing Times student nurses survey found that only 7% of student nurses felt there were no barriers to raising a concern on placement, while 24% of those who did raise a concern felt it had negative consequences for them.
After the shock of Mid Staffordshire some employers are much clearer about needing to encourage student nurses to speak out and to protect them, but that is far from universal. Students are understandably fearful of sacrificing their careers at such an early stage.
Despite that many do speak out. The Speak Out Safely campaign wants a safe environment for all student nurses to be a priority, setting a standard for the rest of their careers. It is the job of all of us – universities, NHS trusts, trade unions and the NMC – to make sure student nurses can indeed safely raise concerns. That’s why Patients First is supporting the Nursing Times campaign.
Roger Kline is a director of Patients First and Research Fellow at Middlesex University
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