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Practice comment

The NHS must support its staff to speak out against poor practice


Whistleblowing has become synonymous with bullying and harassment. Praising nurses not pillorying staff for reporting incidents will empower them to challenge practice, says Jane Reid

For many healthcare professionals, challenging practice has become synonymous with whistleblowing. Unfortunately, due to a number of high profile cases where whistleblowers have been badly supported or openly victimised, whistleblowing is often viewed negatively, leaving people anxious and reticent to speak out. Over the years “whistleblower” has also become a pejorative term, resulting in the negative labelling of individuals, rather than reinforcing the notion that speaking out is fundamental to exercising a person’s professional accountability and ethical duty.

Despite the Public Interest Disclosure Act that came into effect in July 1999 to protect whistleblowers, too many have endured isolation and paid a high personal price for raising their concerns, including loss of employment, financial hardship, divorce, and a host of mental and physical health problems. In cases where nurses have sought to highlight that patients were at risk due the incompetence and poor performance of senior medical staff, too many have found themselves diminished by oppressive hierarchies and collusions of silence, as well as bullying, harassment and even physical assault. 

When faced with the need to challenge practice I have found the phrase “not on my watch” has proved invaluable. Over the course of my career I have relied on this phrase to frame my position when choosing to escalate a professional concern, speak up about an issue, or question the practice or professional conduct of a colleague. These short but powerful words emphasise the importance of doing what is right - however uncomfortable - and the need to exercise professional accountability to ensure patient safety.

Reflecting on my career, many of the situations that have resulted in my speaking out were not easy. My attention was not always well received, particularly if the challenge concerned individual behaviour or risky practice. In my experience, in order to depersonalise the situation it is important to focus on patient safety as the driver for raising concerns.

Highlighting a concern can be difficult and is rarely easily resolved because the systems we work in are complex and working with people is inherently unpredictable. However, in our pursuit of safety and quality difficult conversations, although unpleasant, should be seen not as the exception, but the norm.

To enhance care we need to create a “safety culture” where teams feel they are working in an environment where it is safe to speak out about poor practice. Staff are more likely to feel empowered to speak up if they are praised rather than pilloried for doing so.

Although speaking up is challenging  and we cannot  predict the outcome and impact of our actions, if we have the patient’s best interests at heart,  and are motivated by the ethical principle of beneficence, we will  increasingly find ourselves supported and heard by our peers, medical colleagues and managers.

Given the evidence that the Public Interest Disclosure Act has failed to protect whistleblowers working in the NHS, I welcome the public consultation announced last month to amend the NHS Constitution. The consultation will examine how to make clear the rights and responsibilities of health service staff and their employers in respect of raising concerns about practice. This consultation is necessary because legislation can only work if organisations have systems in place that give people the confidence to voice concerns and then support them for doing so.

However, amendments to the NHS Constitution will not be a panacea. Affecting real change is dependent on creating the right conditions and culture at a local level. We need transparency to be able to qualify the scale of harm within our organisations, to take steps to learn from error and to be able to disclose the truth arising through serious untoward incidents.  This will require the executive leadership of NHS Boards to set the tone for ethical caring and the support of the entire NHS. In this way we can ensure that patient safety comes first.

JANE REID,CoPMRE, BU, is clinical advisor for the National Patient Safety Agency and president of the International Federation of Perioperative Nurses


Readers' comments (4)

  • Speaking out and making a formal complaint re poor/bad practice has cost me my job as a result of bullying from senior management and NO change in practice.
    Would I do it again? Yes. However, I am aware of the price that nurses who are concerned re poor standards are a 'nuisance' but sycophants are a manager's delight.

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  • I am so glad Jane Reid was able to say ‘not on my watch’ and see change happen regularly.
    At CAUSE (Campaign Against Unnecessary Suspensions and Exclusions UK) we hear the other stories that ‘Anonymous’ told and cause the terrible damage that Ms Reid so well described.
    The Dept of Health and all the people producing policies and changing the NHS constitution seem to be coming at this from the wrong end. Rather than expect nurses and midwives and other NHS staff to speak out, they should be looking at measures such as the number of staff suspensions, mortality rates and other patient outcomes, to identify poor management.
    The only useful advice I have seen for people who feel duty bound to speak out, is in an article by Terry Dennis, available on the Healthcare Alliances website, that gives possible reasons why organisations become ‘toxic’ and how staff can protect themselves if they do take the risk .
    Julie Fagan founder member , CAUSE

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  • When you speak out you are seen as difficult and you can forget about promotion you apply for a post and is over looked but is still expected to do the said job when senior staff or not available. I have now reached a stage whereby I will continue to speak out for the benefit of the patient. The sad thing is some of us nurses will scurry away in a corner when things come to a head and are never brave enough to speak up when things are clearly wrong. As for people who whistle blow being supported you must be joking it may look good on paper but please speak to nurses up and down the Country about being supported.

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  • It is very difficult to speak out when the problem is not concrete, such as behavior and altitude. You come across a lot of people speaking out about medication errors, and staff not being reprimanded but what about the managers who are not able to show empathy to staff or patients, cannot communicate approprietly and disempower staff.

    The Human Resources department make any complaint of bullying very difficult, and causes the person to feel like a victim. There are not supportive policies to enable staff to speak up which would improve patient care.

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