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Asking students to whistleblow 'unwise' due to lack of support

  • 16 Comments

Asking student nurses to speak up about concerns while on placement could be “unwise” due to a lack of clarity about who they should report to and no available evidence on how mentors should help them, academics have said.

Following a review of literature, academics from the Council of Deans of Health found there was a “dearth” of studies on how nursing, midwifery and allied health professional students can whistleblow.

They said this was particularly concerning given that, since the 2013 Francis report on care failings at the former Mid Staffordshire Foundation Trust, NHS organisations have been advised to encourage students to raise concerns.

They called for an “ambitious agenda” of research on the matter to be set up by universities across the UK to ensure students could be better supported to speak up.

”There is a lack of clarity around who students should raise their concerns with and no research on…personal tutors, mentors or practice educators”

Council of Deans steering group on whistleblowing

The literature review was carried out by the University of Bedfordshire on behalf of the Council of Deans.

It follows a major report on whilstleblowing in the NHS last year – the Freedom to Speak Up review – which found cases where universities took the side of the mentor rather than the student raising a concern, and that students were sent to clinical placements despite previous reports of bullying.

Academics at the University of Bedfordshire found that while there had been some improvements in the treatment of whisteblowers in recent years, it still remained difficult for them to speak up and therefore problems were not always reported.

It also indicated that students who raise concerns could be placing themselves at risk of being victimised.

“Raising a concern carries an emotional burden for the student as they may be fearful of potential adverse consequences,” said the review.

“Whilst students are now expected to report concerns, professional guidance suggests that the organisational culture within universities and practice environments remains a strong influence,” it added.

However, the review revealed there was a lack of guidance for students on how to escalate a concern.

“Asking students to more actively raise concerns where there is such little clarity and volume of existing research is problematic and possibly unwise”

Council of Deans steering group on whistleblowing

It also found there was no research on the impact that link lecturers or practice educators have on supporting students to speak up.

In addition, the review noted that while guidance produced by the Nursing and Midwifery Council encourages students to report problems to mentors, the NMC’s standards for mentors do not make reference to student concerns about quality of placements.

“The words ‘concern’ and ‘concerns’ [in the mentor standards] are almost exclusively used in relation to student performance and whether this is satisfactory in achieving the learning objectives for the placement,” said the review, called Supporting nursing, midwifery and allied health professional students to raise concerns with the quality of care.

Among its 11 recommendations, the review called for a comparison of university policies on raising concerns across the UK to establish best practice.

It also recommended a study be undertaken of healthcare students who have reported concerns on the quality of clinical care, to identity what prevents and assists whistleblowing.

Meanwhile, the review said universities should ensure whistleblowing is taught throughout programmes of study, as per a recommendation in the Freedom to Speak Up report.

Commenting on the review, two members of the Council of Deans’ steering group on whistleblowing said the “dearth” of studies available on student whistleblowing was particularly concerning following the Francis report.

Aled Jones, senior lecturer at Cardiff University’s school of healthcare sciences, and Robin Ion, head of division in mental health nursing and counselling at Abertay University in Scotland, said: “There is a lack of clarity around who students should raise their concerns with and no research on the enabling or hindering roles of key educational stakeholders that work closely with students, such as personal tutors, mentors or practice educators.

“Asking students to more actively raise concerns where there is such little clarity and volume of existing research is problematic and possibly unwise, especially as NHS staff who have more experience and authority often find that raising concerns is a challenge.”

“While there is a professional expectation that students like their registrant colleagues, should raise concerns when they see them, practically (at the moment at least) there are good reasons why students may refuse to heed this call,” they said.

They said it was “imperative [that] an ambitious agenda of research in this area is agreed upon by researchers and higher education institutions across the UK”.

  • 16 Comments

Readers' comments (16)

  • There's a lack of support for permanent staff who whistleblow too. Nothing new

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  • hotshiningsun

    Students are in a vulnerable situation - they are not protected by the rights given to employees and need to pass their placements which could be compromised by speaking out. It is unfair to expect them to whistleblow when staff will not

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  • A student nurse who whistleblows will never become a registrant. Their career is over before it begins. What does that say about patient safety???

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  • NEVER - You would be hurling junior staff staff into a turbulence of backlash & recrimination which will be the order of the day. Isolation followed by false allegations. Homelife & holidays disrupted by managers phoning for stupid things.
    Dont think about whistleblowing unless you have the support of families and the money to defend yourself through the High Court, (£11,000) which I have just done successfully.
    The regulatory process is corrupt, self serving and at the bidding of stakeholders and do nothing to protect nurses

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  • Now might be a good time to remember that only a few months ago HEE successfully fought a court action to deny junior doctors even the same veneer of protection student nurses have. This is how committed Hunt is to his idea of open and honest reporting. But then it is a bit of a Tory theme to blame the most vulnerable for the failings of those better positioned to change things.

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  • to the appropriate person through the correct in-house channels rather than go outside and above and beyond is not problem as re-dress is quite an important issue. If it is to the detriment of the service user by all means. Thus demonstrating leadership. Student or no student.

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  • The system now is geared to achieve harm and early death to vulnerable people. Whether it arrived deliberately or by accident is debatable. But these consequences are fiercely defended at very, very high up levels in the NHS, Local Authority, Justice systems, government and involved financial organisations. Anyone getting in the way of retaining early deaths of vulnerable people or criticism of those managing the delivery of this situation, irrespective of who they are - student whistleblower, doctor, nurse, carer or member of the public (citizen whistleblower) - will, I believe, be subjected to abuse and false allegations.

    Why do I believe it? I had false allegations targeted at me which very nearly put me into a situation where I would have been taken through the criminal court. The patient "ceased to live" at a very convenient point for the NHS and LA managers.

    Every time I hear mention by government of the increasing cost of care for the elderly it nauseates me. They are feeding us with fear about it being too expensive but it is the bad management that is way too expensive. Person centred care is relatively very cheap and does not have the ludicrously expensive ramifications of bad management. But what do those in management positions now actually know about person centred care. Some I can think of are just modern day versions of Himmler.

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  • Would Nursing Times please report to us what is happening in Scotland where NHS Scotland has been running the NHGS Confidential Alert Line now for some time?

    Does it work?

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  • Correction to my comment above-

    NHS Confidential Alert Line

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  • This isn't only a problem for students. I've worked for various agencies as a locum over the last 11 years in mental healthcare and have resigned from a number of positions due to expressed concerns about the way in which patients have been treated in different contexts. I've also been sacked for similar reasons. NHS staff, who are more accustomed to the security of a permanent post have, in my experience over that time, become increasingly inured to bureaucratic obstacles designed to limit costs in an already severely under resourced sector. Younger nurses seem reluctant to rock the boat for fear of the long term consequences to their careers while their senior colleagues have become increasingly cynical and time serving...
    It's no surprise that this coincides with the fragmentation of services (health and social care most obviously) preceding apparent plans to hive off any potentially profitable parts.

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