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.
- Francis: Student nurses ‘discouraged’ to speak out on placements
- Francis: Student nurses should be trained in raising concerns
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”.