Yesterday I signed the Nursing Times Speak Out Safely petition.
I signed it because I believe that a serious debate is needed and if a petition calling for specific action helps start that debate, then I support that kick-start. The actions it calls for are fraught with difficulty and implementation would be problematic, but the law drafting process would hopefully create something workable. Relying on current professional codes of conduct has sadly proved insufficient and something stronger is needed to encourage those who see poor and/ or dangerous practice to speak up without fear of ostracism, bullying or losing their livelihood.
I also signed the petition because I occasionally hear about or see the effect on students of witnessing poor practice. The pricking of their professional idealism, the disappointment with those who should be role models and leading them, it is a corrosive disillusionment that encourages apathy. This disillusion, if not countered quickly and robustly, can easily be the start of a downward spiral that ends in a newly qualified nurse being socialised into not speaking out because they see no consequences of poor practice, or personally unpleasant consequences of speaking out that they don’t yet have the confidence to deal with. Supporting students to speak out is my duty as a leader in an organisation that educates nurses for practice and to improve practice.
Guidance for nursing and health care professional students in the Faculty of Health and Life Sciences at Oxford Brookes University includes the following statement:
“As a pre-qualifying student on a professional practice programme you have a professional duty to put the interests of the people you care for first and to act to protect them if you feel they may be at risk. We recognise that it might not be easy for you to raise a concern. You may be unsure what to do or the process may seem quite daunting. The following guidelines and flow chart are designed to help you. These guidelines are for students, practice assessors and link lecturers if they have concerns regarding practice or suspect poor, inconsistent or unprofessional practice in their placement.”
The full guidance can be found here, and is available and accessible to all students, staff and associates.
The importance of speaking up is discussed with students during placement preparation, and the guidance is also included in mentor updates and shared with our practice partners. We are in the process of including a link to it in each placement profile, with a statement about safe and supportive placements to reflect the new NMC quality assurance framework terminology too.
All this helps, but nothing can prepare an individual for the pressure that comes from raising concerns about a colleague’s judgement, actions or attitude. When students find themselves in such a situation we support them in preparing statements, attending investigative interviews, and debriefing, as necessary. We reassure them that challenging poor practice is an important part of their role. It is their duty to be candid about what they see. Students bring fresh eyes, open minds and enquiring attitudes. Their frequent movement through a range of practice areas enables them to act as sensitive antennae, finely tuned to the subtle differences in standards between placements, the culture of the teams they transit through, and the authenticity of a learning environment. I hope we give them the confidence to speak up about their experiences, good and bad, and I hope by actively supporting Speak Out Safely I will reinforce their confidence in the Faculty’s support.
June Girvin, Dean of the Faculty of Health and Life Sciences, Oxford Brookes University