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Speak Out Safely

'Challenging poor practice is an important part of a student’s role'


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


Readers' comments (9)

  • Tiger Girl

    I heard a whistleblower on BBC Radio 4 this morning - I think the name was Lisa Martin. Awful story, as usual: you do the right thing, then find yourself unemployable.

    Telling people they have a duty to raise concerns, simply isn't enough!

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  • In reply to Tiger Girl:

    I know it isn't enough. That's why we have the support systems in place that I describe in the piece. Raising concerns isn't easy, and practically supporting students to do so is my duty.

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  • It is much easier to support a student raising concerns whilst they are a student and I am glad to see systems in place for that. But is this new? I trained in the 1980s and have to say that I and my fellow students were well supported by our college of Nursing and out Tutors and Clinical Teachers. The students I mentor today are well supported by their Uni. I would worry if it were any other way.

    The real problems occur when they qualify and become autonomous practitioners.

    Whilst I applaud universities which provide a supportive environment and systems for their students, I would also like to see a lot more time and effort put into giving them the skills to challenge.

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  • I don't think it is much easier to support a student raising concerns whilst they are a student, as opposed to supporting a qualified nurse. Student's need to be suppported, of course. This is an absolute 'given'. The issue is, the responsibility of the HEI in partnership with placement providers, to support the student in an often difficult process, especially when it is about raising concerns about qualified professionals and the care they provide. Raising and escalating concerns about practice is often difficult enough for qualified staff to do, let alone a student who is beginning to learn about how to be a professional, and who are in a vulnerable position.

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  • I am currently studying an access to nursing, so my pathway to nursing is just beginning. How would I go about reporting an establishment that I do not have a placement with, but I am connected as a service user?

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  • mags | 22-Oct-2013 10:49 am
    I agree totally. When I was a student I witnessed poor practice while on a placement and it was the good relationship with my mentor which helped me feel safe enough to talk to her about it. She used it and what happened subsequently as a learning experience. I learned how to deal with such an incident and she was 100% supportive and encouraging.
    As a qualified nurse, you are very much on your own. The support just doesn't exist. I am grateful for having the experience of being supported whilst a student. At least I had the chance to see how poor practice should be challenged.

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  • tinkerbell

    Tiger Girl | 19-Oct-2013 12:14 pm

    I hope the CQC are beating a path to Lisa Martins door to employ her as they are allegedly seeking to employ whistleblowers, we need people like her and others who are willing to speak out despite consequences to themselves and who still say they would do the same again. It shouldn't be this way but sadly it still is, especially in private care homes.

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  • tinkerbell | 29-Oct-2013 6:56 pm

    I agree with you but have doubts about 'despite consequences to themselves' when they risk a life of mental devastation, loss of reputation and financial ruin to themselves and family. some manage to pull out of such situations in a more fortunate manner than others.

    Let's just pray that such an era is coming to an end and in the future people will be free to speak out without putting all or some of the above in jeopardy as after all there is no justice in being treated in such a way when defending the more vulnerable.

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  • tinkerbell

    Anonymous | 30-Oct-2013 8:27 am

    I join you in that prayer but I too have a hope that out of these dark days and from all the loss of life, abuse & neglect the current & next generation of nurses will be much more supported and mentally armed to deal with anything they witness that is unethical and brings our profession into disrepute. It is also unethical to leave wards too short staffed to complete proper, essential care. Coping is not the same as caring. Our wards should not be a battle ground where staff are left shattered on a daily basis trying to do 'more with less'. What utter, cruel, madness that bit of spin was. Savings could have been made without attacking front line staff who were delivering the care. How about sacking a few useless, incompetent managers. Ambition and stupidity, a dangerous combination.

    Some managers have a lot to answer for and should be personally accountable in the future for unnecessary, preventable deaths caused by inadequate staffing levels and allowing bullying cultures to survive. I am quite happy to be responsible and accountable if I have been given the tools to do the job safely. No manager should be allowed to get away with 'I didn't know what was happening' on the shop floor, they need to make it part of their job to know. It should be atop their job description. No cop outs. Staff need to be regularly informing & challenging them that inadequate staffing levels are 'unacceptable & will not be tolerated'. Management need to be out and about, actively finding out what's happening, 'management by walkabout' not stuffed in an office somewhere in front of a computer screen ticking boxes and faffing about with paper or whatever it is they do, whilst staff and patients are unheard and treated with contempt. They should not be able to absolve themselves of their responsibility and accountability and be given the golden handshake when it all goes pear shaped. If they don't like that amount of responsibility then kindly leave and get another job where you can do the least harm.

    With strong moral leadership on the ground and at top level & reinforcement in the universities and on placements and current initiatives encouraging staff to speak out safely and all the current reports by Francis et al, I hope the students will set the bar and standards they are taught in theory to exist in reality. No more lip service and selling ourselves short or compromising ourselves in a bullying culture by being too fearful to speak out safely. Hopefully we will reach a place and time where the bullies and those who don't care have nowhere to hide anymore and especially not in any profession where peoples lives are at stake. I am hopeful that the times are changing (albeit very slowly) where the bullying culture and conspiracy of silence created by these office bods and bean counters (who wouldn't know what a patient looked like if one came up and slapped them in the face) and their reign of terror is soon to end.

    They have undermined and abused the majority of good, honest, decent, caring health care workers who are trying to give their best under extreme circumstances.

    Someone said 'in a moral crisis, those who remain neutral, should have a special place in hell reserved for them'. Apologies if I have misquoted but the substance remains the same.

    Let's hope the old timers can strengthen and instil confidence in the newbies to challenge and form a collaborative alliance working together to reclaim all that's good.


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