To act as our patient advocates, we must recognise when care has fallen short
Sometimes, knowing when to speak out isn’t easy. Yet, if we see care we would not want for our relatives or ourselves and do not raise concerns, we implicitly accept these poor standards.
The momentum gathered by Nursing Times’ Speak Out Safely campaign has been impressive: over 60 hospitals, community trusts and other bodies have signed up. It is innovative in supporting all staff to speak up on poor care.
Standards of care can fall short in small ways: nurses ignoring relatives as they approach a nurses’ station; a buzzer left unanswered for too long; colleagues talking about their weekend exploits, oblivious to the presence of their patient.
These “small things” give strong verbal and non-verbal messages to patients and relatives they are not important. In the maelstrom of day-to-day work, it can be all too easy to forget that we have the privilege of being part of others’ lives at times of great stress and vulnerability.
There are times when I have participated in or not addressed the small things. On one shift handover, I remember to my lasting shame complaining about a broken nail to a colleague in front of a dying patient and their relatives. How could I have thought my trivial cosmetic problem was relevant? I once escorted a patient to a ward and a staff nurse glowered and said: “Who said you could bring her here now?” in an aggressive tone. “She” was conscious, alert and heard every word. I capitulated and said nothing to the nurse.
Preparing for difficult conversations
● Be clear about the reason and purpose for the conversation
● Beware of assumptions you make about the other person’s intentions
● Draw the person in by describing how an observer would see the scenario
● Consider how you have contributed to the issue (Ringer, 2006)
● Make sure your trust has signed up to Speak Out Safely. Go to nursingtimes.net/sos
We may remember similar episodes. It is not easy to challenge a peer but we have a duty to do so. These conversations can be difficult but many websites, articles and books give tips on doing it.
Difficult conversations often do not go to plan but, with even small amounts of preparation, they can achieve the desired outcome.
It’s important to start in the right way. Draw the person in by describing how an observer would see the scenario: “I need your help with what just happened. Can we talk about it?” (Ringer, 2006).
As nurses, we spend more time with patients than any other health professional so are privileged and empowered by seeing the whole spectrum of care. We have a duty and a responsibility to be their advocates.
Next time we participate in or witness a “small thing”, it is worth bearing in mind the question: “Is the standard we walk past the standard we accept?” (Morrison, 2013).
Erica Reid is a senior nurse at NHS Scotland, has a wide experience of frontline nursing and is a Health Foundation quality improvement fellow at the Institute for Healthcare Improvement
Ringer J (2006) We Have to Talk: a Step-By-Step Checklist for Difficult Conversations. www.mediate.com/articles/ringerj1.cfm
Morrison D (2013) Chief of Army Message Regarding Unacceptable Behaviour. www.youtube.com/watch?v=QaqpoeVgr8U