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Pauline Griffiths: ‘Concerns must be raised immediately – not to do so exposes patients to harm’

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Telling students that ‘nothing is too small’ helps them to raise concerns, says Pauline Griffiths

Student nurses have a legal, professional, and moral responsibility to raise concerns should they witness inadequate care delivery, as clarified in the guidance from the Nursing and Midwifery Council on raising and escalating concerns.

The criticism of universities within the Francis report for failing to act when poor or failing care was present in students’ placement areas is sobering reading and demonstrates the responsibilities educators carry to act appropriately when students raise concerns.

Students bring new eyes to those poor care practices that may have become institutionalised and if a student thinks instinctively “that doesn’t seem right” then there is a high probability that it isn’t.   

“The criticism of universities within the Francis report for failing to act when poor or failing care was present in students’ placement areas is sobering reading”

A first-year student on his first placement sees an 87-year-old frail lady being pulled down the bed by her ankles. He thinks this is wrong and sees other practices that he knows are causing patients harm and/or do not reflect respect for patients’ right and dignity, and raises a concern immediately with his personal tutor. Concerns must be raised immediately, and not merely agonised over in a reflection essay two months after the event – not to do so leaves vulnerable patients exposed to harm.   

Concerns ideally can be raised with the person involved face to face or with senior members of the team, however, students often fail do so because the leadership structures are not clear to them and /or they fear that they will be victimised and singled out as a “trouble maker” . 

This fear of victimisation is a potential barrier to raising concerns especially as the student is seeking a positive ward report and to have their competencies signed off.  To protect patients and students a robust and straightforward strategy is required so, if worried about any aspect of care, the students at Swansea University can contact the us and ask for advice without delay. Our number one message to our students is that nothing is too small to raise a concern about.

In partnership with safeguarding officers and senior staff from partner health boards, we agreed on the processes to ensure students are prepared adequately to raise concerns and that ongoing support is available from both the university and from safeguarding officers.

Too often previously if students reported concerns a suitable legal approach was not then followed, for instance once a concern has been raised the issue must not be discussed in the clinical area or with others while the investigation is being conducted. Three key nominated contacts from the university provide support and advice to students from notification to final case review.  

Students experience care delivery “behind closed doors”. Such care can at times be – and I must emphasis this is a tiny minority of the care that students view – inadequate, disrespectful and indeed criminally harmful. We must help students to have the confidence to raise concerns in these cases, to do nothing must not be an option.

Dr Pauline Griffiths is director of pre-qualifying studies at Swansea University

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