Nursing Schools have a responsibility to ensure safe care, says Roger Kline
One year ago the Francis report criticised the failure of trainee doctors and student nurses in Stafford Hospital to raise concerns, and the failure of their medical schools, nursing departments and NHS hospitals to ensure they did.
Today, I am struck by the determination of most student nurses to do the right thing. But all the evidence is that it is still not easy. Nursing Times’ own survey last year reported that over three-quarters of student nurses felt raising concerns ran the “risk of being viewed as a troublemaker by my placement” and just 6% reported that “there are no barriers to raising concerns on my placement”.
“Astonishingly, student nurses still don’t even get the limited protection of the Public Interest Disclosure Act”
The head of Staffordshire University’s school of nursing told the Francis inquiry that nursing departments had had resources cut and suggested that the Nursing and Midwifery Council code of conduct and nursing ethics were sacrificed by some nurse managers. The public inquiry itself asked whether “the failure of students to complain suggests that they were being socialised to accept a culture of indifference where poor standards were the norm”. Astonishingly, student nurses still don’t even get the limited protection of the Public Interest Disclosure Act.
There are reasons to be optimistic though. My own discussions with groups of student nurses, including Care Makers, suggests most student nurses are determined that they will raise concerns when they are on placements.
Nursing schools are doing a better job explaining how to raise concerns and supporting them, although it is disappointing that many have still not signed up to Nursing Times’ Speak Out Safely campaign.
We have moved on but not far enough. The evidence from Public Concern at Work is that “newer employees are most likely to blow the whistle (39% have less than two years’ service)”. Student nurses on placement are, by definition, new. They may realise that they have joined a ward where the culture takes for granted poor practice that is at odds with their own gut feelings and what they have been taught.
The Francis report, and other evidence, shows how easy it is for longer-serving staff in a poor, understaffed or bullying environment to accept as normal poor care that shocks newcomers. When students challenge poor or unsafe care it may feel very threatening to existing staff who may “shoot the messenger”.
The NMC, having miserably failed to support whistleblowing students and nurses in the past, is now trying to sharpen up its act. Its most recent guidance Raising Concerns Guidance for Nurses and Midwives is good and makes clear that the principles apply to student nurses. It explains that you are required to tell your college or appropriate placement staff immediately if patients are put at risk of harm
Whatever the issues - lack of staff, being asked to undertake delegated tasks you are not trained to carry out, abuse of patients, shoddy equipment - nurse students are required to speak out.
Last year, health secretary Jeremy Hunt said: “We must ensure that the compassion that led nurses and healthcare assistants into the profession does not get ground out of them.” One way to stop that happening is for students and newly qualified nurses to be fully supported when they stand up for patients on placement or in their first job.
All those who have a responsibility for ensuring safe care - regulators, managers, lecturers, nurses and midwives - must support students who may well, understandably, feel anxious about the consequences of “speaking truth to power.” Nursing Times has played its part. The rest of us must too.
Roger Kline is research fellow at Middlesex University , and a director of Patients First