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Where creating an open culture starts

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Speaking out safely includes making it safe for staff to say if they cannot cope

I’d like to think things have changed since the days when I was a newly qualified staff nurse.

Then, nurses wore hats and Nightingale wards were the norm. The hierarchy expected unquestioning respect and deference. I vividly remember our tutor leading a discussion on allowing patients to use our first names, with her assumption that we most assuredly should not. Such was the culture of the day.

I remember one day in my first ward as a new staff nurse, being in sole charge and feeling unable to manage the workload with the resources I had. There were 30 heavily dependent patients, one staff nurse (me), two auxiliary nurses (one allocated to baths, task allocation at its best and worst) and two student nurses.

Calling the nursing officer for help, I was asked in a terse tone, “Can you not cope, Nurse Maclean?”, as I was called then, before the phone was slammed down. No strategies were given to help me cope, no extra pair of hands, not even a visit to see what I was trying to express in my cry for help.

Questions to ask about your culture

● What are your core team values?
● What are the unwritten “rules” new staff have to learn to be accepted?
● What stories do you tell to each other about your team?
● Can you describe the culture you personally create when you are leading the team, whether on a shift, or as team leader?
Shein EH (2010) Organisational Culture And Leadership. West Sussex: Wiley and Sons

No, I couldn’t cope. Four patients were post-operative following major vascular surgery that day, three had wounds you could put your hand into, with complex dressing regimens, the majority needing assistance, and two patients regularly escaped in their wheelchairs to smoke in the bathroom.

Almost 30 years later I still shudder to remember this - evidence indeed of how failure to cope was not an option that day.

I don’t know what the nurses at Mid Staffordshire said to their equivalent of nursing officers, but did they get a version of the “coping” response that I had 30 years previously? What can we do, within our influence, to make sure voices are heard?

The Speak Out Safely campaign is now a year old. When organisations sign up, it means that they want to hear the “not coping” requests for help.

Speaking out, however, carries with it a responsibility to make sure that the behaviour we exhibit when in a position of authority over others means they too can speak out.

How do we respond when someone comes to us with a concern? This may be a relative, a visitor, a patient, a healthcare assistant or a student. Do we ignore them by not making eye contact as we pass? Does our body language say we’re too busy to listen? Do we play down or, worse, dismiss their concerns?

Speaking out safely is about the culture we create. It is about our individual interactions and behaviour. We all have a responsibility in speaking out safely, and it starts with us.


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 in Boston

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