Nurses still afraid to blow the whistle - RCN

Published: 05 December 2011

Embargoed: 00:01hrs, Monday 5th December 2011

Nurses still afraid to blow the whistle - RCN

In almost half of cases where nurses have raised concerns about issues such as staffing levels and patient safety, no action was taken, according to a new survey by the Royal College of Nursing (RCN). More than 80% of nurses have raised concerns with their employers about such issues.

A survey of over 3000 members of the Royal College of Nursing (RCN), which looked at attitudes towards reporting worries about patient safety, clearly showed that nurses were committed to improving care for patients. This was despite the fact that the overwhelming majority (84%) said they would be concerned about victimisation, personal reprisals or a negative effect on their career if they were to report concerns to their employers.

The RCN expressed concern that this indicates a worsening situation in comparison with a similar survey in 2009, and may be a reflection of the increasing pressures on staff in the NHS.

More than a third of nurses (34%, up from 21% in 2009) revealed that they had been discouraged or told directly not to report concerns at their workplace and only a third (35%, compared with 46% in 2009) felt confident that their employer would protect them if they spoke up.

Dr Peter Carter, Chief Executive & General Secretary of the RCN, said:

“It is extremely worrying that nurses are being explicitly told not to raise concerns – after all we have learnt about the consequences when problems are not tackled. Cases such as the terrible situation that arose at Stafford hospital, precipitating a major public enquiry, should be adequate warning about the consequences of slashing staffing levels and ignoring staff concerns. It’s very important that when we know 56,000 posts are at risk in the NHS, staffing levels across the board don’t lead to another disaster.”

Of those who had reported concerns (80%, up from 63% in 2009), 38% had filled in incident forms which are a formal mechanism for documenting situations that are a potential threat to patient safety, while 72% had reported concerns to their line manager. Despite using a variety of methods to report concerns, less than a fifth of nurses (20%, compared with 29% in 2009) said that their employers had taken immediate action to resolve the situation. Worryingly, almost half (48%, compared with 35% in the previous survey) said that no action was ever taken.

The vast majority (over 99%) of registered nurses understood their professional responsibility to report worries about patient safety but fears about personal reprisals meant that only 35% (compared to 43% in 2009) would be confident to report concerns without thinking twice.

The survey does suggest that work by employers and regulators such as the NMC, alongside high profile media coverage on the issue, has increased awareness of the laws around whistleblowing (73% are now aware that their trust has a whistleblowing policy, in contrast with 2009 when 45% did not know either way). The RCN applauds employers for the improvements seen in this area, but is deeply concerned that the situation in terms of staffing on the wards is widening the gulf between the rhetoric and the reality of protecting staff who speak up.
Another concern is that almost half (49%) of members are unaware that they can als

o raise concerns with organisations other than their employer, such as the Care Quality Commission. Similarly, despite the act having passed in 1998 only 42% of respondents were aware that they were protected in law if they raise concerns about wrongdoing. This suggests that there is still more to do in terms of establishing the rights of staff to raise concerns without fear of reprisals.

Dr Peter Carter added:

“This is yet more evidence that nurses have genuine concerns that they will be victimised if they speak up. All too often, they're right. Policies and guidance from employers and the NMC are welcome, and have done a great deal to increase awareness about the importance of whistleblowing. However it is absolutely vital that nurses are protected in practice, and that they have confidence that managers will support them. This support, which should be from the line manager on the ward to the Chief Executive of their trust, is crucial if we are to avoid another dreadful example of poor care which carries on unchallenged.

“We’ve had laws protecting whistleblowers for over a decade now, however they are not fulfilling their purpose if they are not used due to a fear of reprisals. The senior managers at any Trust must demonstrate in practice that any concerns will be welcomed and acted upon, and they also need to ensure that feedback is given to those who raise concerns. We are concerned that the gap between policy and reality may be a reflection of how stretched NHS staff are, dealing with acutely ill patients with fewer staff than before. It is patients who suffer where staffing levels are eroded and concerns are not dealt with, so the impact of cuts cannot be underestimated.”

The RCN is also urging its members to raise any concerns they may have about the safety of their patients via a dedicated phone line which allows RCN members to talk in confidence about serious and immediate worries that patient safety is being put at risk in their workplace. The RCN then uses this confidential information to support the nurse to raise concerns and, if needed, will step in swiftly to investigate concerns directly with employers.

In 2009, the RCN called for all healthcare organisations to hold a register of staff concerns that must be reported to their Board regularly. In the two and a half years since this call, the practice on the ground has clearly failed to meet this requirement.


Notes to Editors

3151 members of the Royal College of Nursing took part in the online survey in October and November 2011.

RCN members can call 0345 772 6300 if they have serious or immediate concerns about patient safety in their workplace, which local processes are unable to resolve.

The results of the survey conducted in 2009 can be viewed here - http://www.rcn.org.uk/newsevents/news/article/uk/rcn_launches_phone_line_to_support_whistleblowing_nurses

For further information, interviews or illustrations please contact the RCN Media Office on 0207 647 3633, press.office@rcn.org.uk or visit http://www.rcn.org.uk/newsevents/media

Royal College of Nursing (RCN) is the voice of nursing across the UK and is the largest professional union of nursing staff in the world. The RCN promotes the interest of nurses, healthcare assistants and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations.