Raising concerns: a guide for RCN representatives
This guidance is for RCN representatives who have been approached by a member or group of members who have concerns about care in their workplace. When a member approaches an RCN representative or branch, they are asking the RCN for support. All RCN representatives and branches have an important part to play in supporting members to raise concerns.
Members may choose to discuss concerns with any RCN representative or activist, but it is the RCN steward who is primarily responsible for supporting them. It is also the steward who will represent them should speaking out have a detrimental effect on their terms and conditions of employment.
As an individual, you need to be aware of the RCN guidance on raising concerns for members and, as an RCN representative, you should use this guidance in addition to the employer’s policy on raising concerns (whistleblowing) when members seek your advice.
The information in these pages can also be downloaded as a pdf or ordered as printed copies from RCN Direct. See resources.
- Raising concerns early
- Information for all representatives and activists
- Be prepared to support members
- Information for RCN stewards
- Meet with the member to discuss their concern(s)
- Hitting a brick wall: don’t take no for an answer
- Follow up
- Escalated concerns
- Information for RCN safety representatives
- Resources
Raising concerns early
We don’t want members to wait for a problem to develop. While concerns may not have an immediate impact on patient care, there may be long term effects.
In these cases, members may raise a matter or issue and ask the RCN to discuss and decide if it can be considered as a concern and, if so, respond collectively.
Examples could be (this is not an exhaustive list):
- changes to the staffing or skill mix in an area will result/is resulting in staff not having sufficient time to answer call bells promptly or monitor patients effectively
- changing mandatory training to an e-learning format that may not be fit for purpose or providing staff with the necessary skills to deliver high quality care
- changing shift patterns that may have an effect on the health and wellbeing of staff or effect their ability to deliver appropriate levels of care
- a lack of moving and handling equipment on the ward or poorly maintained equipment.
In matters such as these, representatives can work in partnership to raise these concerns in the appropriate forum (ie staff side, health and safety committee, training and education committee) and prevent a problem emerging in the first place.
By raising concerns early, before any impact on patient care, unions can offer support in finding pragmatic and workable solutions.
Information for all representatives and activists
Be prepared to support members
It is important that you are prepared should a member contact you to discuss their concerns about nursing care in the workplace.
When a member approaches you because they have seen a situation that is concerning to them, and they want advice about whether they should speak out and how to do this,the test question is:
Has the situation caused harm or distress or if you let the situation carry on it is likely to result in harm or distress?
If the answer to the above question is “yes” or “I’m not sure” then the concern will need to be taken forward. Safetyrepresentatives and learning representatives should refer the member to the local RCN steward who will meet with them to discuss their concerns. Be sensitive to the issue/s the member or group of members are raising - some may need immediate advice on next steps. If there is no local RCN steward, refer the member to RCN Direct so they can be allocated a member of RCN staff. Help the member to access and read the guidance on raising concerns to prepare for their meeting and reassure them that the RCN will support them throughout the process.
Information for RCN stewards
Meet with the member to discuss their concern(s)
Arrange to meet the member in a comfortable and safe environment to discuss their concerns. When you meet, check they have read the members’ guidance and bring to their attention the section on their rights and responsibilities in relation to raising concerns.
First, ask the member to tell you their story based on:
- when did the issue causing concern happen?
- where did it happen?
- who was involved?
- what happened?
- how did it happen?
- what evidence (if any) do you have?
This may be a series of events or one occurrence, but while the member is telling their story make notes of the context and especially, which aspects of care are causing concern.
Then go through the story with the member for clarification and to make sure you have captured all concerns about care.
Next, to describe the concerns in a language that will make sense to the manager and help them in turn to respond, you can use the Principles of Nursing Practice.
You may have already matched your employer’s values and standards to the Principles of Nursing Practice, which can also demonstrate where the area of concern is not meeting organisational commitments. Use the principles as a benchmark to illustrate where care is, or is in danger of, falling below standard. You can also use the Principles of Nursing Practice mapping form to clearly set out where the member’s concerns show that this may be happening.
The member can now write a statement that gives factual information about their concern, taken from the story they have told you. The form can also be used to show the employer the connection between local values not being upheld and potential negative outcomes for patients. The member should provide evidence to substantiate their concern and this process may help indicate the kind of evidence that would be appropriate.
When the member has written a statement and letter to management, ask them to send you a copy as you will need to complete an A-Z form or open a file on the RCN case management system. You will be able to discuss the case with your mentor during your mentorship/case supervision meeting.
Although mentorship sessions are planned, contact your mentor at any time if you need extra support or to document further developments. Again, be sensitive to the issue/s the members or group of members are raising. You may need to contact your mentor before a planned session.
Your mentorship records should be used to capture your involvement in supporting a member to raise concerns. It will provide you and the RCN with an audit trail of our efforts on behalf of the member.
You should also discuss the situation that is causing concern with any other RCN representatives in your organisation (where there are other representatives) and/or other trade union representatives as appropriate, so that you can co-ordinate further actions through partnership forum and/or safety committee etc.
Hitting a brick wall: don’t take no for an answer
If you feel like the concern is not being acted upon or taken seriously, you will need to support the member to escalate the concern. In the first instance, you can use your mentorship session to review the case/concern and explore your next steps.
These next steps could involve further actions locally or formally handing the case to the RCN regional office to raise at a higher level within your organisation, for example a letter from you regional director to the director of nursing.
You should use your mentorship record to document the next steps. If further information comes to light, or you are finding the process challenging, don’t wait for your next mentorship session, contact your mentor at the earliest opportunity.
The health care regulator will investigate any concerns voiced by an individual member, a representative or the RCN as an organisation. If you are unable to get any positive action from the employer, you should discuss with your mentor how best to escalate the issue, including with the relevant health care regulator. This can be done anonymously and the health care regulator will always feedback its findings.
You may find that as a nursing professional and an RCN representative, you feel uncomfortable and perhaps conflicted. You may feel that you wish to raise the concern yourself as an accountable practitioner, for example by alerting the health care regulator. The RCN supports all members to raise concerns so please make sure that we are aware that you have done so.
Follow up
Use the action journal, through the RCN case management system, to capture the key actions agreed and to remind yourself of the next steps. The member, and the RCN, will expect you to feed back any actions taken. Ask the member to keep you informed of what is happening in the workplace.
Escalated concerns
If you have formally passed the case on to the RCN regional office, inform the member in writing that you have done this and who will be supporting the case from then on.
Information for RCN safety representatives
If you are a safety representative and are approached by a member with concerns about patient care, refer the member to a local RCN steward for representation. However, you should arrange a workplace inspection of that area, preferably with other trade union safety representatives.
Inspections should ideally be carried out in partnership with an employer’s representative. However, there is nothing stopping representatives carrying out inspections on their own or with other representatives. You may also consider using the safety committee to ask for staff absence data, incident reports etc.
You should discuss this activity with your mentor, and the RCN steward representing the individual member should be kept informed of any developments. If any further concerns about employment practice are raised you should also discuss these with the RCN steward.
The RCN Handbook for safety representatives, chapters 10, 11 and 16 and the Top ten actions for safety representatives will help you.
You may also want to discuss the situation, being mindful not to disclose details of individual members, with other trade union safety representatives and raise the concerns together.