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Why a fair and just learning culture is key to patient safety

Dr Denise Chaffer 19 Nov 2021 RCN President

RCN President Dr Denise Chaffer explains how promoting a fair and just learning culture across the health and social care system can improve conditions for staff and patients.

Health and care services right across the UK continue to face unprecedented pressures. Poor staffing levels, severe staff shortages, increased sickness levels and higher than usual demands on services lead to elevated risk to patient safety and levels of stress in our nursing workforce. Add to this the need to address fair pay and we have a perfect storm which needs urgent resolution. Please take the opportunity to have your voice heard in the current RCN ballots for NHS staff in England and Wales; and take a moment to vote on this very important matter. Another way to make sure Government hears you is to support our action on the Health and Care Bill currently making its way through Parliament.

Alongside our interim General Secretary and Chief Executive Pat Cullen, I recently met the NMC Chief Executive Andrea Sutcliffe and we discussed concerns about the number of nursing staff leaving the register. In addition to retirement, the NMC’s recent Mid-Year Register Report says the key reasons given by nurses leaving were too much pressure and negative workplace culture.

The findings of this report really highlight the importance of embedding a just and learning culture and its importance to patient safety. A learning organisation has safety at its heart and designs systems that support staff to work safely. This includes understanding the significant link between the health and wellbeing of staff and safer practice and therefore, better care for the populations we serve.

Learning organisations also recognise the importance of understanding the context within which many nurses work and the harmful effects of a blame culture. A blame culture leads to high levels of disciplinary rates and staff experiencing inequity and discrimination. Additionally, we see everyday occurrences of incivility, lack of kindness and bullying. This will be familiar to many RCN representatives and staff who work so hard to support members in these circumstances.

But there is a solution. My employer, NHS Resolution, has published guidance which focuses on promoting fairness and gives examples of some frameworks to ensure consistency in approach.

Some organisations have significantly reduced their disciplinary rates by understanding system failure as opposed to individual failure. They also save on resources which are not being directed away from care delivery to expensive and time consuming unnecessary disciplinary processes. It is important employers take an open and transparent approach to promoting fairness. Those that do will find their workforces thrive. It sets the stage for nursing staff to innovate and demonstrate excellence.

On the subject of excellence, this month in my role as President I’ve been delighted to celebrate leadership and witness the best of nursing at a range of events. I went to the Nursing Times Awards and had the pleasure of presenting the Nursing Leadership award to Cliff Evans from Medway NHS Foundation Trust. Cliff was recognised for developing and leading the delivery of specialist emergency nursing and practitioner courses both in his own organisation, county and further afield – leading to significantly reduced staff turnover.

I also took part in judging the RCN Wales Awards. The achievements of all the entrants should be celebrated, particularly considering the current pressures. Many congratulations to everyone for doing such fantastic and innovative work during these challenging times.

Our Interim Chair of Council Carol Popplestone and I represented the RCN at the Field of Remembrance service on November 11. This was a very moving experience to be part of, honouring and remembering those who sadly lost their lives whilst serving in the armed forces.

Next week, the RCN will be celebrating the contribution of nursing support workers. Many years ago, I started my career in the NHS as a nursing auxiliary caring for elderly care patients. I recognise and appreciate the value and contribution that nursing support workers bring and would like to extend my thanks to this very important group of staff and I hope you will take the opportunity to mark the day in your workplace. 

Further information

Nursing Matters podcast from our Professional Nursing Committee

Find out more about our Fair Pay for Nursing

Discover how you can get involved in Nursing Support Workers’ Day 
Dr Denise Chaffer

Dr Denise Chaffer


Denise has been President of the RCN since July 2021 and is currently the Director of Safety and Learning for the NHS Resolution (formally known as NHSLA).

Page last updated - 19/04/2022