Nurses fear retaliation for speaking up on safety


One of the biggest barriers to patient safety is nurses' fear of retribution if they speak up, according to hospital C-suite executives and risk managers surveyed this year by American International Group (AIG).

Regarding the fear of speaking up for safety, the AIG survey agrees with the research of the National Association for Healthcare Quality (NAHQ) which finds that despite 20 years of quality and safety improvements, healthcare providers still hold back from speaking up, fearing retaliation and intimidation.

Physicians agree, even though they are often the reason nurses are fearful of speaking up. Dr Peter Angood, CEO of the American College of Physician Executives says the fear of retaliation is so "very distinct and quite palpable" that some hospital staff are afraid to mention a threat to patient safety exists.

Steve Harden, CEO of LifeWings a patient safety training company, states: "As a result of my own work with 140 healthcare organizations over the last 13 years, I have come to the conclusion that if we could get staff to speak up without fail when they perceive a problem with patient care, we could fix 85% of patient harm."

Harden added that LifeWings recommends three steps that can change the fear of speaking up: first, train staff to speak up.
"Telling is not training,” said Harden. “Training means you have told them how, shown them how (with a demonstration), given them an opportunity to practice through role play and/or simulation, and given them expert feedback on their practice. If you haven't done this you haven't trained.”

Secondly, you should put an escalation policy in place. Staff must absolutely know who to call to escalate an issue to get a satisfactory resolution. The number one reason trained nurses fail to speak up is that there is no mechanism in place to give them immediate support at the bedside.

Finally, you should put a ‘no retribution policy’ in place. The second most often cited reason for not speaking up is captured in this anonymous quote from a nurse: "Sure, administration will support me when I speak up. They'll even come to the bedside if I need them to. But later, for the next three months, that physician will make my life a living hell. And no one will do anything about it."

Harden believes these three items go hand-in-hand: train; escalate; stop retribution, and that by using them you can overcome one of biggest barriers to patient safety today.

Nurses, American International Group (AIG), healthcare, safety, risk management, transparency