Nurse whistleblowing should be seen as ‘method of continuous improvement’

Nurses should speak out against poor care even when ‘silence is the easier option’, a conference of primary and community care nurses has heard.

Ashleigh Fox, a learning disability nurse and care director at Catalyst Group Care, told attendees at the Queen’s Institute of Community Nursing (QICN) Annual Conference that nurses should ask themselves ‘what message do my choices send?’ and see whistleblowing as a ‘method of continuous improvement’.

‘We are the safeguard, we are the culture, we are the example,’ Ms Fox said.

Wrestling with self-doubt

Ms Fox, who is known for blowing the whistle about systemic abuse against people with learning disabilities and autism at Winterbourne View in 2011, said the decision to speak out made for ‘one of the hardest periods of my life’ but that it was important for nurses to raise the alarm when they see poor practice.

‘I felt the pressure of the culture – the sense that if I spoke up, I would be isolated, I would lose my job, I’d be labelled as difficult, and I think that’s really important to acknowledge [that] for nurses, whistleblowing isn’t a simple act of heroism,’ she told the conference.

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‘I think it’s a wrestle with fear and self-doubt and with risk. I think changing some of the narrative around [whistleblowing] would be helpful.

‘I think bringing that to the forefront and not framing whistleblowing not as a negative but framing it as a method of continuous improvement.’

A marginalised community 

Ms Fox warned that Winterbourne ‘is not the outlier’ and said ‘echoes’ of what she saw still remain across social care settings today.

One attendee watching the online conference described how people with a learning disability are ‘still marginalised’ compared with the general population and warned that the fall in people training to become learning disability nurses could also reduce healthcare equality in this area.

‘We always talk about community engagement and all-inclusive processes in decision making; however, most times, people living with a learning disability are not considered when questionnaires or surveys are being designed,’ another nurse pointed out.

The risk of ‘closed cultures’

Ms Fox said there was an issue of ‘closed cultures’ in care environments which were preventing good care delivery.

‘Closed cultures in care, poor cultures in care, don’t just happen.

‘Good cultures don’t just happen. They are created and sustained and challenged by the choices that each of us make every day in the moments that matter,’ she said.

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‘I would like to invite everyone to hold this one central question in mind, what is my responsibility when silence feels like the easier option?’ she added.

Feeling empowered to speak up

Ms Fox called on nurses to ‘think about the cultures’ where they work and to ask themselves if they ‘feel empowered to speak up’.

‘Who feels safe to challenge poor practice?’ she asked.

She added: ‘Every time practice leadership happens. It shifts the culture. It shapes behaviour, changes expectations, and it creates this ripple effect.’

‘So, the question isn’t, am I a manager? Do I have authority? The question is, what culture do I intentionally create when I walk into the room, and what message do my choices send?’

Ms Fox said ‘practice leadership’ was not about ‘being the most senior person in the organisation’, but about creating an atmosphere where people feel ‘safe to speak up’.

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‘It is very much about how you show up, how you’re being visible and role modelling the type of care that you want to see,’ she explained.

In June, Nursing in Practice exclusively reported that NHS England has projected that England could run out of its domestic supply of learning disability nurses by 2028 unless ‘drastic action’ is taken.

Last summer, Nursing in Practice shared the unique challenges of nurses speaking out in primary care given the independent and at times isolated nature of their work.