Healthcare providers should prioritise staff wellbeing to ensure that staff are able to speak out and protect patients, a report from the Florence Nightingale Foundation (FNF) has suggested.
The report, which explores the influence of leadership and culture on patient deterioration, was commissioned by NHS England’s ‘Worry and Concern’ Task and Finish Group to identify issues affecting nurses’ ability to raise concerns.
Nurses need to work in a culture of learning at work underpinned by the principles of ‘psychological safety’, for example, to avoid patient deterioration being missed.
This came as part of work to improve understanding of acute deterioration in healthcare settings, including learning disability, mental health, and care home settings.
Research conducted by the FNF highlighted that the culture and leadership can impact the quality of the care delivered to the patient, for better or for worse.
FNF chief executive and report co-author, Professor Greta Westwood, said that the report demonstrated ‘the vital role that nurse leadership at every level can play in addressing patient deterioration, improving outcomes, and reducing avoidable mortality.’
The report found that clinical nursing staff often identify deterioration in patients through intuition based on ‘gut feeling’ and emphasised the importance of nurses in raising or escalating an intuitively based concern.
However, nurses often face barriers to raising concerns that can come from organisational culture and leadership in healthcare settings, it said.
‘Cultures of fear and blame’ combined with understaffing and overworking were found to be significant barriers to speaking up and ‘can lead to clinical staff feeling more hesitant in raising worries and concerns out of fear’.
Of the 27 nurses interviewed for the study, 14 described a fear of ‘putting your head above the parapet,’ due to concerns of being blamed, reprimanded, or even facing adverse consequences for their career.
One student participant told the FNF that fears that speaking out would affect their future kept the ‘hierarchical culture going’.
Additionally, 11 of the 27 participants described how a culture of overworking negatively impacts staff’s ability to deliver patient centred care and detect deterioration.
The report noted: ‘Participants described overworking as staff managing large numbers of patients, having limited time to spend with each patient, increasingly older populations, and illnesses becoming more complex.’
In response, the FNF suggested that leadership should implement principles of remodelling and set the tone for a culture of psychological safety and mutual support. Additionally, they proposed that there should be more training for junior nurses, student nurses, and other nursing staff to ensure they are able to speak out if they spot the signs of deterioration.
Deputy director of safety and improvement at NHS England, Jane Murkin, said that the Worry and Concern steering group were ‘very appreciative of this important work,’ and that the report’s findings had already been shared with the seven pilot sights across the country participating in the Worry and Concern Improvement Collaborative.
