Nurses Too Scared to Speak Up

Rebecca Hendren, for HealthLeaders Media , March 29, 2011

AACN President Kristine Peterson, RN, MS, CCRN, CCNS, says there has been progress made. "Compared with what we learned in 2005, nurses now speak up at much better rates and are now nearly three times more likely to have spoken directly to the person and shared their full concerns," Peterson says. "This increased focus on creating cultures of safety needs to continue until every health professional feels empowered to speak up to reduce errors and improve quality of care."

Despite the improvements, the "report confirms that tools don't create safety; people do," says David Maxfield, vice president of research at VitalSmarts and lead researcher of "The Silent Treatment." "Safety tools will never compensate for communication failures in the hospital."

This makes sense. What's the point in spending hours training staff to use a checklist or follow certain steps if nurses are too scared to speak up and say something when an error is revealed? This study was a wake-up call for me when thinking about patient safety, despite the fact I hear stories about belligerent surgeons, condescending physicians, and bullying nurses every day.

Just recently I heard a story from Gary Sculli when I spoke to him about implementing techniques from aviation crew resource management in nursing.

"While conducting a CRM session for nurses I asked the question, 'What would you do if you saw a physician about to do something that was going to cause harm to a patient?'" says Sculli. "A nurse confidently said, 'I would tell him to stop'. Then I said, 'What if he or she ignored you and continued?' What the nurse said next astounded me. 'Hey, I told him. It's on them at that point, but I would document what occurred.'"

This is a perfect example of what the study shows. We have a culture where nurses have been ignored, condescended, abused, or generally disrespected for so long that many have checked out and don't want to rock the boat or get into trouble. Or risk being shouted at.

How can any of us be happy about the fact we have a culture where people are so scared to speak up that they willingly let an error happen rather than risk saying something? What will it take to force us to confront the basics? Perhaps we need to stop developing new programs until we figure out a way to communicate?

Physicians and nurses must check their egos at the door and commit to improving the culture and communicating with respect. Without the concerted effort of the complete caregiving team, nothing will ever change. For the sake of our patients, we must empower everyone on the healthcare team so that all are valued and engaged in keeping our patients safe.

Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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