The courage to speak out: A study describing nurses' attitudes to report unsafe practices in patient care

To identify workplace factors that influence patient advocacy among registered nurses (RNs) and their willingness to report unsafe practices.

A prior study by Black illustrated that 34% of respondents were aware of conditions that may have caused patient harm but had not reported the issue. The most common reasons identified for failing to report issues were fear of retaliation and a belief that nothing would prevail from the reports.

Using Black's study as a model, reporting data were collected from a sample of RNs actively practicing in acute care hospitals.

While reasons for reporting are consistent with Black's study, data suggest that a nurse's experiences and working environment are prime factors in their willingness to report patient care issues.

Although RNs may not have personally experienced workplace retaliation, fear of retaliation when reporting unsafe patient care practices still exists. Nursing leadership's ability to facilitate a culture of safety by proactively addressing unsafe practices fosters a level of comfort for patient advocacy and willingness to report issues. Education, professional associations and existing protection laws are available resources which contribute to organizational support systems.

The findings of this study are consistent with the literature in that organizations need to create a supportive workplace environment whereby, through collective input and leadership, reporting protocols are in place that empower RNs to report unsafe conditions. Direct care nurses are positioned, especially well to identify and speak up regarding conditions that may result in near misses or actual adverse events. Therefore, it is the responsibility, and duty, of nursing management to create and facilitate reporting systems that will be utilized without fear of retaliation and that will contribute to a culture of safety and patient advocacy.