Speaking Up in Hierarchical Operating Rooms: A Qualitative Descriptive Study of Nurses' Safety Communication With...

Hierarchy can inhibit nurses from raising patient-safety concerns in operating rooms, yet how Chinese peri-operative nurses navigate this with surgeons versus anaesthetists remains underexplored.

To explore when and how peri-operative nurses in Chinese operating rooms voice, withhold, or adapt patient-safety concerns with surgeons and anaesthetists.

A multi-site qualitative descriptive study using the Critical Incident Technique, supplemented by an interpretive interprofessional workshop.

Twenty peri-operative nurses from three tertiary hospitals in Taiyuan, China, were recruited through stratified purposive sampling. Each completed one in-depth interview, generating 40 critical incidents, and a subsequent workshop informed interpretation. Template thematic analysis was conducted, using psychological safety and power distance as sensitizing concepts.

Three themes were developed: (1) nurses spoke up mainly when risk was concrete and imminent; (2) they used cautious linguistic and non-verbal strategies to preserve professional relationships and face; (3) voice depended on prior punitive experiences, perceived openness, and task relationship. Anaesthetist-directed concerns were more collaborative, whereas surgeon-directed concerns required greater deference.

Speaking up was situational, relational, and shaped by hierarchical norms and local team climate, with nurses adapting concerns to different professional audiences.

Nurse voice in Chinese operating rooms is target-specific, shaped by professional jurisdiction and local team climate. Findings support nurse managers, peri-operative educators, and interprofessional leaders in developing psychologically safer climates, hierarchy-sensitive communication training, and role-specific strategies for raising concerns with surgeons and anaesthetists.

Not applicable.