Failure to report poor care as a breach of moral and professional expectation

Abstract

Cases of poor care have been documented across the world. Contrary to professional requirements, evidence indicates that these sometimes go unaddressed. For patients, the outcomes of this inaction are invariably negative. Previous work has either focused on why poor care occurs and what might be done to prevent it, or on the reasons why those who are witness to it find it difficult to raise their concerns. Here, we build on this work but specifically foreground the responsibilities of registrants and students who witness poor care. Acknowledging the challenges associated with raising concerns, we make the case that failure to address poor care is a breach of moral expectation, professional requirement and, sometimes, legal frameworks. We argue that reporting will be more likely to take place if those who wish to enter the profession have a realistic view of the challenges they may encounter. When nurses are provided with robust and applied education on ethics, when “real‐world” cases and exemplars are used in practice and when steps are taken to develop and encourage individual moral courage, we may begin to see positive change. Ultimately however, significant change is only likely to take place where practice cultures invite and welcome feedback, promote critical reflection, and where strong, clear leadership support is shown by those in positions of influence across organisations.

Conflict, confusion and inconsistencies: Pre‐registration nursing students’ perceptions and experiences of speaking up for patient safety

“…Lindh et al (2008) identified final-year Swedish students needed confidence and courage to enact their moral responsibility and shield the patient from harm. Since Lindh et al (2008) initial findings, further results corroborate that reporting of errors relates to students' moral and professional stance (Bickhoff et al, 2016;Ion, Jones, et al, 2016;Ion, Olivier, & Darbyshire, 2019). In Australia, Bickhoff et al (2016) found that students need moral courage to respond to poor clinical practice.…”

“…Since Lindh et al. (2008) initial findings, further results corroborate that reporting of errors relates to students’ moral and professional stance (Bickhoff et al., 2016; Ion, Jones, et al, 2016; Ion, Olivier, & Darbyshire, 2019). In Australia, Bickhoff et al.…”

“…Ion et al. (2019) define poor care as deliberate actions or omissions that involve neglect, incompetence or abuse by healthcare staff. In this current study, students believed all nurses should strive for best practice, but were confronted, disturbed and perplexed when observing RN making excuses about their poor clinical practice.…”

“…Ion et al. (2019) believe that repeated behaviour and difficulty in speaking up may inadvertently perpetuate a culture of avoidance and sustained silence. A just culture encourages and enables people to feel safe to voice their concerns, and it is one in which reporting errors, calling out poor practices and near misses is supportive and without fear (Barnsteiner & Disch, 2012).…”

Positive organisational scholarship in healthcare

“…Whether you consider discourse sourced from academe, the mass media, social media, government or international organisations, trials and tribulations abound. Respectively, we read of: ‘workplace bullying… burnout… and turnover… among clinical nurses’ (Kim, Lee, & Lee, 2019) as well as ‘Failure[s] to report poor care’ (Ion, Olivier, & Darbyshire, 2019); ‘hospital… overspending’ (Campbell, 2019, para. 1), while ‘Patients who require… treatment in hospital are dying unnecessarily because of the poor care they receive’ (Roberts, 2017, para.…”