Teaching Nurses to Speak Up - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Last week, I taught a class for a group of senior students who are graduating in May. Our topic was Professional Transition in Turbulent Times. I asked the students to talk about things that they were anxious about as they began their first job. One student made an insightful observation – things are just so crazy and chaotic right now, I see nurses doing things very differently than we are taught in school. I know some of the practices are just wrong and not safe but I don’t feel confident enough to speak up and question them.

It was interesting that she brought up this problem. Many nurse leaders are observing the same thing – poor practice going unchecked and nurses staying silent even when they know things are wrong. One CNO told me about a patient incident that had reached her desk that shocked her but what shook her the most was that no one said anything. When did this happen – she asked – when did nurses stop speaking up when there are quality and safety issues. The answer is complicated.

The Covid-19 pandemic has been massively disruptive to nursing teams. Turnover has skyrocketed, and the nurse experience versus patient acuity gap has expanded. A key aspect of ensuring quality and safety on teams is the willingness of nurses to speak up and speak out if something is wrong. Yet too often, young nurses are reluctant to speak up for the following reasons:

A concern that they will be seen as ignorant by other team members.
A concern that they will be judged as incompetent.
A concern that they will be seen as being negative.
A concern that they will be seen as disruptive.

If the environment is perceived as being psychologically unsafe, nurses are hesitant to speak up to other members of their team out of fear. For young Generation Z nurses, these crucial conversations are especially stressful. Nurse leaders play an essential role in creating psychologically safe cultures for staff to question practices, report problems, or propose new ideas. Dr. Amy Edmonson, an expert on psychological safety, recommends that leaders check in with their teams by asking for feedback on the following statements:

It is easy to speak up about what is on your mind on this team.
If you make a mistake on this team, it is often held against you.
People on your work team are usually comfortable talking about problems and disagreements.
People on this team are eager to share information about what does and does not work.
Keeping your cards close to your vest is the best way to get ahead on this team.

With so many inexperienced nurses in acute care settings today, nurse leaders should talk openly about speaking up and speaking out. There is no better way to do this than providing examples of situations where burying a problem is not the right approach. Some examples you can give include the following:

A normalization of bullying behaviors on the team.
Acceptance of assignments you don’t feel competent to perform.
Family or patient disrespect toward clinical staff.
When you see a colleague demonstrating an unsafe practice.
The omission of nursing care that is vital for patient recovery.
A repeated absence of critical supplies needed to give care.
Professionals who perform activities outside their scope of practice.
Violation of essential policies and procedures.

Simon Sinek (2014) noted that good leaders make us feel safe and more confident about speaking up and speaking out. As we lead a younger and sometimes less confident nursing workforce, that should be our goal.

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