The experience of learning to speak up: a narrative inquiry on newly graduated registered nurses

Abstract

Cultivating a safe and open culture of communication and mentoring new graduates to speak up will benefit patient safety now and in the future by helping to retain committed patient advocates who could mentor future generations.

Challenges of fresh nursing graduates during their transition period

“…Chandler, [10] Law and Chan [11] and this study found that fresh nursing graduates have high expectations from themselves and others as they are expected to take up their new role and adapt to a new environment in a short period of time. Expectations cause an increased level of anxiety as they worry about being gossiped about or criticised by colleagues which echoes Kelly & Ahern, [9] Morales [22] and Teoh, Pua & Chan.…”

“…[8,9] They expect to adapt and learn new roles immediately; they feel frustrated when they fail to meet their own or others' expectations. [3,5,10,11] They also fear duty handover and hesitate to speak up when there is a need to communicate with physicians, senior nurses, patients and relatives. [3,8,11,12] In addition, they are discouraged when they find variance between theory and practice in clinical contexts which causes them a lack of confidence and poor clinical performance, [12][13][14][15][16][17][18] given their lack of sufficient knowledge, skills, and experience to bridge the gap.…”

Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews

“…The recommendations were classified under the following themes: respect and honesty; a health service that is well led; competent health-care professionals; the safety of care; care of an appropriate standard; public involvement through empowerment; and the care of children. Although there was no explicit recommendation on whistleblowing, a number of recommendations foreshadowed some of those of later reports, such as 'a duty of candour' to patients (recommendation 33), a framework of regulation independent of government (recommendations [39][40], doctors' Code of Professional Practice incorporated in the contract of employment (recommendation 45), a regulatory body, and professional code of practice for health-care managers (recommendation 91), a national reporting system (recommendations [109][110][111][112], and incentives to encourage the reporting of sentinel events (recommendations 113-118).…”

“…Although there was no explicit recommendation on whistleblowing, a number of recommendations foreshadowed some of those of later reports, such as 'a duty of candour' to patients (recommendation 33), a framework of regulation independent of government (recommendations 39 and 40), doctors' Code of Professional Practice incorporated in the contract of employment (recommendation 45), a regulatory body, and a professional code of practice for health-care managers (recommendation 91), a national reporting system (recommendations [109][110][111][112], and incentives to encourage the reporting of sentinel events (recommendations [113][114][115][116][117][118]. However, more generally, stress was placed on changing the 'culture of the NHS'.…”

“…85,87,90,91,102 This advocacy role has been recognised as a crucial part of a nurses' training, 109,122,124 and perceived as fundamental to helping nurses recognise when care is poor. Ion et al 99 note the natural human tendency to describe oneself in the most positive light, leading whistleblowers to claim to be strong characters, whereas non-whistleblowers blame factors outside their control for their failure to report, perhaps suggesting that, at some level of consciousness, nurses understand and believe that their primary responsibility is to the patient.…”