Why do nurses choose to stay silent?: A qualitative study

Abstract

Aim This study aimed to explore nurses' views and experiences regarding remaining silent. Background Silence is a barrier for organizational improvement and can occur for many reasons; it cannot be simply defined as the opposite of speaking out. Method An exploratory qualitative design was used for this study. Data were collected using semi‐structured interviews in 2016 with 24 nurses who were recruited by using a snowball sampling method. Results Three themes emerged as a result of the thematic analysis: fear, silence climate and disengagement. The first theme contained three subthemes: avoidance of being seen as a troublemaker, financial loss and reluctance to reveal lack of ability or knowledge. The results indicated that nurses remained silent when they felt unsupported or psychologically unsafe in their work environment. Conclusion Encouraging nurses to express their opinions is essential for creating a psychologically safe nursing work environment and an organizational climate that supports open communication. Because the majority of healthcare professionals are nurses, they can act as role models and change agents for other nurses if they are encouraged to share their ideas and opinions without fear of retribution.

Identifying predictors of employee silence about patient safety based on environmental factors among nurses in Ardabil:A Cross-Sectional Study

“…If the nurses conclude that they do not have the power to change the environment or that there is no bene t for them to speak, they accept the situation and prefer to remain silent. Their silence affects their job satisfaction, job burnout, and the quality of their care of patients and has dangerous consequences for patients (42). So, managers and policymakers can improve the quality of patient care by strengthening nurses' decision-making in various elds.…”

“…Some nurses have reported that there was no place for them to speak during patient rounds (47). Sometimes silence among nurses is caused by the fear that they will be known as someone who complains too much, lose their nancial resources, or not be promoted to higher ranks (42).…”

Examining moral injury in clinical practice: A narrative literature review

“…42,43 Organizational culture influences moral distress and MI, especially when administrations are not conducive to concerns or input from staff. 42,44 Yalçın et al 45 found nurses remain silent under various circumstances, including fear of retaliation, job loss, or being labeled as a troublemaker or novice. In addition, an adverse work environment and lack of support and action from the administration in response to speaking up prevent nurses from voicing their opinions.…”

“…The strict hierarchy of a healthcare organization reduces approachability, creating barriers to healthcare workers communicating with the administration on behalf of patients or the healthcare team. 39,45 Therefore, when MI is reinforced, healthcare workers face repeated PMIEs yet cannot speak up and be effective change agents or reconcile the moral conflict.…”

Associations among authoritative leadership, organizational climate, job embeddedness and voice behavior in clinical nurses: a cross-sectional study in China

“…The voice behavior of frontline nurses with abundant clinical experience are crucial for identifying organizational issues and aiding in management decision-making, demonstrating signi cant reality and applicability [2]. Yet, more and more studies have shown that nurses exhibit low voice behavior [3], and Kee et al's study analyzed possible reasons for this, including considering voice behavior as 'risky', being disrespected and ignored, and unexpected outcomes [4]. Furthermore, some low voice behaviors also cause risks of con icts with leaders, the deterioration of interpersonal relationships, and career development obstacles [5].…”