Nurses Too Scared to Speak Up

Rebecca Hendren, March 29, 2011

How many quality improvement projects are going on in your organization right now? How many committees are devoted to improving safety? If you're like most facilities, there are probably dozens. Across the country, countless hours are devoted to preventing errors that harm patients through creating checklists, protocols, automated systems, and the like.

Are they worthless?

That's what I started wondering when I came across a new study that examines why poor communication is still the biggest patient safety danger of all.

The report is a combined effort from the American Association of Critical-Care Nurses (AACN) and the Association of periOperative Registered Nurses (AORN) in partnership with VitalSmarts, a training and organizational performance company. AACN and VitalSmarts produced the seminal "Silence Kills" data five years ago that found:

  • 84% of physicians have seen coworkers taking shortcuts that could be dangerous to patients
  • 88% of physicians say they work with people who show poor clinical judgment
  • Fewer than 10% of physicians, nurses, and other clinical staff directly confront their colleagues about their concerns

The 2006 data greatly enhanced our conversations about how to improve safety and led to efforts such as AACN's healthy work environment initiative that has been adopted by many organizations.

Wanting to see what's changed in the last five years, the organizations, joined by AORN, conducted another study that surveyed 6,500 nurses and nurse managers. The data revealed some alarming statistics, released in a report "The Silent Treatment." Eighty-five percent of respondents said a safety tool had alerted them of a problem that might have been missed and potentially harmed a patient and yet 58% percent revealed they didn't say anything about it.

Among the study's key findings:

  • More than four out of five nurses have concerns about dangerous shortcuts, incompetence, and disrespect demonstrated by their colleagues
  • More than half say shortcuts led to near misses or harm, and only 17% of those nurses shared their concerns with colleagues
  • More than a third say incompetence led to near misses or harm, and only 11% spoke to the colleague considered incompetent
  • More than half say disrespect prevented them from getting others to listen to them or respect their professional opinion, and only 16% confronted their disrespectful colleague

"Safety tools such as protocols and checklists guard against honest mistakes," says AORN Executive Director/CEO Linda Groah, RN, MSN, CNOR, CNAA, FAAN. "However, this study tells us there is more work needed in the OR to support the surgical team's ability to establish a culture of safety where all members can openly discuss errors, process improvements, or system issues without fear of reprisal."

Rebecca Hendren Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at
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