Second and third-year student nurses’ perspectives of raising concerns or whistleblowing in the clinical practice setting: an enduring dilemma

Abstract

Background
Despite recent changes in the UK whistleblowing legislation and professional policies, recrimination against those who speak out about poor healthcare practice remains problematic. Nursing students have been recognised as a group who are particularly vulnerable to recrimination, yet there is comparatively little research focusing on the perceptions of whistleblowing amongst this group.

Aim
To explore student nurses’ perceptions of whistleblowing and raising concerns including the influence of current UK legislation and Nursing and Midwifery Council policy on their decisions to speak up about unacceptable practice.

Methods
A sequential mixed-methods design was used in this study. Phase one collected quantitative and qualitative data via a survey conducted in September 2017, and phase two collected qualitative data in focus group interviews between December 2017 and February 2018. Sampling was purposive and nested; 202 second and third-year nursing students were recruited from the Preregistration Nursing BSc programme in an East of England University.

Analysis
Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were analysed using framework analysis.

Findings
Most nursing students had witnessed wrongdoing in their clinical placements, yet 40% had not raised concerns. Students supported the NMC policy and were aware of their duty to raise concerns. However, the policy created an enduring dilemma: failure to raise concerns would risk future registration, but speaking out may invite recrimination. A key fear was the potential for backlash to impede their progression on the course. The risk of harm to patients was a powerful motivator for raising concerns; conversely, the fear of recrimination was a significant barrier. Lack of understanding of how to escalate concerns, coupled with very low awareness of protective legislation were contributory factors. While some students would raise concerns no matter what, for many, the fear of being identified as a ‘grass’ and facing backlash was too much. This fear was intensified for students who were from Black, Asian and minority ethnic groups or were not British.

Contribution to knowledge
Raising concerns is a complex issue that cannot be resolved by legislation or policy alone. Assurances of confidentiality, a supportive culture, independent investigation of wrongdoing and education about whistleblowing at the start of the course are key influences on nursing students’ willingness to speak up about malpractice.

Date of Award	22 Feb 2023
Original language	English
Awarding Institution	University of Bath
Supervisor	Bryan Clift (Supervisor) & Sue Higham (Supervisor)