Student nurses' lived experience of patient safety and raising concerns

Introduction
Following the investigation into the Mid Staffordshire Hospital (United Kingdom) and the subsequent Francis reports (2013 and 2015), all healthcare staff, including students, are called upon to raise concerns if they are concerned about patient safety. Despite this advice, it is evident that some individuals are reluctant to do so and the reasons for this are not always well understood.

Study aim
This research study provides an insight into the factors that influence student nurses to speak up or remain silent when witnessing sub-optimal care.

Design
An interpretive phenomenological study using the principles of hermeneutics. The study took place in one university in the North of England and the sample consisted of twelve adult nursing students.

Methods
Following ethical approval and informed consent, each participant took part in individual semi-structured interviews over a three-year period. Data was transcribed and analysed using ‘Framework for Applied Policy Research’.

Findings
Four key themes were identified: context of exposure, fear of punitive action, team culture and hierarchy. On the one hand, students recognised there was a professional obligation bestowed upon them to raise concerns if they witnessed sub-optimal practice, however, their willingness to do so was influenced by intrinsic and extrinsic factors. Students have to navigate their moral compass, taking cognisance of their own social identity and the identity of the organisations in which they are placed.