Challenging practice is perhaps one of the most difficult things that a nurse has to do. Seeing practice that is harmful or potentially harmful is not only upsetting but also can be very stressful. Having found myself in a “challenging” situation this week I can testify that it makes you question yourself, your judgement and your motives in all sorts of ways. Whilst I won’t go in to the in’s and out of my situation it’s suffice to say that I had concerns over some practice and raised them. It wasn’t easy and took courage and thought .. however I am left reflecting on several things:
The NMC Code clearly states:
“You make sure that patient and public safety is protected. You work within the limits of your competence, exercising your professional ‘duty of candour’ and raising concerns immediately whenever you come across situations that put patients or public safety at risk. You take necessary action to deal with any concerns where appropriate.”
As nurses we must raise concerns immediately whenever we come across situations that put patients at risk and we must take necessary action …. It couldn’t be more easy to understand. And yet I am not sure that everyone understands that nurses have this professional duty. Most nurses I have met have an understanding of the code and where their responsibility lies – but the difficultly comes when we work with people who are not nurses. Do they understand our code as we do? Do they even know what our code contains? Do they understand our professional responsibility? I think the answer to this is, sadly, sometimes no!
Which leaves me with a question …. How do we resolve this?
The fundamental problem is that often until we challenge and raise concerns we are unaware of how others will take this and what their understanding is. My concerns and challenge to thinking this week was met with shock that anyone would dare to raise concerns and what appeared to be a lack of knowledge that this is what nurses have a duty to do! We have to be that voice that says “what about the safety of the people we care for” we have to stand firm and take the action needed to ensure the care of our patients remains at the heart of all decisions both clinical and financial, but until we actually do this we never know how it will be received. I understand that it’s human nature that when someone challenges you it can be hard to listen, as it can seem like a criticism, and although we have to take this into account when we challenge, we must not let it confine us. I think that there is some work to do here in educating others in our code and how it translates into practice and I think that we as nurses should use our code more to help and empower us to do the best by our patients.
Another reflection I have is that what happens when your challenge to practice or approach is taken negatively by the people you challenge? What do you do then? This is when you start to question your own judgement … it’s the “is it just me?” thought process. This becomes even more difficult if you are challenging upwards, that is to say challenging managers or directors as you can be working against the system. Raising concerns is not easy.
My last reflective thought is – oh wow its stressful!!! Lots of thoughts spinning through your head, was I right to say something? Am I making a fuss? Why don’t people understand a nurses responsibility? But would I do it differently next time? No I would not. As someone very wise said to me this week “one day the person you challenged may be sat wishing that they has a nurse to challenge for them” We raise concerns because those in our care can’t – the people we challenge aren’t our primary concern … the people we care for are.
Even though my week has been awful, even though through raising concerns I have put my head well above the parapet I am proud to say that the needs of the people I care for come, and always will come, first.