Two worlds colliding: Nursing students speaking up for patient safety in rural healthcare settings

Two worlds colliding: Nursing students speaking up for patient safety in rural healthcare settings

During clinical placement nursing students may observe clinical practices that breach safety standards. Students are often perceived as inferior and struggle to belong as a health care team member. This creates uncertainty for students about situations where they feel they need to speak up to prevent patient harm. The difficulties are amplified in rural contexts due to the lack of structured support, a lack of education resources, and the absence of the multidisciplinary team at the site. Through an Interpretive Description lens this study aimed to create practice-based solutions that enable students to speak up without fear. This study began with a rigorous review and analysis of the concept of speaking up for students. A two-phased sequential data collection process involved twelve in-depth interviews and six focus groups with students to examine their perceptions, experiences and influences on speaking up during rural placement. The participants were recruited from two universities who completed a placement in rural and regional clinical placement settings. The findings revealed that students encounter a complex alienating culture that undermines their psychological safety and compromises their ability to speak up. Students are conflicted when witnessing breaches in policy and practice and are confused when health care staff justify their unsafe practices. Students speaking up behaviours correlate with experiences they have during placement. Learning to speak up is complex and the trajectory to becoming confident and competent is not clear-cut. The ability and willingness to speak up is influenced by underlying intricacies relating to people and the workplace culture. Students become aware of potential risks associated with speaking up, gaining a sense of agency and developing strategies to mitigate risk. The complex nature of the placement setting and diversity in patient safety curricula creates challenges for students to speak up in practice. Nursing students are the future healthcare workforce who need to be valued and included in the safety culture to feel psychologically safe and have a sense of agency, enabling them to voice their concerns and contribute to preventing patient harm.

File reproduced in accordance with the copyright policy of the publisher/author.