At work we regularly encounter situations that are not right: for example, a patient had a fall, because we were understaffed; or a potentially dangerous mistake happened because a fellow worker was exhausted from overwork. The two main official avenues for these situations, apart from informing your manager, are to file a Datix report or to whistleblow. Of course, these avenues are not bad and we would not discourage anyone from making use of them. At the same time, they can lead to a passive attitude in the actual moment. Often we can see that things are not going well before something actually happens. We are often paralysed and don’t react, but why?

Maybe we might think it’s someone else’s job to say something; or we might be afraid that we’ll be seen as troublemakers; we might think that nothing can be done in the moment and that only official channels, such as a Datix report, are suitable to change things. Below I give a few examples from work where I remained paralysed, when perhaps I should have done something to intervene..

I worked a bank shift in ED at the BRI together with a young nurse. We had four patients, two of whom were actually one-to-one. They were two young women who were admitted after suicide attempts. One of them had tried to hang herself in the hospital toilet and my young colleague had found her early enough. The fact that both were one-to-one and we had two other patients was the first, but not the main problem. The matron thought of discharging one of the young women. I received a phone call from the night-guard of the sheltered home where she was living. She told me that the woman had been coked up and panicky during the whole of the previous week and that the sheltered home could not guarantee her safety. I told the matron. The matron said that we would have to wait for the psychiatrist to do an official assessment. The assessment took 5 minutes: “How serious was your suicide attempt? Do you think you will do it again?” and so on. In the end the matron and the psychiatrist decided to discharge the woman. The young nurse and I looked at each other in slight disbelief, but then it was the big boss and the expert who made the decision. What did we know about other possibilities within the hospital? It all felt wrong, but both of us did not have the courage to do something about it.

I worked a shift in orthopaedics theatres. Our list was all over the place, as one patient had been called in too late and had breakfast, so we had to postpone their elective surgery to the afternoon. The list coordinator gave us a trauma case instead and they gave us a revision at the end. Together with the consultant there were two younger surgeons. The consultant was mainly concerned with the final revision and left the two younger surgeons to do the partial hip replacement. Before the surgery started, one of the surgeons said that “we will be quick”, it seemed like he wanted to impress the consultant and reassure him that there would be enough time for the revision. From then on the surgeon hurried the scrub nurse and the health care assistant. The surgery started in a hectic atmosphere. An instrument fell to the floor. The scrub nurse became nervous. I noticed that everything seemed too rushed, but I don’t know much about hip surgeries. When cutting the hip bone the surgeon seemed to slip and when we were cementing, the scrub nurse had forgotten to bring in the cement gun. When closing the wound the male surgeon commented to the female anaesthetist that “it only took 25 minutes”. We don’t know if the woman who had her hip replaced will have problems – but there are studies which say that female surgeons who take longer than male surgeons for their operation have 15% less revisions. We can’t know, unfortunately, because the revision system is not transparent at all. What we do know is that there was no need to rush like that; it seemed like the surgeon’s vanity project. The scrub nurse and I were aware of the hectic atmosphere early on, but we didn’t dare to question the ‘mighty’ surgeons, despite all the nice talk of ‘speaking up’.

I worked on the new ward on the sixth floor, where they pack in patients in massive rooms. I was told I had a one-to-one with an older lady who had two falls since being in the hospital. Her lower lip was like a black balloon, I felt very sorry for her. I also had to keep an eye on the neighbour to her right, as she needed assistance to walk to the loo. My one-to-one patient was confused, but we had lovely chats about her time in the army, when she defended women soldiers single-handedly with a machine gun against desert tribes who tried to lash them. We also talked about the handsome general who gave her a medal. You get the gist. The neighbour to her left was equally confused, but much more mobile. On the previous day-shift, security had to bring her back on to the ward. She needed a one-to-one, too, but there wasn’t any. She loved pub songs, so I tried to sing a few classics (“Que sera, sera”) with her, while still responding to the desert story. I even managed to get four of the older ladies to sing together and was temporarily proud of myself, until the mobile neighbour woman buggered off to the male bay, while I helped the other lady to get off the toilet. I should have spoken up earlier and demanded that another one-to-one was needed, but I didn’t. In the background of this was the announcement of the trust that we are in financial difficulties and that bank shifts will be reduced to the minimum and allocation-on-arrival rates will be cut. Who can expect that a floating allocation colleague would appear to make sure that the outsourced security staff doesn’t have to pick up the pieces. As it was a bank shift, I was paid £52.30 for this six-and-a half-hour human juggling act.

I think that I am a fairly self-confident individual, but in these situations I didn’t speak up. We need a culture of speaking up, but for that we need a collective self-confidence: we as workers know what is needed to guarantee a safe level of care for our fellow patients. We must not be afraid to ask for it and not just rely on Datix…