Raising concerns about poor nursing care : the moral and professional responsibility of nursing students and registered nurses

Background and rationale: This work is presented against a background of concern about aspects of the quality of care provided by health services in the UK and beyond, with much of this related to nursing care in particular. It is specifically concerned with the responsibilities of nursing students and registered nurses who are witness to instances of patient abuse, neglect or incompetence, in other words, poor care. Key ideas: Over thirteen peer reviewed publications, including empirical work, a systematic review, discussion, philosophical and educational papers, it argues that poor care is a reality across the world. In addition, despite clear legal, moral and professional guidance and expectation, those who witness it sometimes fail to raise a concern, leaving vulnerable patients at risk. It provides some of the earliest explanations for this phenomenon among student nurses, and argues that these bystanders are obligated to take action to protect those in their care. Moreover, drawing on the idea of free will, it makes the case that they are free to do so, albeit with some potential consequences. Conclusions: In order to address the failure to speak out in the face of poor care significant consideration must be given to the education and preparation of practitioners for the world of clinical practice. This should include steps to develop student understanding of their professional and moral obligations, as well as approaches which promote the development of moral courage and the ability to think critically. Change is most likely to occur if these issues are addressed against a backdrop of strategic engagement, where policy and process is clear and where academic and practice leaders model openness and transparency.