Factors influencing nurses' decisions to raise concerns about care quality

J Nurs Manag. 2007 May;15(4):392-402. doi: 10.1111/j.1365-2834.2007.00679.x.


Aim: To explore factors that influence nurses' decisions to raise concerns about standards of practice.

Background: Health care practitioners have a key role in monitoring care quality. Nurses are required by their professional body to raise concerns about standards; however, under-reporting is the norm.

Method: Grounded theory was used to collect and analyse data from semi-structured interviews with 142 practising nurses, theoretically sampled from three Acute NHS Trusts in England.

Findings: Fear of repercussions, retribution, labelling and blame for raising concerns, about which they predicted nothing would be done, were identified as disincentives to raising concerns. Reporting was perceived as a high-risk:low-benefit action. Nurses lacked confidence in reporting systems.

Conclusions: Disincentives to reporting need to be addressed if an open culture, which promotes quality, safety and learning, is to be developed. Findings give cause for concern and indicate a need to review organizational and professional guidelines, and organizational reporting systems.

MeSH terms

  • Adult
  • Assertiveness
  • Attitude of Health Personnel*
  • Conflict, Psychological
  • Decision Making*
  • England
  • Fear
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Middle Aged
  • Motivation
  • Nurse's Role / psychology
  • Nursing Methodology Research
  • Nursing Staff / education
  • Nursing Staff / psychology*
  • Organizational Culture
  • Practice Guidelines as Topic
  • Professional Competence / standards
  • Quality of Health Care* / standards
  • Safety Management / organization & administration
  • Self Efficacy
  • Surveys and Questionnaires
  • Whistleblowing / psychology*