‘Culture of fear’ in NZ health system

June 1, 2021

Two-thirds of nurses surveyed have witnessed unsafe nursing practice by their peers, new research suggests – double the rate of some international findings.

Wendy Blair
Wendy Blair

Yet few report it due to a punitive “culture of blame and fear” in New Zealand’s health system, NZNO professional nursing adviser (PNA) Wendy Blair said. “They fear speaking out, because of what the repercussions might be, for them and for their colleagues,” she said. “Nurses are actually being set up to fail.”

Blair recently completed her PhD research Nurses’ recognition and response to unsafe practice by their peers for which she surveyed 231 nurses including 13 interviews. Sixty-six per cent of participants reported working with a colleague they felt was practising in an unsafe manner, over the previous year. That was higher than reported in previous studies1, 2, 3 in which the rate ranged from 30 to 40 per cent.

Blair said she was “shocked” by the extent of the problem, which appeared to be across all sectors.

Low staffing ratios and poor skills mix, along with excessive workloads and poor organisational cultures meant nurses often took “short-cuts”, Blair said.

“We [NZNO] deal every day with nurses who have made errors, because they’re under enormous pressure.”

NZNO had recently supported nurses who had lost their jobs in aged care over errors – but had been responsible for up to 60 patients in a facility. “Nobody should have a patient ratio that high,” Blair said.

“The environments are so challenging, it’s very hard to practise within them, and then, when things go wrong, nurses are blamed and punished.”

A culture which supported nurses to seek help was needed – not punishment, she said. “There are very few who are truly unsafe practitioners. Most just need help, support and education – but also to work in an environment where it is okay to make mistakes, to ask for help, and not be blamed or punished when things go wrong.”

Nurses needed to be able to talk about their practice in an “honest, non-punitive way” with issues resolved at the lowest possible level. “But our current blame culture doesn’t allow that.”

She blamed a health system driven by “dollars” rather than providing good care.

“We need to change the way we talk about health. We talk about dollars, finance, but we don’t talk about people, health and suffering. We are working in a depersonalised system – it’s frustrating.”

Dealing with nurses fearful of making or reporting mistakes was something NZNO dealt with every day, so it was “immensely frustrating” to see how widespread the problem was, Blair said.

Blair’s research has been published in the international Journal of Advanced Nursing4 and is also being published in the international Journal of Clinical Nursing.

References

  1. King, G. & Scudder, J. N. (2013). Reasons Registered Nurses Report Serious Wrongdoings in a Public Teaching Hospital. Psychological Reports, 112(2), 626-36. doi.org/10.2466/21.13.PR0.112.2.626-636
  2. Maurits, E. E. M., de Veer, A. J. E., Groenewegen, P. P., & Francke, A. L. (2016). Dealing with professional misconduct by colleagues in home care: a nationwide survey among nursing staff. BMC Nursing, 15(59), 1-11. doi.org/10.1186/s12912-016-0182-2
  3. Weenink, J. W., Westert, G. P., Schoonhoven, L., Wollersheim, H. & Kool, R. B. (2015). Am I my brother’s keeper? A survey of 10 healthcare professions in the Netherlands about experiences with impaired and incompetent colleagues. BMJ Quality & Safety, 24, 56–64. doi.org/10.1136/bmjqs-2014-003068
  4. Blair, W., Kable, A., Palazzi, K., Courtney-Pratt, H., Doran, E. & Oldmeadow, C. (2021). Nurses’ perspectives of recognising and responding to unsafe practice by their peers: A national cross-sectional survey. Journal of Clinical Nursing, 30(7-8), 1168-1183. doi.org/10.1111/jocn.15670