Reflective accounts

Reporting poor care

A CPD article improved Ruth Beretta’s knowledge of raising concerns and reporting poor care in clinical practice

A CPD article improved Ruth Beretta’s knowledge of raising concerns and reporting poor care in clinical practice

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What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice?

The article discussed raising concerns and reporting poor care in practice. It explained the difference between making errors and poor care, and outlined the moral, professional and legal obligations nurses have to report instances of poor care.

What did you learn from the CPD activity, feedback and/or event and/or experience in your practice?

I have learned that errors are the unintended outcome of genuine mistakes, whereas poor care results from abuse, neglect or incompetence, or any reason other than an error. Therefore, it is best practice for nurses to report errors, and to learn from their mistakes. 

Examples of poor care include ignoring an error and covering it up, documenting that care has been given when it has not, and mistreating or wilfully neglecting a patient.

The article outlined some of the reasons why poor care can occur, including structural changes in healthcare, low staff morale, inadequate staffing levels and the devaluing of essential nursing care. 

The article also cited authors who have suggested that nurse education now values academic achievement more than fostering caring attributes in aspiring nurses, indicating that these nurses might have a ‘too posh to wash’ attitude or are uncertain about when they should speak out about poor standards of care.

How did you change or improve your practice?

As an educationalist, I am responsible for devising learning materials, monitoring assessment and quality-assuring learning in practice for nursing students. Therefore, it is important for me to provide learning materials and assessments that include examples of when care is considered inadequate, to enable students to recognise such instances in their practice.

Assessment of theory and in practice should address the importance of patient safety and safeguarding procedures, and it is essential that students and nurses understand the policies and procedures for reporting and escalating concerns. My students often also work as healthcare support staff, so I will ensure they know how to address concerns in their workplace.

I am aware it is important for students to have adequate opportunities to evaluate and reflect on their practice, as recommended in the article.

How is this relevant to the Code? Select one or more themes: Prioritise people, Practise effectively, Preserve safety, Promote professionalism and trust

Prioritising people incorporates delivering fundamental care effectively and treating people with dignity and respect. This message should be conveyed to students, so that they focus on providing person-centred care, rather than merely managing tasks or meeting targets.

Preserving safety puts the protection of patients and service users at the centre of nursing care. This theme of The Code states that it is important for nurses to raise and escalate concerns about safety, to work within the limits of their competence, and to take measures to avoid errors. My responsibility in education is to ensure students understand their role in identifying concerns and in speaking out about them when required.

Educating nurses to be skilled in critical thinking and to be reflective practitioners should promote a culture of professionalism and trust, to ensure the standards and values of The Code are adhered to, so that the public can have trust and confidence in the profession.

Ruth Beretta is a lecturer at Open University, Bristol

This reflective account is based on NS873 Ion R, Jones A, Craven R (2016) Raising concerns and reporting poor care in practice. Nursing Standard. 31, 15, 55-62. These questions are the same as those on the NMC templates that UK nurses and midwives must use for revalidation

Write your own reflective account 

You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. To write a reflective account for Nursing Standard, use the NMC reflective accounts form 

Complete the four questions about the CPD article you have just read, writing about 800 words in total. How to submit your reflective account

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