Advice and development

Raising concerns: it’s rarely easy, but be brave, because it’s the right thing to do

Advice for nursing students on how to challenge poor practice – take 7 top tips

Advice for nursing students on how to challenge poor practice – your 7 top tips

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Clinical placements can be challenging for nursing students, especially if you are new to them. No textbooks or lectures can fully prepare you for the difficulties you may face.

As I have progressed through my training, I have discovered that placements are as much about gaining an insight and understanding of the organisational culture and the challenges of modern nursing as achieving proficiencies and clinical skills.

One of the major difficulties we face is feeling able to challenge colleagues. This can be daunting for nursing students, and during my first year of training I found it difficult to speak up about practice I perceived as wrong.

It’s common to encounter healthcare practice that needs to be challenged

Speaking to my peers, it seems that challenging poor practice is a common problem for nursing students, with many of us having witnessed or been involved in some kind of adverse situation while on placement.

Under the Nursing and Midwifery Council (NMC) code, we must make sure that ‘those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged’.

‘The ability to challenge practice we disagree with is an important part of our development’

When I overheard a patient being described as attention-seeking because she did not want to comply with her medication, I knew this was an inappropriate and unhelpful comment, so it wasn’t difficult for me to challenge the person who made it.

But I had heard this phrase before on many occasions, so why did I not speak up earlier?

7 ways to challenge poor practice

  • Professional disagreement is perfectly okay It’s how you do it that matters. Challenging does not have to mean disagreeing to the point of conflict, so remain calm, show respect for the other person’s views and explain clearly why you disagree with their decision
  • Be curious, and don’t be afraid to ask why a decision has been made If it feels wrong, it most likely is, but there may be reasons you are not aware of, or you may simply have misunderstood the situation
  • Develop relationships with placement staff This will make it easier for you to discuss any concerns as they arise. It will also help you understand why decisions have been made
  • Build confidence by attending multidisciplinary team meetings Prepare by writing down things you feel are beneficial to the team and the patient. This will demonstrate your problem-solving skills and your desire to work collaboratively with the team – beneficial if you have to challenge a colleague’s decision
  • Engage in reflective practice This will help you become more self-aware, discover why you feel so strongly about an issue, and what you might do differently next time
  • Raise the matter first with the person concerned If you are uncomfortable doing this, talk to your practice supervisor, practice educator or a senior nurse on the ward, who should be able to help. Talk to your lecturers so they can support you
  • Familiarise yourself with local policy Find out if your workplace has a freedom to speak up guardian, who you can speak to in confidence


Students have the right to be heard when advocating for patients 

One fear is the possible repercussions of disagreeing with a nursing colleague, doctor or any other health professional. We are there to learn and do not want to be viewed as troublemakers, but it is our duty to act as advocates for our patients and if we feel uncomfortable with something we have seen or heard, we have the right to say so.

From using inappropriate wound dressings to staff expressing stigmatising views, poor practice can come in many forms. It takes courage to raise concerns, but the ability to challenge practice we disagree with is an important part of our development, even if it takes us out of our comfort zone.

Nursing students have the same duty of care as every other healthcare professional

As a nursing student, it is easy to feel like the least knowledgeable person in the room, but we have the same duty of care to our patients as every other health professional. If we expect our patients to comply with treatment and to trust us, we must advocate for them, always remembering the 6Cs and our core values.

I still find it difficult to build up the courage to disagree with other professionals or put my ideas forward, but building confidence and assertiveness comes with time and experience, and the good news is that it does get easier.

Guidance on raising concerns

Francesca Hufton is a second-year mental health nursing student at Canterbury Christ Church University

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