Almost 60% of nurses report they have at one time or another felt unsafe to speak up or were unable to get others to listen when medical software alerted them to a problem that may have been missed and harmed a patient (eg, drug interaction).

These data and more were reported in The Silent Treatment 2010, a new study by the American Association of Critical Care Nurses (AACCN), the Association of periOperative Registered Nurses (AORN), and VitalSmarts, which examines three specific concerns: dangerous shortcuts, incompetence, and disrespect observed among physicians. The Traditional Survey section of the study collected data from 4,235 nurses, of whom 832 were managers. Among the findings :

Dangerous Shortcuts

84% work with people who “take shortcuts that could be dangerous for patients” (ie, not washing hands long enough, not changing gloves when appropriate, failing to check armbands, forgetting to perform a safety check).

41% have spoken to their manager about the person whose shortcuts create the most danger to patients.

31% have spoken to the person taking the dangerous shortcuts, and shared their full concerns.


82% work with people who “are not as skilled as they should be (for example, they aren’t up-to-date on a procedure, policy, protocol, medication, or practice or are lacking basic skills).”

48% have spoken to their manager about the person whose missing competencies create the greatest danger to patients.

21% have spoken to the person, and have shared their full concerns.


85% work with people who “demonstrate disrespect” (ie, are condescending, insulting, or rude).

46% say that disrespect undercuts respect for their professional opinion.

16% have spoken to the person who is demonstrating disrespect, but haven’t shared their full concerns.

24% have spoken to the person who is demonstrating disrespect, and shared their full concerns.

Current safety tools, providing warnings to caregivers of potential problems, are only effective when the caregiver who is warned is able to speak up and get others to act. The data in this study reveal that caregivers, including nurse managers, are often unable to be this candid.

Physician-nurse partnerships are critical to the quality of care provided to patients, particularly among certain specialties. If a situation such as this occurs, how can nurses speak up in a way that doesn’t sound accusatory? How can an environment be shaped to encourage those to speak up?