Are Institutions Educating Baccalaureate Students to Feel Comfortable Speaking Up for Patient Safety?

Speaking up in the clinical setting occurs when nurses serve as patient advocate by verbalizing their concerns with the aim of resolving issues and enhancing patient safety (Fagan, Parker, & Jackson, 2016; Kent, Anderson, Ciocca, Shanks, & Enlow 2015; Omura, Maguire, Levett-Jones, & Stone, 2017). Speaking up is recognized as a duty that nurses have and as a means to prevent failures in patient safety and occurrence of adverse events. Even with these understandings, research has shown that nurses face multiple barriers when deciding whether or not to speak up (Hall, Klein, Betts, & DeRanieri, 2018). While teamwork and communication have been highly emphasized in the healthcare setting to improve safety, it is important to note that one study in the aviation profession found an over emphasis on team can actually serve as another barrier by discouraging individuals from speaking up (Bienefeld & Grote 2012). Assuming that teamwork in any enterprise may share the same dynamic, it could be that too much education focus and training on teamwork in healthcare may also negatively influence the nurse who is deciding whether or not to speak up. Okuyama et al. (2014) found when education was specifically focused on speaking up, it proved to be an effective way to positively influence behaviors of participants. This highlights an opportunity whereby speaking up can be taught to nursing students during their undergraduate years for the purpose of enhancing their comfort, and increasing the likelihood they will, in fact, employ this skill set, with the end goal of improving patient safety. Thus, an answer to the question ‘What curriculum is being taught in baccalaureate nursing programs to help students feel comfortable speaking up?’ gives nursing education researchers an evidence-based place to move forward with investigating this topic. Ourreview of literature uncovered only three studies related to the research question. Knowing that teaching speaking up can improve participants comfort while a focus on teamwork can be a negative influence, we propose that future research be focused on gathering data to determine whether nursing programs are actively teaching their students how to speak up, and how this is being done.