Student Perceptions of the Real World: Silence Still Kills

Thursday, 15 July 2010: 11:10 AM

Jacqueline Fowler Byers, PhD, RN, NEA-BC, CPHQ, FAAN
College of Nursing, University of Central Florida, Orlando, FL
Mary G. Harper, PhD, RN-BC
Nursing, Western Governors University, Salt Lake City, UT

Learning Objective 1: Identify seven crucial concerns in the workplace identified by senior BSN students.

Learning Objective 2: Discuss research, practice, leadership, and educational implications of a culture of silence.

Purpose: The landmark report, To Err is Human (IOM, 2000), illuminated the extent of medical errors.  Subsequent research, reported in Silence Kills, identified seven areas in which lack of communication contributes to these medical errors (Maxfield, Grenny, McMillan, Patterson, & Switzler, 2005).  Despite heightened attention to patient safety, medical errors remain a significant source of mortality and morbidity.  The purpose of this study was to determine student perceptions of organizational culture to determine if nurses are willing to address co-workers who demonstrate below standard performance.

Methods: Twenty three  senior BSN students were asked to describe a time in their clinical experiences when they witnessed any one of the concerns delineated in Silence Kills and how the issue was handled. The sampling units were the text of their on-line postings. Written responses were analyzed qualitatively using abductive inference textual content analysis. Following individual textual coding, consensus was determined on thematic congruence. 

Results: Each of the seven crucial concerns in Silence Kills were identified by students.  Students observed the involvement of staff nurses, charge nurses, and nurse managers in these crucial issues.  In most cases, the concerns were not addressed by managers, nurses, or students. The most common concerns were broken rules, disrespect and poor teamwork. Students were shocked by the breach of standards yet unwilling to speak up due to their status as students. One student indicated that she could see herself doing the same things as a clinician and another student described her difficulty remembering rules that are not modeled by nurses.

Conclusion: This study revealed a continued prevalence of the themes described in Silence Kills,, thus negatively impacting patient safety.. Nursing faculty, nurses and nurse leaders must educate and facilitate the empowerment of nurses to break the silence in order to promote a safe and healthy work environment.