by Rachel Wood RGN

Assumptions are often made based upon an individual’s job title rather than their skills and competence. As a Registered Nurse, it was often assumed that I wasn’t clever enough to make it to medical school and so my clinical view was second best.  The culture of the organisation, my gender and medical dominance made it difficult to speak out and on occasion I was reprimanded “you mustn’t question Doctor, he knows best”   Well question I did and consequently was always in trouble.  I saw myself as a rebel rather than a trouble maker.

On one occasion, I was nursing a patient involved in a gas explosion who had been admitted to accident and emergency with severe burns. Once a surgical airway was established I suggested that we could now protect the cervical spine, (this had been delayed due to concerns around constriction due to the burns). My suggestion was ridiculed as although correct, the Consultant managing the trauma had allowed himself become distracted by the severe burns, overlooking the fact that the patient had been thrown across a building and so was at risk of cervical injury.  Determined to protect the patient’s cervical spine, I asked the anaesthetist to make the same suggestion. He did so and the Consultant agreed.  As galling as this was, I did at least manage to ensure the patient received the correct treatment.

It is really unbelievable that a set of unfounded assumptions and hierarchical system could have such detrimental effect on patient safety. This happened a number of years ago and I hope is not representative of today’s clinical practice, or is it?

A number of advance have been made around identifying and mitigating risk. System weakness is identified and then tested method applied to try to manage the barriers. Numerous reports and evidence around cultural change and effective leadership published. However I remain concerned as I see the health service struggle to face daily challenges, that this important work will be missed. How do we campaign for change? How do we support organisations to plan for a future when it takes all its energy to deal with the now?

Rachel Wood is a Professional Learning & Development Facilitator for the RCN and Registered Nurse with 25 years of critical care experience.  She is embarking on a project to develop and pilot a tool for cultural change in healthcare.  The tool will be founded in the principle of reconciliation, root cause analyses and learning from error.

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