Registered nurses’ perceptions and experiences with speaking up for patient safety in hospitals

Background: Despite evidence showing the importance of open communication in improving patient safety, communication failure remains one of the main causes of patient adverse events. Aim: This study explored nurses' perceptions and experiences with speaking up for patient safety in Korean hospitals. Methods: Fifteen nurses were recruited from four tertiary hospitals in two cities in South Korea to participate in an online semistructured interview. Data were categorised by inductive content analysis techniques. Findings: Although most nurses perceived that speaking up is important and half of them claimed that they were assertive in general, only one-third reported that they would speak up for patient safety without hesitation in their workplace. Speaking up was challenging for nurses, particularly with senior nurses and physicians, at least partly due to the social characteristics embedded in Korean culture, such as respect for the hierarchy and value of groups' ideas more than that of individuals. When speaking up, nurses used a variety of strategies such as using polite language with embedded signals of subordination. We found that nurses used not only problem-focused voice, but also suggestion-focused voice. The nurses' speaking-up behaviours resulted in positive or negative consequences, impacting their future communication behaviours. Discussion: Investing in individual skill building and organisational supports to ensure a safe environment for speaking up is crucial for overcoming the barriers from the longstanding cultural influences in Korean hospitals and for empowering nurses to speak up for patient safety. Conclusion: There are gaps between nurses' perceptions of the importance of speaking up and their ease with speaking up in practice. (c) 2022 Australian College of Nursing Ltd. Published by Elsevier Ltd.