Challenging poor practice

Have you witnessed poor practice? Many of us have.

A few examples might include:

  • district nurses using inappropriate wound dressings for a variety of reasons,
  • generally poor adherence to aseptic non-touch technique (ANTT),
  • nursing assistants wearing earphones to listen to music while giving a patient a wash,
  • and food being left to go cold in front of patients who needed assistance eating.

I found it particularly difficult to speak up during my first year. Partly because I was worried about repercussions in my assessment documents. Partly because I was always worried that I might be overreacting. Have I misunderstood how ANTT works? Maybe that is also an appropriate dressing that will work just as well? Sometimes I spoke up immediately – for example, when a nurse was about to pull a sheet out from under a patient with a sacral moisture lesion instead of rolling them. Sometimes I went away and did some reading first before speaking to staff members to make certain I was not in the wrong. Although I felt horribly guilty about it, sometimes I just corrected the problem myself and didn’t challenge the staff member at all.

I believe one reason why poor practice does not get challenged is when the witnessing staff member is concerned about ‘making waves’ and being part of a team. This was also one of my concerns and although it does not make the situation any less uncomfortable, I simply had to tell myself: Is this a team I am proud to be a part of? The answer was a resounding no.

Please be aware that the Nursing and Midwifery Council (NMC) now supports nursing students in raising staff and Trust awareness of these potential problems. The new NMC Code (2015) includes a much more prominent section on your duty to raise concerns (see the third section called ‘Preserve Safety’). There is an acceptable way of doing this, which should be with your mentor initially. If you cannot do that (e.g. they are not on duty or your concern is with the mentor themselves), then the Practice Education Facilitator (PEF) will be your next option.  Always inform your Academic Advisor (AA) soon after raising your concern with the placement. Your AA should help you fill in the PLE and make sure any forms/records have been completed so that care can be improved.


Remember your 6C’s. Having the courage to speak up about poor practice is not easy – I won’t pretend that it is. But that patient in front of you trusts you to care for them. Don’t let them down.

Please share your views about poor practice in the poll below.