Psychological Safety – How can we empower Nurses today?


How can we empower Nurses today?

How can we empower nurses today is the blog topic set by #NurseBloggers2020 for February as part of the 2020 International Year of the Nurse and Midwife. How a nurse and midwife leader sets a culture of psychological safety on the ward is a hugely important factor in empowering nurses to speak up and express concerns. This blog explores some practical ways that nurse and midwife leaders can empower their teams and strengthen a psychologically safe environment

The culture of nursing

Nursing has a culture of avoiding the critical conversations that need to be had instead of stating concerns. Often nurses may complain amongst themselves rather than addressing the issue directly. When the culture on the ward does not foster an environment that allows for questioning and direct communication this impacts on staff feeling psychologically unsafe and unable to speak up without fear of consequences. For a team to be able to provide safe patient care nurses must be empowered to speak up. The role of the nurse/midwife manager is crucial in modelling leadership and communication skills that grow a psychologically safe environment and empower staff to speak up.

The wider multi-disciplinary team

The nurse/midwife manager’s role in creating a psychologically safe environment extends beyond the immediate nursing team to the wider multi-disciplinary team. Effective teams are those that feel safe and supported to be able to raise concerns and communicate directly. How communication is modelled with medical and allied health colleagues as well as nurses is equally important. As a senior nurse leader in a speciality area; it is part of the role to work closely with the senior medical and allied health staff. Leading by example extends to your interactions with senior medical and allied health staff. There is plenty of evidence that suggests that nurses don’t call out bad behaviour for fear of retribution or worse still an acceptance that because someone always behaves that way that this is accepted as the norm. 


Building trust with your team members is one of the most important aspects of building a psychologically safe environment. Brene Brown describes a seven stage braving inventory that is useful to understand how trust is built and earned and can be applied to being a nurse leader.

  1. Boundaries- respect for another’s boundaries and when you are not clear about what’s okay and not okay, you ask. You are willing to say no.
  2. Reliability – you do what you say, don’t overpromise and are able to deliver on commitments and balance competing priorities.
  3. Accountability- You admit your own mistakes, apologise and make amends
  4. Vault- you don’t share information and experiences that are not yours to share. Confidences are kept.
  5. Integrity – you choose courage over comfort, you choose what is right and you choose to practice your values.
  6. Nonjudgment – I can ask for what I need and you can ask for what you need. We can ask each other for help without judgment.
  7. Generosity- being generous with your interpretation of the intentions, words and actions of others.

Brene Brown

Speaking up and patient safety

Many nurses will be aware that there is a direct link between staff feeling that they can speak up and raise concerns and patient safety. Often the nurses are the eyes and the ears for patient safety when no one else is around. The ability to speak up in a way that empowers team members and prevents harm to patients cannot be underestimated. The consequences of not speaking up as the American Association of Critical-Care Nurses(AACN) puts it “Silence kills”

How as a leader to encourage your team to Speak up

Amy Edmonson has written extensively about psychological safety in organisations.  Amy describes 3 ways to create psychological safety in health care which talks about three important elements; 

  1. Framing the work – Amy suggests that we should remind the team at the beginning of each shift about the nature of the work that we do as nurses. What does this mean in practice? Put simply it is about the leader creating an opportunity at the start of each shift to remind staff that we are all here to care for patients and keep them safe. In order to do this Amy uses the term “bringing our full self to work” which means that we are present at work and actively listening and observing the patients that are assigned to our care and listening actively to the concerns of the staff when they pick up when things are not right.
  2. Modelling fallibility – This comes back to my earlier blog where I talked about the importance of admitting when as a leader we have got something wrong. Modelling fallibility is an important leadership behaviour. It is about acknowledging to your team that you are human and can’t see everything and might miss something. You are then inviting the help of the team to help you in letting you know when you might have missed something. Amy suggests that by inviting their input by saying as a leader “I’d love your input” or “ what do you think?” reduces the psychological cost of having to speak up by inviting feedback.
  3. Embrace messengers – There are two simple words “thank you” that as a  leader you use when staff come to you with concerns, ideas, suggestions for improvement. This is important as it is sending the message that you are open to and welcome feedback and has a direct correlation to patient safety.

Changing culture and behaviours is one of the most difficult aspects of change to manage. It is time-consuming, requires endless amounts of tenacity and patience and energy and takes time to see the efforts of hard work. The three components of Amy Edmonson’s framework above begin to give you a framework and something to work on with your team to begin that journey of change and start to develop a psychological safety within teams.

“ Daring leaders who live into their values are never silent about hard things”

Brene Brown 

How coaching can help you

As a coach, I help people to discover what is holding them back from having difficult conversations and to understand how limiting beliefs may be holding them back from progressing in their leadership roles. Click here to book a complimentary coaching session to learn how I can help you.

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