title: Factors influencing nurses' decisions to raise concerns about care quality.
abstract: OBJECTIVE
  To explore factors that influence nurses' decisions to raise concerns about standards of practice.
  
  
  BACKGROUND
  Health care practitioners have a key role in monitoring care quality. Nurses are required by their professional body to raise concerns about standards; however, under-reporting is the norm.
  
  
  METHODS
  Grounded theory was used to collect and analyse data from semi-structured interviews with 142 practising nurses, theoretically sampled from three Acute NHS Trusts in England.
  
  
  RESULTS
  Fear of repercussions, retribution, labelling and blame for raising concerns, about which they predicted nothing would be done, were identified as disincentives to raising concerns. Reporting was perceived as a high-risk:low-benefit action. Nurses lacked confidence in reporting systems.
  
  
  CONCLUSIONS
  Disincentives to reporting need to be addressed if an open culture, which promotes quality, safety and learning, is to be developed. Findings give cause for concern and indicate a need to review organizational and professional guidelines, and organizational reporting systems.
authors: School of Nursing, Midwifery and Social Work, University of Manchester, UK. moira.j.attree@manchester.ac.uk
authors: Moira
authors: M
authors: Attree
mesh_terms: D000328:Adult; D001242:Assertiveness; D001291:Attitude of Health Personnel; D003220:Conflict, Psychological; D003657:Decision Making; D004739:England; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000523:psychology*; D015279:Organizational Culture; D017410:Practice Guidelines as Topic; D011361:Professional Competence / Q000592:standards; D011787:Quality of Health Care / Q000592:standards; D017751:Safety Management / Q000458:organization & administration; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D035642:Whistleblowing / Q000523:psychology*