title: A concept analysis of undergraduate nursing students speaking up for patient safety in the patient care environment.
abstract: OBJECTIVE
  An analysis of the concept of nursing students speaking up for patient safety in the workplace.
  
  
  BACKGROUND
  'Speaking up' is assertive communication in clinical situations that requires action through questions or statements of opinion or information with appropriate persistence and is linked to patient safety. Previously, the concept of speaking up has focused on the registered or experienced practitioners, there is minimal discussion relating to student nurses. Analysis of the elements of students speaking up will identify the key elements that will give understanding to their position and experiences.
  
  
  METHODS
  A concept analysis.
  
  
  METHODS
  Literature included publications between 1970-2015 from, MEDLINE, CINHAL, PUBMED and SCOPUS. Search terms included patient safety AND speaking up; AND pre-registration/undergraduate nursing students, patient advocate, error reporting, organizational silence, whistleblowing and clinical placement/practicum.
  
  
  METHODS
  The Walker and Avant concept analysis model was modified and used to examine the literature.
  
  
  RESULTS
  Nursing students speaking up behaviour is influenced by individual and contextual factors that differ from those influencing more experienced colleagues. Motivators and barriers to voicing concerns include moral and ethical beliefs, willingness and confidence to speak up in the workplace. Students' subordinate and often vulnerable position creates additional tensions and challenges that impact their decisions and actions.
  
  
  CONCLUSIONS
  This concept analysis provides a clear definition of 'speaking up' in relation to nursing students. The analysis will facilitate understanding and operationalization of the concept applied to learning and teaching, practice and research.
authors.affiliation: School of Health, University of New England, Armidale, NSW, Australia.
authors.forename: Anthea
authors.initials: A
authors.lastname: Fagan
authors.affiliation: School of Health, University of New England, Armidale, NSW, Australia.|Hunter New England Area Health Service, Valentine, NSW, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Parker
authors.affiliation: School of Health, University of New England, Armidale, NSW, Australia.|Oxford Brookes University and Oxford University Hospitals, UK.
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
mesh_terms: D003142:Communication; D006801:Humans; D005791:Patient Care; D061214:Patient Safety; D013338:Students, Nursing; D035642:Whistleblowing
keywords: clinical placement/practicum; error reporting; organizational silence; patient advocate; patient safety; pre-registration; speaking up; undergraduate nursing students; whistleblowing