In almost half of cases where nurses have raised concerns about issues such as staffing levels and patient safety, no action was taken, according to a new survey by the Royal College of Nursing (RCN). More than 80% of nurses have raised concerns with their employers about such issues.

A survey of over 3,000 members of the RCN found that the majority (84%) said they would be concerned about victimisation, personal reprisals or a negative effect on their career if they were to report concerns to their employers.

The RCN expressed concern that this indicates a worsening situation in comparison with a similar survey in 2009, and says it may be a reflection of the increasing pressures on staff in the NHS.

More than a third of nurses (34%, up from 21% in 2009) revealed that they had been discouraged or told directly not to report concerns at their workplace and only a third (35%, compared with 46% in 2009) felt confident that their employer would protect them if they spoke up.

Dr Peter Carter, chief executive and general secretary of the RCN, said: “It is extremely worrying that nurses are being explicitly told not to raise concerns – after all we have learnt about the consequences when problems are not tackled. Cases such as the terrible situation that arose at Stafford hospital, precipitating a major public enquiry, should be adequate warning about the consequences of slashing staffing levels and ignoring staff concerns. It’s very important that when we know 56,000 posts are at risk in the NHS, staffing levels across the board don’t lead to another disaster.”

Of those who had reported concerns (80%, up from 63% in 2009), 38% had filled in incident forms which are a formal mechanism for documenting situations that are a potential threat to patient safety, while 72% had reported concerns to their line manager. Despite using a variety of methods to report concerns, only a fifth of nurses (20%, compared with 29% in 2009) said that their employers had taken immediate action to resolve the situation. Almost half (48%, compared with 35% in the previous survey) said that no action was ever taken.

The vast majority (over 99%) of registered nurses understood their professional responsibility to report worries about patient safety but fears about personal reprisals meant that only 35% (compared to 43% in 2009) would be confident to report concerns without thinking twice.

The survey does suggest that awareness of the laws around whistleblowing has improved (73% are now aware that their trust has a whistleblowing policy, in contrast with 2009 when 45% did not know either way).

Almost half (49%) of those surveyed were unaware that they can also raise concerns with organisations other than their employer, such as the Care Quality Commission. Similarly, despite the act having passed in 1998 only 42% of respondents were aware that they were protected in law if they raise concerns about wrongdoing.

Dr Peter Carter added: “This is yet more evidence that nurses have genuine concerns that they will be victimised if they speak up. All too often, they’re right. Policies and guidance from employers and the NMC are welcome, and have done a great deal to increase awareness about the importance of whistleblowing.

“However, it is absolutely vital that nurses are protected in practice, and that they have confidence that managers will support them. This support, which should be from the line manager on the ward to the Chief Executive of their trust, is crucial if we are to avoid another dreadful example of poor care which carries on unchallenged.

“We’ve had laws protecting whistleblowers for over a decade now, however they are not fulfilling their purpose if they are not used due to a fear of reprisals. The senior managers at any Trust must demonstrate in practice that any concerns will be welcomed and acted upon, and they also need to ensure that feedback is given to those who raise concerns.

“We are concerned that the gap between policy and reality may be a reflection of how stretched NHS staff are, dealing with acutely ill patients with fewer staff than before. It is patients who suffer where staffing levels are eroded and concerns are not dealt with, so the impact of cuts cannot be underestimated.”