Loud and Clear: Speaking Up for Patient Safety (Podcast)

As advocates for their patients, nurses need to be empowered to raise concerns about potential issues


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“In the Cleveland Clinic way, patients come first, and we’re always going to stand up to do the right thing for a patient,” says Craig Tobias, MSN, MBA, RN, Director of Acute Nursing Care at Cleveland Clinic Marymount Hospital.

Standing up for patients includes speaking up and alerting others when something doesn’t seem right. But finding your voice and expressing yourself can be intimidating, particularly for new nurses. In a recent episode of Cleveland Clinic’s Nurse Essentials podcast, Tobias discusses when and how to raise concerns about patient care and safety, including:

  • Advice for phrasing questions so they sound like you are seeking clarity rather than interrogating someone
  • Creating a culture where nurses are encouraged – and taught how – to speak up
  • Helping nurse leaders hone their listening skills and validate caregivers’ concerns
  • The emotional toll it takes on nurses when they choose not to speak up
  • Putting mechanisms in place that encourage dialogue, such as tiered huddles

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Nurse Essentials episodes at my.clevelandclinic.org/podcasts/nurse-essentials or wherever you get your podcasts.

Podcast excerpt

Podcast host Carol Pehotsky, DNP, RN, NEA-BC: We both have spent time in periop and PACU services, and it’s different speaking up in a different specialty. What would you share with nurses who are new to our specialty or to nursing in general?


Tobias: We have to actually really make sure we take the time to train and orient it. Right? So, definitely don’t avoid it. Don’t wait until that situation occurs to say, “Hey, here’s the day, you should stop the line.”

We have enough examples, being a large healthcare system and having a lot of experience in stopping the line. We can share those experiences before we even get to that scenario. And this way, we’re setting that groundwork of, OK, here’s a really good one for you. So-and-so didn’t sign the consent form and wants to take the patient to surgery. No, we’re going to stop the line. That’s an automatic one, right? Then we give new caregivers some support and knowledge base of what stop the line really means. Versus, it’s two in the morning and I have to call a doctor for something, and they don’t want to wake up and then we do that whole thing round and round and round. Or it’s the weekend and I don’t want to bother my nurse manager because they’re home. And we run into these other nuances.

I think if we educate on the front end about what’s important and why – and then give them real time examples of what we’re dealing with – it helps cement that, too.

Pehotsky: Yeah, absolutely. It’s content to be delivered. And so for any of our listeners – no matter which organization you’re from, really – if you’re a leader, considering that, and if you’re not in a leadership position, taking to your leadership, really talking about how do we integrate this into residencies and into nurse fellowships – into any training to really make sure that the first time I’ve spoken up isn’t the first time in clinical practice.


How do I create simulations or case studies or other opportunities that it’s safe for nurses to practice those phrases? So, when it happens the first time clinically, there’s those canned phrases they can pull out of their back pockets.

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