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Silence and/or Reflection Inaction?
As the stories of Susan and Elizabeth show, many nurses learn to keep
quiet, are reluctant to speak out, stay invisible, don‘t rock the boat or put
their heads above the parapet. Later we were to discuss this in our co-
inquiry group as a further cycle of action and inquiry which is presented in
the next chapter. During the non participant observations of the inter-
professional team meetings, I noticed the nurses did not ask questions
and remained silent unless directly spoken to. In contrast the
physiotherapists, occupational therapists and doctors asked frequent
questions and spoke vociferously. This ‗passive‘ culture seems a long way
from the radical transformative learning that reflective practice is supposed
to induce (Gustafasson & Fagerberg 2004, Glaze 2001, Johns 2000, 1997,
Mezirow 1990).
During our co-inquiry meetings we discussed the blossoming middle
management posts in the NHS as a consequence of the policy directive
called clinical governance (DH 1999). Many of these new posts focused on
risk assessment procedures and practice development. There was now a
managerial function associated with filling in critical incident forms (part of
the reporting system attached to risk assessment). We believed these
forms while supposedly there to help staff, were inadvertently contributing
to a culture of blame and fault finding. However, the rhetoric of the NHS is
one of moving to a non blame culture (Wise 2001). I remembered my own
unwillingness to complete such a form 44 . Contrary to the literature above,
in the co-inquiry group we suggested admitting mistakes in a field of
practice that tended to blame others felt unsafe so that nurses learnt to
keep quiet. They learnt not to act in relation to their dissatisfactions.
Therefore, we wondered if it was safer to whinge and less exposing than
reflecting. It is certainly not easy to expose ones errors to others as Maria
noticed:
44 See chapter 3 when I was late giving a prescribed drug for Mary.
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