Speaking up for patient safety: An interview with Kathy Nabbie

Summary

As part of our ‘Speaking up for patient safety’ interview series', we spoke to Kathy Nabbie, a theatre scrub nurse practitioner and non-medical surgical first assistant. Kathy talks to us about the cultures she has witnessed in both NHS and private healthcare organisations, and why she now will not accept a shift if she feels not enough is done to ensure patients’ safety.

Questions & Answers

Hi Kathy. Thank you for joining us. Could you start by telling us a little about yourself?

 I’m a registered nurse and non-medical surgical first assistant with over 40 years’ experience working in operating theatres. I trained at Whittington University Hospital, Broomfield University Hospital and the University of Greenwich. I have previously worked at the National Hospital for Neurology and Neurosurgery Queens Square London, HCA Princess Grace Hospital and King Edward VII Hospital. I am now employed by HBSUK, an insourcing service.

I also cover the odd locum agency shift and at weekends work in an NHS dermatology minor ops department assisting with the backlog of NHS dermatology patients.

Having worked within the NHS and in private organisations, can you tell us about your experience of the cultures within them both? Is there a difference?

It varies. I have found in the private hospitals where I’ve worked, some have excellent standards while others can be really unsafe. There are some where I will refuse a shift if I feel that not enough is done regarding patient safety.

If I work a few shifts and I complain about anything I find to be unsafe, I am told “to shut up, keep my head down, do the job and go home”. If this happens, I will not accept another shift.

Within the NHS, I think the culture is slowly improving, but staff are still afraid to speak up—they need to keep their jobs, so they say nothing and just do the work and go home.

I recently worked with a nurse who said to me: "Kathy, I wish I had met you years ago—I like the way you speak up for your colleagues and for patient safety", but many are too frightened to do that.

What did you experience when you tried to raise a patient safety issue?

The response to this question requires a bit of background. Scrub nurses are aware that they cannot do two roles at once, which means they cannot both scrub and assist the surgeons at the same time. The scrub nurse looks after the instruments, swabs, etc, while there should also be a doctor there too to assist or a nurse assistant with a surgical first assistant training. This is a standard set by the Perioperative Care Collaboration (PCC). It is a statement that clearly explains the roles and why it should be followed (see attachment at the end of this interview). The PCC was formed in October 2002: nine professional organisations form part of this statement, including the Royal College of Nursing (RCN),the Association for Perioperative Practice (AfPP), the College of Operating Department Practitioners and the Royal College of Anaesthetists.

So, I’ll give you an example where this wasn’t followed. On one shift in a private hospital, I was asked to scrub for a patient who was having a face lift plus other procedures, but there was no scrub assistant. Of course I refused, saying it was unsafe for both the patient and the staff. I told them I would be happy to assist the surgeon, as I have completed the surgical first assistant course. After a discussion with the theatre manager, and after I had given her a copy of the PCC statement, this was eventually agreed and I assisted for the procedure.

Later that day, the permanent theatre staff admitted to me that they are aware they must not scrub and assist but because it was not the culture of the hospital, they just “go with the flow”.  I decided not to accept another shift there, as I believe it happens often.

What patterns are you seeing in how managers and organisations respond to staff when they speak up?

The usual responses I’ve witnessed by managers and organisations to staff reporting safety issues are shunning the staff, labelling them as troublemakers and also blocking their shifts if they are agency or bank staff.

Do you think bank and agency staff are treated differently to permanent staff?

Yes. It's a case of keeping your head down and your lips sealed because otherwise we are labelled as "just a bank or agency nurse". On one occasion as a bank nurse, during a breast surgery procedure, I was given a cardboard sharps pad for my sharps. Used with ampoules of local anaesthetic on the cardboard sharp pads, together with many blades, needles, etc, means the closure of the pad is difficult and can be dangerous to secure without causing an injury. Staff often discard the pad in the Sharpsmart container without closing it and then the sticky part of the pad then attaches itself to the inside of the container and the person allocated to remove the container for disposal has to be extremely careful to avoid being injured. Staff can be seen shaking the box to help move the sticky sharps pad! It's an easy fix—for a few pence more, a proper puncture proof sharps box can be used per procedure to keep everyone safe.

I raised this to the theatre coordinator at the end of the 6-hour operation, explaining that I was scared and had to be really careful not to injure myself, which would not only affect my own safety but also the safety of the patient and the surgical team. The next day I had a WhatsApp message telling me that my Friday and Saturday shifts to assist a breast surgeon were cancelled. I was not offered any more shifts the following week and I never returned.

We know that staff safety is closely linked to patient safety. How do the issues staff face when speaking up impact patient safety?

One of the issues that really troubles me is the lack of awareness of diathermy tissue smoke evacuation when using cautery in theatres—this really makes a huge impact on both staff and patient safety as the plaque from cauterisation of tissue contains the same constituents as cigarettes, and when inhaled can lead to lung cancer. Patients can also inhale the smoke if evacuation is not used during local anaesthetic procedures. This safety issue really needs to be spoken about at government level.

What changes need to happen at both a local and system-wide level to create an environment where staff are protected when they speak up?

Managers need to accept that changes are important and need to be implemented to keep patients and staff safe. They need to respect and applaud staff for speaking up. They need to actively listen and then initiate an action plan. Not just say "thank you for telling me, I will take it on board". Staff are afraid to speak up and there needs to be processes in place to reassure and protect them—and this should be a pattern both locally and nationwide.

Do you feel that the new regulation of NHS managers will make a difference?

Yes, I definitely feel the regulation of NHS managers will make a difference and we can look forward to this change.

What advice would you give staff who are thinking about speaking up within their organisation?

My advice to staff who want to speak up is to be brave and take a leap of faith. Contact the Speak Up Guardian of your trust and follow up the investigations. 

Wes Streeting recently said: “I'm determined to create a culture of honesty and openness in the NHS where whistle-blowers are protected, and that demands tough enforcement. If you silence whistleblowers, you will never work in the NHS again." I hope the new government plan to support whistleblowers will make a difference.

Further reading

• How I raised awareness of fires in the operating theatre
• Development of the Fire Risk Assessment Score (FRAS) in theatres
• A personal view of the harmful effects of diathermy smoke