By Lisa Esposito

Nurses want to take the best possible care of their patients that they can. Sometimes, that means speaking out about problems that threaten safe care.

Hospital registered nurses may experience continually low staffing levels that don't meet the needs of severely ill patients on their unit. Working conditions can become hazardous, like a lack of protective personal equipment to prevent the spread of infectious diseases, including COVID-19.

If serious concerns are not being addressed and hazardous work conditions continue, nurses need to make an official report. Nurse leaders and experts describe how nurses can safely report unsafe health care conditions and practices while protecting themselves professionally.

Issues Nurses Report

Nurse practitioners and staff RNs report a variety of problems within health care facilities. Frequently reported issues include the following:

-Inadequate staffing levels.

-Lack of personal protective equipment and PPE violations.

-Unsafe, unsanitary work environments.

-Violence in areas such as emergency rooms and psychiatric units.

-Colleagues whose unsafe practices endanger patients.

In a survey about treating COVID-19, released in late April, with more than 32,000 U.S. participants, a majority of nurses responded that they were "extremely concerned" about issues including PPE, safety of friends and family, accessing reliable and credible information on caring for patients with COVID-19, adequate tests kits and training, personal safety and staffing.

The ongoing PPE shortage is the No. 1 issue among nurses surrounding COVID-19, says Ernest Grant. "The second is that in some cases they're still not adequately prepared," he says. "They need to know their position within the facility's disaster plan. Here is where good communication is essential. Knowing what their role is in that particular plan is extremely important, as well."

Safety Violations

Surges in patients with COVID-19 symptoms are putting a severe strain on staffing in California health care facilities, says Amy Arlund, a critical care registered nurse in Fresno who serves on the board of California Nurses Association/National Nurses United.

"The No. 1 issue that we report is when we have violations of our staffing ratios," Arlund says. "The second thing now is the lack of personal protective equipment."

Nurse practitioners – advanced practice nurses who have more autonomy than staff RNs and can diagnose, treat illnesses and prescribe medications – are experiencing similar problems. "Really, in this COVID environment, workplace safety and patient care concerns are at an all-time high," says Sophia Thomas.

In a single day, Thomas says the reporting system amassed reports including 154 reports of a lack of PPE, 83 reports of test kit shortages, some telehealth-related concerns and 40 reports of "just outright, unsafe working conditions."

In-House Reporting Steps

Reporting usually starts internally, by following the facility's reporting procedures and going up the chain of command.

At first, a nurse should go within the system as much as possible, says Nancy J. Brent, an attorney and registered nurse with a solo law practice in Wilmette, Illinois, primarily representing nurses in a variety of legal matters. (Brent notes that she is giving general information for readers rather than specific advice for a particular situation.)

Although titles may differ from one facility to another, nurses make reports to individuals like these:

Charge nurse. With each new shift, a charge nurse is assigned to manage oncoming nurses on a particular unit, often in addition to his or her own direct patient care responsibilities.

Nurse manager. Sometimes called a head nurse, the nurse manager oversees operations for the entire unit and serves as a liaison between staff nurses and upper nursing and hospital management.

Director of nursing. Sometimes called a director of patient care services, this administrator leads patient care for an entire department.

Chief nursing officer. Also known as a chief nursing executive, the chief nursing officer usually reports to the hospital CEO.

Risk management director. Also known as a hospital risk manager, this individual works proactively to prevent situations that could result in liability. Patient safety officer is a similar hospital role.

Documenting concerns and starting a paper trail can protect the nurse making the report. "Probably the best approach would be in writing," Brent says. "Institutions may have specific forms for that. It would be important for nurses to use that form and follow the policy and procedures in that institution to file that written complaint."