The Silence That Costs Lives: Why Psychological Safety Must Start with Nurses

Date published: June 26, 2025

In hospitals across the country, the scariest sound isn’t a code alarm. It’s silence.

Silence when a nurse notices a subtle decline in a patient but hesitates to call the rapid response team. Silence when a junior staff member knows a dosage seems wrong but feels too intimidated to speak up. Silence when someone sees a mistake unfolding and watches it happen anyway.

We call this the β€œauthority gradient.” It’s the unspoken hierarchy in healthcare that keeps people from challenging those above them, even when patient safety is on the line. And while it’s understandable it’s also deadly.

I’ve been in healthcare over four decades. I’ve worked in trauma bays, ICUs, helicopters. I’ve taught thousands of nurses.

And I can tell you: preventable harm doesn’t come from lack of knowledge. It comes from fear. Fear of being wrong. Fear of retaliation. Fear of being labeled β€œdifficult.”

That’s why psychological safety the belief that you can speak up without fear of embarrassment or punishment isn’t a soft skill. It’s a patient safety intervention.

Nurses Are the First Line. And Too Often, the Quietest.

Nurses are the eyes and ears of the care team. They’re the ones at the bedside. They know the patients. They notice the early signs, when someone’s color shifts, or a voice sounds different, or a small number starts trending the wrong way.

But in a culture where voicing concern feels like challenging authority, nurses learn to second-guess themselves. Especially new nurses. Especially women. Especially anyone made to feel they don’t belong at the decision-making table.

And that delay, those extra seconds or minutes spent β€œwaiting to be sure”, can be the difference between life and death.

What the Research Tells Us (That We’ve Ignored Too Long)

The Joint Commission, the National Academy of Medicine, and decades of root cause analyses point to the same issue: communication failures are a leading cause of preventable harm. Up to 70% of sentinel events are linked to miscommunication or lack of speaking up.

Psychological safety is the foundation that allows every other safety initiative to succeed. It doesn’t matter how good your protocols are, if the people using them are afraid to question a decision, you will miss things.

And yet, many hospitals still struggle to name this. Or worse, they conflate β€œsafety culture” with compliance checklists.

Real Psychological Safety Starts With Leaders

If you are a nurse manager, a CNO, or anyone in a position of leadership, you have more power than you think. Culture starts at the top, but it’s reinforced every shift, every handoff, every eye roll or raised voice.

Here’s what building real psychological safety for nurses looks like:

Model humility. If you make a mistake, say so out loud. Let your team see that speaking up is safe, even when it’s hard.

Invite dissent. In team huddles, ask, β€œWhat are we missing?” or β€œDoes anyone feel uneasy about something today?” Then pause. Really pause.

Use structured communication tools. SBAR. CUSS. Check-backs. These aren’t just acronyms, they’re permission slips for anyone, regardless of rank, to speak up.

Stop shaming in its tracks. If someone is mocked or dismissed for raising a concern, address it immediately and in front of the group. Silence equals endorsement.

Recognize courage. When someone uses their voice, acknowledge it, even if their concern turned out to be a false alarm. The goal is not perfection. The goal is speaking up before it's too late.

Respect Is the Baseline. Teamwork Is the Goal.

When I walk into hospitals with high-functioning teams, the difference is palpable. Nurses feel empowered. Doctors listen. Mistakes still happen, but they get caught early, because someone said something.

In those environments, respect flows laterally and vertically. It’s not about hierarchy, it’s about shared mission. And that shift changes everything.

Patients don’t just get better care. Staff feel safer. Retention improves. Litigation risk drops. And most importantly, lives are saved.

What Will You Normalize?

Psychological safety isn’t a poster in the break room. It’s what you tolerate in a hallway conversation. It’s who gets interrupted in rounds. It’s whether your team believes they’ll be backed up or punished for doing the right thing.

The best nurses I know don’t just give meds and monitor vitals. They advocate. They notice what others miss. They speak when it’s uncomfortable.

But only if they’re given the safety to do so.

So if you’re in a position to create culture, ask yourself: Are you protecting your people from harm, or from blame? Because in the end, silence is not neutrality. It’s risk.

And we can’t afford it anymore.

I’m curious when was a time you wanted to speak up, but didn’t? What got in the way? Or what made it safe for you to try? Drop your story below. We learn most from each other.

Want to go deeper? Watch my TEDx Talk: How Not to Die in the Hospital Or explore our safety training at Lifebeat Solutions

Visit our website https://drjuliesiemers.com/lifebeat-solutions/ and book a consultation with us. For inquiries, you can also reach out via email at [email protected].

#PatientSafety #NurseLeadership #PsychologicalSafety #SpeakUpForSafety #NurseEmpowerment

The Silence That Costs Lives: Why Psychological Safety Must Start with Nurses

Date published: June 26, 2025

In hospitals across the country, the scariest sound isn’t a code alarm. It’s silence.

Silence when a nurse notices a subtle decline in a patient but hesitates to call the rapid response team. Silence when a junior staff member knows a dosage seems wrong but feels too intimidated to speak up. Silence when someone sees a mistake unfolding and watches it happen anyway.

We call this the β€œauthority gradient.” It’s the unspoken hierarchy in healthcare that keeps people from challenging those above them, even when patient safety is on the line. And while it’s understandable it’s also deadly.

I’ve been in healthcare over four decades. I’ve worked in trauma bays, ICUs, helicopters. I’ve taught thousands of nurses.

And I can tell you: preventable harm doesn’t come from lack of knowledge. It comes from fear. Fear of being wrong. Fear of retaliation. Fear of being labeled β€œdifficult.”

That’s why psychological safety the belief that you can speak up without fear of embarrassment or punishment isn’t a soft skill. It’s a patient safety intervention.

Nurses Are the First Line. And Too Often, the Quietest.

Nurses are the eyes and ears of the care team. They’re the ones at the bedside. They know the patients. They notice the early signs, when someone’s color shifts, or a voice sounds different, or a small number starts trending the wrong way.

But in a culture where voicing concern feels like challenging authority, nurses learn to second-guess themselves. Especially new nurses. Especially women. Especially anyone made to feel they don’t belong at the decision-making table.

And that delay, those extra seconds or minutes spent β€œwaiting to be sure”, can be the difference between life and death.

What the Research Tells Us (That We’ve Ignored Too Long)

The Joint Commission, the National Academy of Medicine, and decades of root cause analyses point to the same issue: communication failures are a leading cause of preventable harm. Up to 70% of sentinel events are linked to miscommunication or lack of speaking up.

Psychological safety is the foundation that allows every other safety initiative to succeed. It doesn’t matter how good your protocols are, if the people using them are afraid to question a decision, you will miss things.

And yet, many hospitals still struggle to name this. Or worse, they conflate β€œsafety culture” with compliance checklists.

Monitoring and Reporting

Collecting and analyzing data on safety incidents to identify trends and areas for improvement.

Establishing Standards

Developing and enforcing safety protocols to ensure consistency and quality across healthcare organizations.

Promoting Education

Providing training and resources to healthcare professionals to enhance their knowledge and skills in patient safety.

Encouraging Transparency

Creating a culture where healthcare workers feel empowered to report errors and near-misses without fear of retribution.

FAQ image

Driving Innovation

Leveraging technology and research to implement cutting-edge solutions for patient safety challenges.

FAQ image

Real Psychological Safety Starts With Leaders

If you are a nurse manager, a CNO, or anyone in a position of leadership, you have more power than you think. Culture starts at the top, but it’s reinforced every shift, every handoff, every eye roll or raised voice.

Here’s what building real psychological safety for nurses looks like:

Model humility. If you make a mistake, say so out loud. Let your team see that speaking up is safe, even when it’s hard.

Invite dissent. In team huddles, ask, β€œWhat are we missing?” or β€œDoes anyone feel uneasy about something today?” Then pause. Really pause.

Use structured communication tools. SBAR. CUSS. Check-backs. These aren’t just acronyms, they’re permission slips for anyone, regardless of rank, to speak up.

Stop shaming in its tracks. If someone is mocked or dismissed for raising a concern, address it immediately and in front of the group. Silence equals endorsement.

Recognize courage. When someone uses their voice, acknowledge it, even if their concern turned out to be a false alarm. The goal is not perfection. The goal is speaking up before it's too late.

Respect Is the Baseline. Teamwork Is the Goal.

When I walk into hospitals with high-functioning teams, the difference is palpable. Nurses feel empowered. Doctors listen. Mistakes still happen, but they get caught early, because someone said something.

In those environments, respect flows laterally and vertically. It’s not about hierarchy, it’s about shared mission. And that shift changes everything.

Patients don’t just get better care. Staff feel safer. Retention improves. Litigation risk drops. And most importantly, lives are saved.

What Will You Normalize?

Psychological safety isn’t a poster in the break room. It’s what you tolerate in a hallway conversation. It’s who gets interrupted in rounds. It’s whether your team believes they’ll be backed up or punished for doing the right thing.

The best nurses I know don’t just give meds and monitor vitals. They advocate. They notice what others miss. They speak when it’s uncomfortable.

But only if they’re given the safety to do so.

So if you’re in a position to create culture, ask yourself: Are you protecting your people from harm, or from blame? Because in the end, silence is not neutrality. It’s risk.

And we can’t afford it anymore.

I’m curious when was a time you wanted to speak up, but didn’t? What got in the way? Or what made it safe for you to try? Drop your story below. We learn most from each other.

Want to go deeper? Watch my TEDx Talk: How Not to Die in the Hospital Or explore our safety training at Lifebeat Solutions

Visit our website https://drjuliesiemers.com/lifebeat-solutions/ and book a consultation with us. For inquiries, you can also reach out via email at [email protected].

#PatientSafety #NurseLeadership #PsychologicalSafety #SpeakUpForSafety #NurseEmpowerment