New Nurse Roadmap · Communication and Safety
Speaking up is hardest when you are the least-experienced person in the room. You may worry that you misunderstood the situation, will annoy someone senior, or will be remembered as difficult. But experience does not make silence safer. Your job is not to win an argument—it is to make sure a concern is heard, understood, and acted on through the appropriate pathway.
Start with the observable concern
“I noticed ___. I am concerned because ___. I need clarification or help with ___ now.”
That structure separates what you observed from what you fear, makes the risk visible, and gives the other person something specific to address.
Use the smallest clear statement first
Many concerns can begin as a focused question: “Can we pause so I can clarify the plan?” or “This finding is different from the earlier assessment. Can we review it together?” Keep the message about the patient, task, order, handoff, or process—not the other person’s competence or intent.
For a structured update, the AHRQ TeamSTEPPS SBAR tool organizes communication as Situation, Background, Assessment, and Recommendation or Request. You do not need every detail before calling. Lead with why the person needs to listen now.
When the first statement does not resolve the concern
If you still believe there is a meaningful risk, state the concern again more directly. AHRQ’s Two-Challenge Rule gives teams a shared method for respectfully challenging a plan when clarification does not ease concern about potential harm. This tool is intended for high-risk situations and works best when the organization teaches and supports it.
AHRQ also describes the CUS technique: “I am concerned,” “I am uncomfortable,” and “This is a safety issue.” Use the exact language and escalation tools required by your organization.
A direct second statement: “I remain concerned that this may create a safety risk because ___. I need us to pause and involve ___ according to the escalation process.”
Escalate the concern, not the conflict
If the response does not address the risk, move through the chain of command or other approved escalation pathway. Do not turn the exchange into a contest over status. State what was observed, what remains unresolved, what has already been done, and what response is needed.
- Be timely. Escalation after the risk has passed may be too late.
- Be factual. Use findings, times, actions, and responses—not labels or accusations.
- Be specific. Ask for assessment, clarification, resources, or a decision.
- Keep the patient protected. Continue appropriate monitoring and care within your role while help is mobilized.
What if you are wrong?
You will sometimes raise a concern and learn that the situation is safe or the plan is different from what you understood. That is not automatically a failure. Ask for the reasoning so you can recognize the pattern next time. A respectful team should be able to distinguish an appropriate safety question from insubordination.
What matters is whether the concern was reasonable based on what you knew, whether you communicated professionally, and whether you followed policy. Do not manufacture certainty. “I may be missing something, but I am concerned because…” is honest and still clear.
Practice before the high-pressure moment
- Find your unit’s escalation policy and identify who comes after the immediate supervisor.
- Ask your preceptor how they want concerns raised during routine work and emergencies.
- Write three phrases you can use when your mind goes blank.
- During debriefs, ask where an earlier question could have changed the workflow.
- Notice leaders who receive concerns well and learn from their responses.
If speaking up leads to retaliation or intimidation
Document events through appropriate channels, preserve factual details, and seek guidance from nursing leadership, education, human resources, a professional association, your union if applicable, or legal counsel when appropriate. Whistleblower and employment protections vary by jurisdiction. Do not rely on a website article for legal advice.
The American Nurses Association’s work-environment guidance connects ethical practice with a workplace that supports nurses in protecting patient rights, health, and safety.
Your next shift
Ask one clear question earlier than you normally would. If a concern remains, state it again with the risk and the help you need. Confidence may come later; professional clarity can start now.
About the perspective: Nathan Cotter draws on experience across bedside nursing, flight nursing, emergency response, leadership, and healthcare operations. This is educational information, not patient-specific clinical or legal advice. Follow applicable law, professional standards, organizational policy, and qualified clinical leadership.