This is an original excerpt written by our team to show structure, depth and referencing. It is modelled on the course named above but is not a university document. Use samples as a study guide and follow your school's academic integrity policy.
The interview
For this assignment I interviewed the nurse manager of a 32-bed medical-surgical unit about how she encourages staff to raise concerns. The manager is illustrative and her name is withheld; the interview took about 40 minutes and followed five prepared questions.
What psychological safety means
Edmondson (1999) defined team psychological safety as a shared belief that the team is safe for interpersonal risk taking. In her study of 51 work teams in a manufacturing company, psychological safety was associated with learning behavior, such as asking for help, seeking feedback and discussing errors, and learning behavior in turn was linked with team performance. In health care, speaking up about a wrong dose or a missed assessment is exactly that kind of interpersonal risk.
Key themes from the interview
1. How leaders respond to bad news. "The first time someone tells me about a mistake, my face decides whether they'll ever tell me again," the manager said. She thanks the person before asking any questions and keeps the conversation about the system, not the individual. This matches Edmondson's (1999) finding that team leaders' behavior shapes whether people believe it is safe to speak.
2. Making questions normal. At daily huddles she asks, "What worried you yesterday?" and shares one of her own uncertainties first. New graduates told her this made it easier to admit they didn't know something.
3. Closing the loop. When a nurse reports a problem, such as a broken bed alarm, the manager reports back on what changed. "If nothing happens, people stop telling you," she said.
4. What still gets in the way. She named staffing shortages, travel nurses who don't know the unit's norms, and hierarchy with some physicians as ongoing barriers.
Comparing the interview with the evidence
A systematic review of 14 interventions to improve psychological safety, speaking up or voice behavior in health care found mixed results. Educational programs alone, such as workshops or simulation, didn't reliably change deeply rooted speaking-up behavior. The authors recommended longer, multifaceted interventions with visible leader support that work across interdisciplinary teams (O'Donovan & McAuliffe, 2020). The manager's approach fits these recommendations: she relies on everyday leader behavior, repeated over time, rather than a single training session. Her concern about physician hierarchy also points to the review's call to work across professions, not just within nursing.
Reflection
The interview changed how I think about leadership. I had assumed that speaking up was mainly an individual nurse's courage. The manager showed that it is also something leaders build or destroy in small moments. As a BSN nurse and future charge nurse, I plan to thank people when they raise concerns, ask open questions at huddles, and tell staff what happened after they spoke up.
References
Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350–383. https://doi.org/10.2307/2666999
O'Donovan, R., & McAuliffe, E. (2020). A systematic review exploring the content and outcomes of interventions to improve psychological safety, speaking up and voice behaviour. BMC Health Services Research, 20, Article 101. https://doi.org/10.1186/s12913-020-4931-2
