The Sounds of Silence: Problematizing Voicelessness in Nursing Practice
Bibliographic record
Abstract
A positive healthcare environment and effective nurse recruitment are widely recognized as interconnected factors that improve outcomes for patients, families, and staff. Despite this, frontline nurses and their managers often have conflicting views on workplace issues. Although some hospitals have implemented "speak-up" initiatives, nurses in acute care settings still feel silenced, as interventions designed to improve workplace culture have had limited long-term impact. This underscores the need for a deeper understanding of how nurses are silenced. This qualitative, ethnographic study aimed to improve our understanding of how nurses are silenced in the acute care workplace. Through semi-structured interviews with registered nurses (n = 14) and administrators (n = 9), observational field notes (20 h), and documents (n = 8), we found that although nurses used various channels to voice concerns about patient safety, patient-centered care, and workplace health to their managers, they still felt ignored and unsupported, leading to feelings of vulnerability, anger, and abandonment. Administrators understood staff frustrations but felt powerless, seeing themselves as conduits for top-down directives rather than active participants in organizational initiatives. These findings offer crucial insights for clinicians, researchers, educators, and administrators aiming to create a more inclusive culture that prioritizes collaboration and high-quality care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".