Witnessing Unsafe Practice: What to Do & Who to Tell

It happens. You’re on placement, you’re watching, and you see something that makes your stomach drop. A nurse gives a drug without checking. A patient’s obs are missed and they’re deteriorating. Someone cuts a corner that could hurt someone. A colleague turns up to shift smelling of alcohol. A relative is spoken to in a way that’s just — wrong.

And then the panic sets in. Do I say something? What if they turn on me? What if I’m wrong? I’m only a student — it’s not my place. What if it affects my placement?

Let’s get one thing straight from the start: it IS your place. Under the NMC Code, every nurse, midwife, and student nurse has a professional duty to raise concerns about patient safety. You are not responsible for understaffing — but you ARE responsible for speaking up when you see something that could harm a patient. This guide tells you exactly how, step by step, who to tell, and what protects you. (And if you’re feeling the emotional weight of this, read my Moral Distress guide first — that’s the feeling side, this is the action side.)

• Medication errors covered up — a wrong dose given and not reported, or no patient monitoring after
• Poor infection control — not washing hands, reused equipment, breaking ANTT (here’s my high-alert meds guide for what safe looks like)
• Ignoring a deteriorating patient — missed obs, ignoring NEWS2, not escalating when someone is clearly unwell (NEWS2 guide here)
• Working under the influence — alcohol, drugs, or impairment that affects practice
• Abuse or poor dignity — rough handling, verbal abuse, ignoring a patient, breaches of confidentiality
• Falsified records — signing for meds/dressings/obs that weren’t done
• Practising beyond competency — doing invasive procedures they’re not trained/signed off for
• Safeguarding concerns — a child or vulnerable adult at risk (this has its own urgent pathway)

⚠️ If a patient is in IMMEDIATE danger — act now. If someone is about to give a wrong drug, a confused patient is about to fall, or a colleague is impaired and about to do something dangerous — intervene immediately, calmly. Stop the action. Get a senior. Call 2222 if it’s a clinical emergency. Here’s how to call a 2222. You do not need permission to keep a patient safe. The rest of this guide is for non-urgent concerns — things you’ve witnessed and need to escalate properly.

1. Step 1 — Raise it with the person directly (only if safe and minor). Calmly, privately: “I noticed X — is there a reason for that, or should we flag it?” Some people genuinely don’t realise. Skip this if it’s serious (impairment, abuse) or you feel unsafe.
2. Step 2 — Your Practice Supervisor / Mentor. This is your first proper port of call. Tell them exactly what you saw. Ask what happens next. They have a duty to act. (If they’re the problem, skip to Step 3 — here’s my guide for when your assessor isn’t supporting you.)
3. Step 3 — Ward Manager / Sister / Charge Nurse. If your mentor doesn’t act, or the concern is about them, go to the person in charge of the ward. Be factual, specific, and calm.
4. Step 4 — Your University Link Lecturer / Personal Tutor. ALWAYS tell your university. They are your safety net. They can escalate through official channels, support you, and make sure it’s recorded. This is the most important step for students — never face a trust alone.
5. Step 5 — The Trust’s Freedom to Speak Up Guardian. Every NHS trust has one. You can contact them directly, anonymously if you prefer. They exist specifically to hear staff concerns — including students. Find them on the trust intranet or ask the PALS office.
6. Step 6 — The NMC (only for serious, unresolved concerns about a registered professional). If the concern is serious (impairment, abuse, significant patient harm) and the trust has done nothing, you can raise a concern with the NMC directly. They investigate fitness to practise. Students can do this — it’s not just for qualified staff.
7. Step 7 — CQC / safeguarding (for specific concerns). If it’s about the overall safety of the service, you can report to the Care Quality Commission (CQC). If it’s a child or vulnerable adult at risk, it’s a safeguarding alert — escalate immediately to the ward manager and your named safeguarding lead. Do not wait.

To your mentor (calm, factual):
“I wanted to raise something with you. On [date/time], I saw [specific, factual observation]. I’m concerned because [why it risks patient safety]. I wasn’t sure what to do, so I’m raising it with you. Could you tell me what happens next, and whether I should record it anywhere?”

To your university link lecturer (email):
“I’m raising a patient safety concern I witnessed on placement at [trust/ward] on [date]. [Brief factual description]. I raised it with [name/role] on [date]. I’d like to discuss what happens next and how the university can support me. Please can we arrange a call?”

Key principle: Be factual (what you saw, when, where). Not judgmental (“they’re dangerous”). Stick to “I observed…” and “I’m concerned that…”. That’s how you get taken seriously — and how you stay protected.

• Write down what you saw — date, time, ward, exactly what you observed, names if known. Do it the same day, while it’s fresh.
• Record who you told — name, role, date, time, what they said they’d do.
• Keep your own copy — in your portfolio, a notes app, or an email to yourself. Do not rely on the trust’s record.
• Submit an incident report (Datix / DatixWeb / Care Opinion) if the trust has one — students can and should report. Ask your mentor how.
• Follow up in writing — after any verbal conversation, send a one-line email: “Following our conversation about [concern] on [date], just confirming what was agreed.”

• Don’t post about it on social media. Ever. No “you won’t believe what I saw on placement today” — even without names. That’s a breach of confidentiality and can get you struck off before you’re even registered. The NMC Code applies to students too.
• Don’t gossip with other students/staff. It undermines you and it’s unprofessional. Raise it through proper channels, not the canteen.
• Don’t confront aggressively or accuse. “You’re dangerous” will make them defensive. “I’m concerned about X” opens a conversation.
• Don’t ignore it and hope it goes away. It won’t. And if something happens to a patient and you knew — that’s on you. The NMC is clear: failing to raise a concern is as serious as the concern itself.
• Don’t try to investigate it yourself. Your job is to report what you saw. Let the trust investigate. Don’t go searching, don’t confront, don’t gather “evidence” like a detective. Report, document, escalate.
• Don’t go alone. Your university link lecturer is there for exactly this. Use them. Here’s how to access university support if you’re not sure who to contact.

✅ The conditions for protection (easy to meet): (1) You raise it in good faith (you genuinely believe it’s true). (2) It’s a qualifying concern (patient safety, crime, breach of legal obligation, danger to health/safety, or cover-up). (3) You raise it to the right person (your employer/university, a prescribed regulator like the NMC/CQC, or — in exceptional cases — the media). That’s it. You don’t have to be right. You just have to be honest. And if you’re treated badly for it, you can take it to an employment tribunal — and students have won these cases.

Final word from me:

Speaking up is the hardest thing you’ll do as a student. It’s also the mark of a good nurse. The patients on that ward can’t speak up for themselves — that’s why we exist. You will never, ever regret doing the right thing. You might regret staying silent. So be factual, be calm, document everything, tell your university, and trust that the system is designed to support you. And if it all feels heavy afterwards — that’s moral distress, and this guide will help you process it. You’ve got this. 💛

References & Further Reading

1. Nursing and Midwifery Council (2015). The Code: Paragraphs 21–24 — raising concerns and duty of candour. NMC.
2. NMC. Raising concerns: guidance for nurses, midwives and nursing associates. Available at: nmc.org.uk/concerns
3. National Guardian’s Office. Freedom to Speak Up Guardians in the NHS. Available at: nationalguardian.org.uk
4. Public Interest Disclosure Act 1998. Whistleblowing protection. legislation.gov.uk
5. Care Quality Commission (CQC). Raise a concern about a service. Available at: cqc.org.uk
6. NHS England. NHS Constitution — the right to raise concerns without suffering detriment.
7. Royal College of Nursing. Raising concerns and whistleblowing advice for members. Available at: rcn.org.uk
8. ACAS. Whistleblowing: advice for workers and employers. Available at: acas.org.uk

Keep Reading — The Two Guides That Pair With This

Moral distress is the feeling. Defensive documentation is your shield. Read both — they were written to be used together.