The Sounds of Silence: Problematizing Voicelessness in Nursing Practice.

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.