Statement of Concern

The Statement of Concern template can be used by you to email the senior decision-maker/manager on duty in your service to raise an issue of concern relating to safe standards of practice or the conditions within the workplace. We want to make it as easy as possible for you to raise your concerns.

Concerns you raise should be entered on the risk register by management, and you are entitled to seek feedback on the concerns you raise.

While it can appear repetitious or futile to continually raise issues of concern, it is professionally important both in terms of your own professional registration and for patient safety that concerns that exist are consistently raised, and that there is a record of raising them.

Also, it is a professional duty under the NMBI Code of Professional Conduct and Ethics Principle 2 to report safety concerns about the healthcare environment.

You can copy and paste the template below into an email and delete/add materials in accordance with the concerns you have.

Re:      Statement of Concern Regarding Safe Standards of Practice

Dear [Insert name of manager]

I am working in [Insert ward/care area]

I have concerns regarding the safety of the practice environment based on:

• Inadequate number of registered nurses/midwives
• Inadequate support staff
• Inappropriate skills mix
• Insufficient medical support
• Inadequate equipment
• My lack of appropriate competence for this clinical setting
• Overcrowding in the clinical environment

​[Insert any additional comments you wish to make]

I am informing you as a manager in this service that in my professional opinion the safety of the care environment, the ability of registered nurses in this environment to practice to the required standards, and the safety of patients are at risk due to these concerns.

I am seeking a timely written response to this clinical risk concern.

[Signed]