Escalation, Indemnity and Speaking Up

Dental nurses must recognise when a concern needs to move beyond a quiet conversation. Escalation is required if the patient may be at risk, a complaint is serious, a statutory duty could be triggered, there is a safeguarding or confidentiality issue, a claim or compensation is possible, or a colleague discourages openness.

Speaking up can be difficult when the concern involves a dentist, owner, senior colleague or a busy clinic. Use calm, patient-centred language: "I am worried the patient has not been told what happened", "Can we pause and make sure this is recorded and explained?", or "I think this needs the complaints lead or indemnity route."

Escalate promptly when there is

• Actual or potential patient harm or significant distress.
• A complaint about clinical care, consent, cost, discrimination or staff conduct.
• A request for compensation, refund, legal action or copies of records.
• A confidentiality, safeguarding or medical emergency concern.
• Pressure to hide, minimise or alter what happened.
• A recurring issue that previous informal action has not resolved.

Indemnity advice is usually sought by the clinician, owner, manager or registrant responsible for the care, but dental nurses should recognise when a case may need that route. If there is possible negligence, legal threat, serious harm or a potential GDC concern, do not improvise explanations or make promises.

Country-specific organisational duties

If someone asks you to hide what happened, the issue is no longer only the original incident. It also becomes a professionalism and patient-trust concern.