Journal of Arak University of Medical Sciences

fa سکوت پرهیاهوی پرستاران: آیا صدای ما شنیده می‌شود؟ The Loud Silence of Nurses: Is Our Voice Being Heard? پرستاری Nursing نامه به سردبیر Editorial در نظام‌های سلامت جهان، پرستاران به عنوان ستون‌های اصلی مراقبت شناخته می‌شوند، اما صدای آن‌ها، با وجود نقش حیاتی‌شان، اغلب در میان انبوهی از سکوت‌های پرهیاهو گم می‌شود. این سکوت، نه به معنای آرامش، بلکه بازتاب فشارهای پنهان، ترس‌های بیان‌نشده، و انفعال تحمیلی در برابر ساختارهایی است که امکان ابراز نظر آزادانه را محدود می‌کنند. «سکوت سازمانی» که سال‌هاست در حوزه‌های مدیریت و روانشناسی سازمانی شناخته شده، در پرستاری به یک بحران جهانی تبدیل شده است. بر اساس یک فراتحلیل کیفی، بیش از ۹۱ درصد از پرستاران حداقل یک بار در دوران حرفه‌ای خود سکوت سازمانی را تجربه کرده‌اند In global healthcare systems, nurses are recognized as the main pillars of care, but their voices, despite their vital role, are often lost amidst a cacophony of loud silences. This silence does not signify tranquility, but rather reflects hidden pressures, unexpressed fears, and an imposed passivity in the face of structures that limit the freedom of expression. "Organizational silence," a concept recognized for years in the fields of management and organizational psychology, has become a global crisis in nursing. According to a qualitative meta-synthesis, over 91% of nurses have experienced organizational silence at least once in their professional careers [1]. The causes of silence among nurses are multifaceted. Part of it stems from defensive silence, meaning a nurse refrains from speaking up before superiors or in hierarchical structures for fear of negative consequences. At other times, we encounter acquiescent silence, where the nurse believes that speaking out is futile and will not bring about any change. Previous experiences of having concerns ignored or autocratic leadership styles reinforce this feeling [1,2]. Furthermore, in some cultures, such as Japan or Egypt, prioritizing group harmony over individual expression leads to the normalization of silence [3]. Silence is not just an individual reaction but a response to an inefficient work environment. Nurses who feel their voices are not heard eventually experience job burnout, decreased motivation, and ultimately, leave the profession [2,3,4]. In a study from Spain, half of the nurses surveyed had considered leaving the profession [3,5]. Job burnout not only harms the nurse's mental health but also reduces the quality of patient care. Fatigue, reduced concentration, and impaired communication with patients increase the risk of clinical errors [1,6]. This vicious cycle of silence and its consequences creates a downward spiral in healthcare organizations: Silence on staff or resource shortages → Increased stress and workload → Job burnout → Decreased quality of care → Intensified dissatisfaction → More silence. If nurses feel that their concerns are ignored even when expressed, silence becomes an adaptive strategy [4]. Meanwhile, the financial impact of nurse turnover is also significant. According to estimates, the turnover cost for a single nurse in the United States is over $44,000, and hospitals lose an average of $3.6 to $6.1 million annually due to nurse turnover [7]. This substantial figure provides an economic incentive for systemic interventions to reduce silence and retain human resources. Solving this problem is not possible through individual training or psychological resilience alone. Although strengthening skills like professional assertiveness can be effective, it will not be sustainable without structural and cultural support [4]. Creating psychological safety in the workplace—where nurses can freely express their concerns without fear of punishment—is a vital starting point for change [6]. Leaders of healthcare organizations play a key role in shaping or dismantling a culture of silence. When managers interact with nurses with empathy, a listening ear, and responsiveness, trust is built, and the space for expression becomes safer. A transformational leadership style, participation in decision-making, and the creation of professional growth paths are among the most important factors in retaining nurses and reducing silence [8]. There is also a need for macro-level policymaking at national and international levels. Programs like the "Global Nursing Workforce," which focuses on supporting the sustainability of the profession, can be effective in addressing the root causes of the problem [7]. Moreover, new guidelines from bodies such as The Joint Commission on preventing workplace violence (effective July 2024), which define requirements for reporting and accountability, can serve as models for combating silence on other issues as well [8]. Ultimately, organizational silence in nursing is not just a communication issue; it is an alarming indicator of the ethical, psychological, and systemic health of healthcare institutions. This phenomenon should be considered an "organizational vital sign." The healthcare system has a duty not only to listen but to act. The voices of nurses must lead to decisions, policies, and structural reforms, so that their silence is no longer loud, but is transformed into an effective cry on the path to improvement.   سکوت سازمانی, فرسودگی شغلی, ترک خدمت پرستاران, سیاست‌گذاری سلامت Organizational Silence, Job Burnout, Nurse Turnover, Health Policy 163 165 http://jams.arakmu.ac.ir/browse.php?a_code=A-10-7900-2&slc_lang=fa&sid=1 Mir Amirhossein Seyednazari میر امیرحسین سید نظری amirhosseinseyednazari@gmail.com 4600319475328460090894 0009-0008-4637-0521 No Department of Medical-Surgical Nursing, Khoy School of Medical Sciences, Khoy, Iran گروه پرستاری داخلی جراحی، دانشکده علوم پزشکی خوی، خوی، ایران Amir Mohammad Dorosti امیرمحمد درستی amirdorosti2006@gmail.com 4600319475328460090895 4600319475328460090895 Yes Research and Technology Committee, Khoy School of Medical Sciences, Khoy, Iran کمیته تحقیقات و فناوری دانشجویی، دانشکده علوم پزشکی خوی، خوی، ایران