Many nurses face bullying and being belittled when they try to whistle-blow, a survey suggests.
Of the 5,277 in the Royal College of Nursing poll who reported having raised an alarm, 24% said they had been discouraged or warned off.
The union said the findings showed there was an NHS “culture of fear”.
Health Minister Dr Dan Poulter said NHS staff who speak out in the interests of patient safety must be protected and listened to.
Ministers have previously called for greater “openness and transparency”.
Whistle-blowing has emerged as one of the key themes in the fallout from the public inquiry into the Stafford Hospital scandal.
In recent months ministers have made it clear to the NHS that staff must be supported when they try to raise concerns, and the Public Interest Disclosure Act, which gives protection to whistle-blowers, must be respected.
But the poll, released by the RCN at its annual conference in Liverpool, found significant problems faced those who tried to raise the alarm.
One nurse who took part said she had seen evidence of intimidation and staff being humiliated. Others reported bullying and being belittled.
Another said: “I put in an incident form highlighting these concerns.
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Many nurses are still experiencing a culture of fear and intimidation if they try to speak out”
Royal College of Nursing
“I was lambasted by my manager for putting in an incident form as it would lead to them being questioned by their manager.”
Of those that had raised concerns, 46% had done so in the past six months.
Nearly half were related to staffing levels and one in five to patient safety.
But 45% said their employer took no action after they had spoken out.
RCN general secretary Peter Carter said: “Many nurses are still experiencing a culture of fear and intimidation if they try to speak out.
“This is putting patient safety at risk.
“One of the key lessons from the Francis report [into failings at the Mid Staffordshire NHS Foundation Trust] was that frontline staff must feel confident that they can raise concerns about patient safety without fear or reprisals.”
The union also said it would be asking the government to clarify the law about nurse students.
As they do not have an employer, the way the act is worded may mean they are not protect, RCN officials said.
Dr Poulter said of the government’s position: “We have been clear that the era of NHS staff not being able to raise their real worries about patient care must come to an end.
“We want all staff working within the NHS to feel able to speak up and raise concerns, and every NHS organisation to take concerns seriously and act on them.
“That is why we have funded a national helpline for whistle-blowers, strengthened the NHS constitution and provided stronger protections for whistle-blowers in NHS staff contracts. We are also giving NHS organisations a new duty to be open if things go wrong, to help build a far more open NHS culture.”