More than half of nurses believe their concerns about patient care are being ignored, according to a survey.
Research for the Nursing Times found that an NHS culture of discouraging staff from reporting problems, rather than supporting them, is putting patients at risk.
More than 800 nurses were questioned by the magazine, which revealed a culture of bullying, with staff scared they will be labelled as troublemakers if they highlight concerns about patient care.
Half of nurses who had raised concerns about the NHS said they were not dealt with properly, while a third felt they were likely to face negative consequences or be ignored as a result of raising concerns. The survey revealed that 84% of respondents had previously raised concerns about a colleague's practice or attitude - of which 23% said they had done so "several times" or "regularly", and 23% "at least once".
But of those who had raised concerns, 52% said there had been no appropriate outcome as a result of speaking out and a similar percentage said doing so had led to them suffering negative consequences. Almost 30% of nurses said being viewed as a troublemaker was the biggest barrier to speaking out, with inaction by managers cited by 23%. Eight out of 10 nurses said the ability to raise concerns in the NHS could be a lot better.
Nursing Times editor Jenni Middleton said: "I have personally spoken to nurses who, having raised concerns, have been sidelined and ostracised by their employers, bullied and marginalised by their colleagues - and end up feeling ashamed and guilty, as well as concerned that their careers are over."
Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: "It is extremely worrying that a large number of nurses still feel their concerns are going unheard, even worse that some have to live with the threat of reprisal. There needs to be greater transparency in the current system so that nurses feel supported when they do raise concerns."
Health Minister Dr Dan Poulter said: "We are determined that staff who have the courage and integrity to speak out in the interests of patient safety are protected and listened to. We have already taken a range of measures to protect and support whistleblowers in the NHS - including funding a national helpline, embedding rights in their employment contracts and issuing new guidance in partnership with trades unions and employers.
"While we were waiting for the publication of the Francis Report, we announced that, from April, the NHS Commissioning Board will be required to include a contractual duty of openness in all commissioning contracts.
"This means NHS organisations will be required to tell patients if they have been significantly harmed while undergoing treatment, apologise, and ensure that lessons are learned to prevent them from being repeated. We are now considering the recommendations of the Francis Report in full and whether we need go further."