When you or someone you love is in hospital, it can be overwhelming. You’re worried, emotions are running high, and healthcare staff are busy. But what if you notice something isn’t quite right or it feels like a condition is getting worse and you hesitate to say anything?
For Melissa Casey, Nurse Manager in the Emergency Department at Concord Hospital, this hesitation is something she sees every day – and it’s exactly why NSW Health is urging families and carers to “Raise It”.
Raise It is a clinical escalation process in NSW public hospitals and health services that allows patients, carers, and family members to escalate concerns about changes in a patient’s condition. It’s simple, fast, and doesn’t require you to have medical knowledge.
Melissa says families and carers are often the first to notice subtle but important changes in a patient’s condition.
“We see it all the time,” she explains. “Families know their loved ones best and can pick up small changes before they show up in our clinical observations.”
These signs might include:
Despite recognising these signs, many people hold back. “There’s often a hesitation,” Melissa says. “Some worry they’ll be seen as a bother. Others – especially older Australians – were raised not to question doctors or authority. They put doctors on a pedestal and feel they shouldn’t speak up.”
She also notes that the busy, high-pressure hospital environment can make carers feel like they’re intruding. “They see nurses rushing and think, ‘I don’t want to interrupt.’ That’s understandable, but it can mean the small changes loved ones notice, those early warning signs, are missed.”
Older patients are often more vulnerable in hospital, especially when managing multiple conditions or experiencing confusion. In these moments, carers play a critical role – but many still feel unsure if they have the authority to speak up.
“Patients might be confused, overwhelmed, or have hearing or cognitive difficulties,” Melissa explains. “That’s when the voice of the family becomes essential. They know what’s normal for their loved one – sometimes better than anyone else in the room.”
Carers – whether partners, adult children or close friends – play a critical role in hospital care. Research shows that many older carers, especially non-next-of-kin like grandparents or foster carers, are unsure if they have the authority to speak up. They often feel they might be dismissed or seen as overstepping. Melissa stresses that these fears shouldn’t stop anyone from raising concerns.
Melissa makes it a point to reassure families at the start of every hospital stay.
“You know your loved one better than we do. If something feels off, please tell us,” she says.
Importantly, families don’t need to use medical terms. “We’re not asking people to be doctors or nurses. Just say, ‘This isn’t normal for them’ or ‘I’m really concerned.’ That’s enough for us to act.”
She encourages simple, clear communication:
Even a small observation can make a big difference. “It might be a subtle change, but for us, it’s valuable information,” she explains.
For Melissa, the importance of speaking up isn’t just professional – it’s personal.
“When my dad was in hospital, he was acting completely out of character. He was confused and saying unusual things. One of the junior nurses took his observations, but I felt something was wrong,” she recalls.
Melissa approached the nurse in charge. “I said, ‘That’s not my dad. Something is happening with him.’ The staff assessed him further and discovered a serious condition – a pulmonary embolism – that could have been life-threatening if missed.”
“It wasn’t that the nurses weren’t caring or observant,” she emphasises. “They just didn’t know him as we did. My voice, speaking up on his behalf, helped get him the care he needed.”
Raise It is a simple, three-step process in all NSW public hospitals or health service:
1. Talk
Speak to a nurse, doctor, midwife, or health worker about your concern.
2. Ask
If you’re still worried, ask the nurse or midwife in charge for a Clinical Review.
3. Call
If the concern remains, call the Raise It line. A senior health worker will respond and ensure your loved one gets assessed quickly.
Melissa stresses that you don’t need to be certain. “You don’t have to know medical terms. You just have to say, ‘Something’s not right. That’s enough for us to act.”
One of the biggest barriers is confidence. Many patients and carers hesitate to speak up because they don’t want to interrupt, feel unsure of their role, or worry about getting it wrong. Melissa says these concerns are completely normal – but shouldn’t stop anyone from raising a concern.
Key takeaways for older Australians and carers
Melissa has a few practical tips for carers and family members:
“Effective communication between families and staff is so important and when we work in partnership it improves outcomes,” Melissa says. “Your voice matters. Your observations matter. Don’t wait.”
Melissa’s advice is clear: “If you’re worried, please speak up. You know your loved one best, and your voice can make all the difference. We are here for you.”
Raise It ensures you don’t have to navigate this alone. It’s designed for patients and carers of all ages, in any hospital setting – emergency, adult, paediatric, maternity, or mental health.
Raise It is available in any NSW public hospital or health service. Find out more by visiting: health.nsw.gov.au/raiseit
Because when it matters most, you should feel confident to trust your instincts and know your voice will be supported.
If something doesn’t feel right, speak up. “Raise It”.