How doctors and nurses can exhibit disruptive behavior

Originally posted in HCPLive.com

by Lisa Schulmeister, RN, MN

“Behavior problems” were reported by 97% of 2,124 nurses and physicians responding to a survey conducted by the American College of Physician Executives (ACPE).

How doctors and nurses can exhibit disruptive behavior The most common behaviors included degrading comments (reported by 85.5%), yelling (73.3%), cursing, inappropriate joking, and refusing to work with one another. The ACPE found that in some instances, nurses and physicians try to undermine each other, often in direct view of patients, families, and other staff members. Other commonly reported disruptive behaviors included refusing to speak to each other, spreading rumors, trying to get someone unjustly disciplined or fired, throwing objects, and sexual harassment. Physical assaults, however, were reported by only 2.8% of the respondents.

When asked who most often exhibits disruptive behavior, 47.9% of those responding to the survey said it was an even mix; 45.4% said physicians; and 6.8% said nurses. Also, 61.2% reported that they believed nurses at their institutions were fired from their jobs for behavior problems, while 22.2% said the same of doctors. Behavior problems arise several times a year, said 30.9% of the respondents, with 30% saying it happens weekly; 25.6% saying monthly; 9.5%, daily; 2.9%, once a year; and only 1.2% saying less than once a year.

In 2007, the Joint Commission created a leadership standard on behavior that requires healthcare facilities to define disruptive behavior and create policies and procedures to address this behavior. Colleagues of mine and I have always said that little would done with respect to disruptive behavior until Joint Commission decides to do something.

Fortunately, the Joint Commission did take action and hopefully, healthcare providers will begin to examine, and change, their behavior.

Lisa Schulmeister an oncology nursing consultant who blogs at Nurses’ Blog.

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  • ninguem

    I’ve seen some of that backbiting undermining nurse behavior, to the point where a group I worked with, preferred one hospital over another, specifically because of the nurse behavior.

    New doc in the group, i found myself described in one (bad) way in a QA note, where same nurse documented opposite in her own chart notes. Not subtle interpretation, it’s claim of abandonment in a QA note with nurse notes saying doctor at bedside over the course of an hour. Doctor is either there, or not there.

    Expressing amazement over the behavior, senior docs gave me the back story. Two compting groups. We were independent. Competing group was hospital-employed.

    ‘Nuff said.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Head exploding now. Brain matter on my keyboard. Does that make me “disruptive”?

    Yes, indeed. The Joint Commission is all over “disruptive” doctors.

    Yet, the all-hallowed Joints, whose bread and butter is all about the checks that come in from hospitals who want to be cars on the accreditation train, has done NOT THING ONE to hold corrupt/unethical/incompetent healthcare executives (or their lawyers) accountable for their actions – actions that just might contribute to the “disruptive” behavior of doctors (or nurses).

    Just like current healthcare “reform” is a one-way street and a dead-end for doctors . . . being labeled “disruptive” (especially for puckering up and blowing the whistle) leaves a doctor with no way out and no way to fight back.

    A little more light reading/rebuttal on the subject:

    http://drjshousecalls.blogspot.com/2009/04/medscape-lays-rotten-egg-offering.html

    Must go. Brain matter on the keyboard and all that. Part of the pennance for being “disruptive” is cleaning up the mess – even if it isn’t yours.

  • http://www.realicu.com www.realicu.com

    Disruptive behavior at a workplace is bad, there is no doubt about. You have to define what constitutes a really “bad behavior”. Throwing phones, destroying furniture and cursing at the nurses station is inappropriate and should be punished. Otherwise, we are all humans and we work with people, and that, sometimes, can get very frustrating. So venting might actually help to maintain healthier work environment.

  • David Allen, MD

    I must say I am known among the nurses as being the ‘nice’ physician but sometimes I think that backfires. I don’t expect nurses to be automatons; they need to think on their own, but I have experienced mocking and disrespectful behavior from them. Only when I, in turn, became angry and serious, was I able to turn them back to being respectful. There are people who, unfortunately, must be treated a little harshly in order to keep them professional. Perhaps other physicians have implemented this philosophy to the extreme.

    I will say that ICU nurses tend to be very good and, believe it or not, I think older nurses tend to be better (on average). The worst experiences I’ve had with nurses are in the VA system as a resident!

  • http://www.blog.greatzs.com ZMD

    I once gave a specific order to a nurse about a patient. Not two minutes later she ignored my order and does something else entirely. I was so pissed I yelled at her. Well guess what. She wrote me up and now I’m the bad guy and she gets to play the victim. I had a meeting with my chairman. His advice? Relationships between doctors and nurses are asymmetric. They can get you in trouble but you can’t get them in trouble. We’ve had doctors fired because of complaints by a single nurse. Advice learned the hard way.

  • http://www.twitter.com/Nurse_Jo Joanna

    As a nurse working in the Canadian healthcare system.. and in a metropolitan teaching hospital my experience is that the doctor vs. nurse working relations are relatively good. As a general observation, psychiatrists, and family doctors and their residents are usually the offer the most respect for what we do. Especially those who have mothers or family who have worked as nurses. No matter what work environment, there will always be power abuse issues by staff. Word of advice: Bring your nurses some cookies, buy a lunch one day out of the blue to show your appreciation.. it will do wonders.