Disruptive physician behavior contributes to nursing shortage: study links bad behavior by doctors to nurses leaving the profession - Doctors, Nurses and Disruptive Behavior

Physician Executive, Nov-Dec, 2002 by Alan H. Rosenstein, Henry Russell, Richard Lauve

IN THIS ARTICLE...

A new survey about physician-nurse relationships uncovers a strikingly high prevalence of disruptive physician behavior that's affecting nurse retention.

RESULTS OF A NEW SURVEY show that disruptive behavior by physicians is helping to fuel the nationwide nursing shortage, heavily impacting job satisfaction and morale for nurses.

The survey results reveal the seriousness of the issue and highlight a lack of physician awareness, appreciation, value and respect for nurses.

Over 90 percent of the survey participants reported witnessing disruptive physician behavior. While disruptive events seem to involve only a small percentage of the medical staff, more than one-third of the participants reported knowledge of a nurse leaving an institution because of disruptive behavior by physicians.

Also disturbing is that more than two-thirds of the survey participants reported that their organizations had codes of conduct in place, but less than 50 percent felt they were effective.

Conducted by VHA, Inc.--a network of community-owned, non-profit health care systems and associated physicians--the 24-question survey was designed to assess the overall status of physician-nurse relationships.

The survey focused on four areas:

1. The overall status and significance of nurse-physician relationships at the hospital level

2. Specific issues related to disruptive physician behavior

3. Common trends, barriers and inciting events associated with disruptive behavior

4. Suggested strategies for support and resolution

A total of 2,562 respondents from 142 acute care, not-for-profit hospitals from 11 VHA regions across the country participated in the survey. Of the participants, 389 listed their title as physicians, 104 as senior level executives and 1,615 as nurses.

Survey highlights

The survey asked about the types of disruptive behavior witnessed or experienced. The most frequent responses included:

* Disrespect

* Berating colleagues

* Use of abusive language

* Condescending behaviors

What were the issues or events that precipitated disruptive behavior?

Nurses felt that the most common circumstances involved placing calls to physicians to clarify physician orders. Physicians indicated that orders not being carried out correctly or in a timely manner were the biggest problems.

The survey found that disruptive outbursts occurred most frequently in operating rooms, medical-surgical units, intensive care units, emergency departments and obstetrics areas.

When asked about disruptive behavior by physician specialty, general surgery ranked number one, followed by cardiology and cardiovascular surgery, neurology and neurosurgery, orthopedics, obstetrics and anesthesia.

Another survey question asked how serious an issue disruptive physician behavior was at the hospital. The overall response to this question was 6.77 on a scale of 1-10, with 10 being extremely serious.

When asked how important a factor disruptive behavior is for nurse satisfaction and morale, the total group response was 8.01--the highest score in the survey.

Nearly 37 percent of the survey participants indicated that nurses were leaving their hospitals as a result of disruptive behavior. Of those who responded positively, the average number of nurses reported leaving per year was 2.5.

About 44 percent of the participants indicated that barriers to reporting disruptive behavior existed. The most common barriers included:

* Fear of retaliation

* The fact that nothing ever changes

* Lack of confidentiality

* Lack of administrative support

* Physician lack of awareness or unwillingness to change

Survey participants also suggested ways to improve the working relationship between nurses and physicians.

Nurses want more opportunities for collaboration and communication, closely followed by the need for education and training for nurses and physicians with programs that foster improved working relationships. Also mentioned was the desire to hold open forums and group discussions.

Physicians listed increased education and training and more opportunities for collaboration as their top recommendations, followed by the need to foster more open forums and group discussions to improve relationships.

Both physicians and nurses said it was only a few physicians who gave the rest of the physicians a bad reputation. They also agreed that disruptive behavior is a two-way street, with nurses sometimes guilty of exhibiting disruptive behaviors toward physicians.

Roots of the problem

One of the key findings in the survey is that perceptions differ dramatically between physicians, nurses and executives when it comes to the causes, responsibilities, barriers and solutions surrounding physician-nurse relationships.

Some of the contributing factors--such as individual personalities, training, gender biases, historical behaviors and environmental forces--may not be easy to alter. Other factors like cultural tolerance, leadership support and the development of appropriate policies, roles and responsibilities that set behavioral expectations can be changed.