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

Some ways to increase physician awareness and sensitivity to this issue is with lectures and newsletters. But the greatest success comes when a physician champion embraces the issue and spreads the word to colleagues.

Another step is to create opportunities for communication among physicians and nurses. This can be done through informal meetings and discussions (during rounds or phone contacts) or more formally through projects, meetings or committee work where physicians and nurses can come together.

More formal educational opportunities will help, too. Programs focused on team building, joint collaboration, conflict management, time management, stress management and even something as simple as phone etiquette for both physicians and nurses, have proven very successful for improving lines of communication.

Of course, a strong, consistent, well-enforced code of conduct that outlines appropriate behavior for staff and physicians is critical to success. The ideal policy should emphasize the right of all employees to enjoy a harassment-free working environment.

Those who do not follow appropriate behavior guidelines must be approached and counseled by a designated group of peers who are trained and prepared to offer specific recommendations. The team must insist that the physician get help.

The process needs to be consistent, but at the same time it needs to be flexible. A single explosive episode from a temporarily overworked physician during summer vacations should have a different response than a physician with a long history of unprovoked abusive behavior.

The intervention team must emphasize that they are most interested in changing the behavior so that the physician can continue to function--not in ending the physician's career.

For those individuals who are unable or unwilling to improve their behavior, the organization must be ready to take appropriate actions. More severe or repeated cases may require counseling or specific education programs. Immediate suspension of privileges must always be an option when faced with recalcitrance from a physician whose behavior directly endangers either staff or patients.

Obviously, health care is not the only industry with problem personalities. Disruptive behavior in any organization destroys the morale of the workers, negatively affects product/service quality and drives away talented employees.

Nurse/Physician Hospital Relationships: Impact on Nurse Retention and
Satisfaction Percent of respondents that have witnessed or experienced
disruptive behavior from a physician

Overall                  91.0
Nurses-All               95.1
Nurses-Admin            100.0
Nurses-Direct Care       94.8
Physicians-All           75.3
Physicians-Admin        100.0
Physicians-Direct Care   75.1
Executives               90.5

Note: Table made from bar graph

Nurse/Physician Hospital Relationships: Impact on Nurse Retention and
Satisfaction What type of disruptive behaviors have you witnessed or
experienced?

                       Top Bar   Middle bar   Bottom Bar
                       = Nurses  = Physicia  = Executives

Physical Abuse           22.2        9.5         12.5
Conderscension           68.6       43.4         52.9
Insults                  43.2       24.9         47.1
Disrespect               79.9       52.7         66.4
Abusive Anger            43.2       32.4         64.4
Berating-Patients        46.4       30.3         55.8
Berating-Colleagues      71.5       42.9         55.8
Berating-Private         52.4       30.9         46.2
Yelling/Raising Voice    59.8       40.4         43.3
Abusive Language         69.4       48.6         67.3

Note: Table made from bar graph

Nurse/Physician Hospital Relationships: Impact on Nurse Retention and
Satisfaction Overall Analysis of Questions 10 & 11

How frequently does disruptive behavior occur?

1-5 Times/year          24%
Never                    2%
Daily                    7%
Weekly                  24%
1-2 Times/month         29%
6-10 Times/year         14%

What precentage of the Medical
Staff exhibit disruptive behavior?

More than 10% of staff  12%
None                     2%
1% of Staff             18%
2-3% of staff           31%
4-5% of staff           21%
6-10% of staff          16%

Note: Table made from pie chart