How to Handle Disruptive Physician Behaviors

Rick Gessler, RN; Alan Rosenstein, MD, MBA; Liz Ferron, MSW, LICSW

Disclosures

Am Nurs Journal. 2012;7(11):8-12. 

In This Article

Introduction

In 2008, the Joint Commission issued the sentinel alert "Behaviors that undermine a culture of safety." It requires healthcare organizations to establish a code of conduct defining acceptable behaviors as well as disruptive and inappropriate behaviors, and to create and implement a process for managing the latter.

How far have we come since then? Not far enough, according to a 2011 survey of more than 800 physicians conducted by the American College of Physician Executives. In the survey:

  • more than 70% of respondents said disruptive physician behavior occurs at least once a month at their organization; more than 10% said such incidents occur daily

  • about 77% said they were concerned about disruptive behavior in their organization, and 99% believed disruptive behavior ultimately affects patient care.

Patients rarely are the direct targets of a physician's disruptive behavior. When doctors hurl insults or instruments, they're usually aiming at nurses. Nurses are the ones who may have to wait hours for responses to pages and calls, suffer the wrath of frustrated physicians, or keep prepped patients occupied while waiting for doctors to arrive for procedures. Nonetheless, patients are affected indirectly because disruptive behavior creates barriers to effective care.

In a 2005 survey of 1,500 VHA nurses, physicians, and administrators, 68% of respondents answered "sometimes, frequently, or constantly" when asked if they saw a link between adverse events and disruptive behaviors. Asked why that link might exist, some nurses said they wouldn't call abusive doctors for information about their patients. (Note: VHA is a national network of not-for-profit hospitals and organizations.) The 800+ nurse respondents said they believed disruptive behavior contributed to:

  • poor postoperative care

  • incorrect or delayed medication orders

  • prolonged patient suffering when doctors failed to answer pages or return calls.

Corroborating nurses' perspectives on disruptive physician behavior and their own delivery of care, almost half (49%) of the respondents in a 2004 survey of nurses said their experiences with intimidation had changed the way they handled order clarifications or questions about medication orders.

The 2012 HealthLeaders Media Industry Survey underscores nurses' dilemma: While 42% of nurse leaders said physician abuse or disrespect of nurses remains common, only 13% of physician leaders thought this was true. Assuming this finding mirrors nurses' experience in hospitals and clinics, what can nurses do to address a situation that causes them distress and can jeopardize patient outcomes?

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