The American Medical Association defines disruptive behavior as “personal conduct, whether verbal or physical, that affects or potentially may affect patient care negatively.” That’s a good starting point, but a policy or code of conduct needs to specify which behaviors are disruptive. These behaviors can be classified as four types:
• intimidation and violence
• inappropriate language or comments
• sexual harassment
• inappropriate responses to patient needs or staff requests.Intimidation and violence includes throwing objects, threatening violence, pushing or hitting others, finger pointing, and invading another’s space. The most common display of intimidation is yelling. Most surveys of nurses show that 40% to 80% have had a physician yell at them.
Despite this broad spectrum of disruptive behaviors, most nurses summarize their experience with problem physician behavior with the word disrespect. All hospital employees have the right to be treated with respect. But merely feeling disrespected is not enough to trigger a meaningful intervention. The disrespectful behavior must be described in terms of institutional definitions of bad behavior.That’s why every hospital medical staff should have a behavioral policy or code of conduct that contains a clear statement of the type of behavior expected from members and a detailed list of prohibited behaviors. Also, the policy must contain a clear description of the process for documenting and reporting disruptive behavior and for protecting those who make such reports from repercussions. Nurses need to be familiar with the policy. If the hospital medical staff doesn’t have such a policy, nursing leaders should intervene. (To see examples of medical staff codes of conduct and behavioral policies, visit http://lazoritz.com/
If you have been directly affected by or have observed behavior that violates the medical staff’s policy or code of conduct, you may want to try talking calmly and privately to the physician and explaining the effect of the behavior. (See Discussing disruptive behavior with the disrupter.) Whether you try this approach or not, you must document the incident and report it. You may be reluctant because you believe the behavior is an isolated act by a well-liked physician who usually acts professionally or because you’ve already talked to the physician privately and he has apologized. In fact, many incidents result from the stress of the moment, not from a chronic pattern of bad behavior. But your role is not to decide whether the behavior is acute or chronic. If it was disruptive, report it—no matter what. The hospital and medical staff leaders will decide if it’s an isolated incident or part of a pattern.You may also be reluctant to report disruptive physician behavior because you fear reprisals. This fear is understandable, but remember that intimidation allows disruptive physician behavior to persist. Hospital and medical staff policies must protect you.
Benefits for all
The intervention by the medical staff should benefit both nurses and physicians. If the physician has a history of abusive, disruptive behavior, obviously the medical staff needs to intervene promptly and effectively—for the good of all. Luckily, this type of physician is in the minority. The majority of disruptive incidents involve competent, effective physicians who resort to this type of behavior during times of stress. (See More than a collegial discussion.) By filing a report, you create an opportunity to make such physicians aware of their disruptive behavior and help them change.
American Medical Association. Physicians and disruptive behavior. Available at: www.ama-assn.org/ama1/pub/upload/mm/
21/disruptive_physician.doc. Accessed September 4, 2007.Johnson CL, Martin SLD, Markle-Elder S. Stopping verbal abuse in the workplace: nurses should not tolerate this behavior and it should be reported when it occurs. Am J Nurs. 2007;107(4):32-34.
0/Disruptive_Behavior_hap_stds.pdf. Accessed May 1, 2007.
Stephen Lazoritz is Principal of the Lazoritz Group, Hospital Interaction Specialists; Clinical Professor in the Departments of Pediatrics and Psychiatry at Creighton University School of Medicine; and Adjunct Professor in the Department of Pediatrics at the University of Nebraska Medical Center in Omaha. Pamela J. Carlson is Vice President, Patient Care Services and Chief Nursing Officer at Children’s Hospital in Omaha.