We expect nurses to model behaviors that reflect courtesy, respect, and good manners. For years, we attributed workplace civility problems to nurse-physician relationships alone. But recent surveys reveal that nurses display almost as much disruptive behavior as physicians. What’s worse, this behavior can hurt patients.
Disruptive behavior also reduces nurse retention. Nurses don’t want to work in a hostile environment. Instead, they seek settings with harmonious relationships and mutual respect.
When disruptive behaviors threaten team performance, they raise the risk of error and patient harm. We need to look in the mirror and either stop any unacceptable behavior of our own or help others understand the need for a professional and healthy work environment. We can no longer afford to tolerate unprofessional, intimidating, disruptive behaviors.
While most healthcare providers have experienced or seen disruptive clinician behaviors, almost half do nothing about it. Disruptive behaviors are grossly underreported. Using demeaning and disrespectful language tops the list. It’s not just what you say, but how you say it. The tone of one’s comments can convey anger, disgust, or disdain for others. Criticizing coworkers in front of others and making inappropriate sexual, racial, or ethnic comments qualify as disruptive. Overt outbursts of anger and throwing objects are intimidating, threatening, and bullying behaviors. So are passive-aggressive behaviors, such as hanging up the phone, failing to respond to repeated calls, and blatantly failing to follow established policies. We all have a responsibility to address these behaviors and reverse the trend of indifference and tolerance that has led to our failure to eliminate this serious problem.
If there has been lack of courage to address these behaviors, there’s now a big stick to add leverage—at least for healthcare organizations accredited by the Joint Commission. Two new leadership standards effective January 2009 require a “code of conduct that defines acceptable and disruptive and inappropriate behaviors” and “a process for managing disruptive and inappropriate behaviors.”
The Joint Commission suggests that to combat behaviors that undermine a culture of safety, organizations provide education; offer skill-based training; develop policies, procedures, and processes to help achieve desired behaviors; and establish a reporting and surveillance system that encourages detection and reporting of unprofessional behavior.
Physicians and high-level executives commonly wield more power in organizations, so when they’re disruptive, the impact is greater. Because it’s difficult to address someone in a position of power, formal systems are needed to promote uniform behavioral standards and accountability for all team members. A consistent process to ensure remediation or sanctions for those who violate the standards is crucial.
Another strong tool to help nurses is the Code of Ethics of the American Nurses Association (ANA). In the Code, we pledge to treat others with respect and profess our commitment to keeping patients safe through compassionate, caring, collegial relationships. The ANA and International Council of Nurses have condemned workplace abuse and harassment of nurses. We have an equal responsibility to seek justice when disruptive behavior targets nurses and to ensure nurse colleagues refrain from engaging in the same behaviors we condemn in others. No matter how skilled and knowledgeable, a nurse must not be allowed to intimidate others.
Over the years, I’ve had opportunities to stop others’ intimidating behavior. I’ve also been on the receiving end of such behavior; a disgruntled employee who was being terminated for cause used threatening language, posturing, and yelling. I remember that interaction as if it were yesterday. It was uncomfortable and frightening.
We can make things better by having policies or codes of conduct that apply equally to all staff and practitioners. We can teach nurses and other coworkers the skills that improve collaborative relationships, such as conflict resolution, assertiveness, and team building. We can perpetuate a culture without blame but rich in opportunities for improvement. We can teach individuals to recognize the difference between expressions of passion and anger.
Let’s live up to the Code and demonstrate zero tolerance for disruptive behavior and promote a culture of safety.
Pamela F. Cipriano, PhD, RN, FAAN, NEA-BC