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Bullying Among Doctors and Nurses: An Alarming Patient Safety Issue

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Bullying Among Doctors and Nurses: An Alarming Patient Safety Issue

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Do you ever wonder how a surgeon could possibly amputate the wrong leg or nurse give a lethal dose of medication? When catastrophic errors, such as wrong-site surgery or inpatient drug overdose make the news, we ask, How could the surgeon be so stupid, the nurse so reckless?

On the surface, outrageous errors like these appear to be the result of an individual’s incompetence, however the causes are much more complicated than meet the eye.

Workplace violence and medical errors are connected and alarming problems. They are the “dirty laundry” of the healthcare industry. They are responsible for thousands of mistakes. They lead to appalling patient and family suffering, huge financial waste, and devastating consequences for professionals and organizations.

What Are Some Terms Used To Describe Bad Behavior?

There is a confusing set of terms that seem to vary depending on who is doing what to whom!

The most common terms are listed below:

• Bullying
• Horizontal violence (behavior between people on the same work level)
• Vertical violence (behavior between people on different levels, such as a nurse manager to her workers)
• Disruptive behavior
• Covert abuse (hidden)
• Overt abuse (open)
• Incivility (rude behavior)
• Interactive Workplace Trauma (IWPT)

For more information about the terminology, check out my 2008 article in Confident Voices eNewletter, “Workplace Abuse: A Glossary of Violence”

What Are Some Common Examples of Bad Behavior Among Doctors and Nurses?

Bad behavior is caused by power dynamics, gender differences, a long history of tolerating poor conduct and lack of skill in handling bad behavior. Fears, resentments, and self-esteem issues collide when nurses and physicians are under severe stress. The following examples give you an idea of what can happen in a hospital. (These are hospital examples but bullying can occur in any healthcare setting.)

• A group of nurses spread negative rumors about a new nurse. The new nurse was excluded from conversations. Information was not always shared. She got a hard patient load. When she asked the manager for help, the manager told her to “just ignore it”. Gradually she became afraid to asking her colleagues for help.
• A nurse was reluctant to call a physician about a worsening patient’s condition because the last time she called him he told her that her question was stupid.
• The labor and delivery nurses did not call an obstetrician about signs that a fetus did not have enough oxygen. This doctor had a habit of screaming at nurses who called him about patients.
• A surgeon got angry because his favorite instrument was not ready. He threw open the door of the operating room. A nurse standing behind the door was struck in the knee. She needed knee surgery to repair the damage. The same day surgery facility lost an experienced nurse when she resigned after her medical leave.

How Common Is Bad Behavior?

• Most surveys show 80- 97% of nurses experience verbal abuse. 1

• 98% of physicians and nurses have witnessed behavior problems with colleagues over the previous year. 2

• Verbal abuse contributes to up to 24% of staff turnover, 42% of nurse administrator turnover. Up to 60% of new nurses leave their first professional position within 6 months because of lateral violence. 20% of these leave forever. 3

What Are the Effects of Bad Behavior?

• Medical error is often cited the 5th leading cause of death in the US. 4

• Communication issues have been implicated in almost 100% of medication errors. 5

• Communication failure is the leading root cause of “sentinel events” (bad medical results). Year after year after year! 6

• Medication errors harm at least 1.5 million people every year. Estimated costs of medical errors in the US are $17 to $37 billion each year. Extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year. 7

Beth Boynton is a national speaker and author of the book, Confident Voices: The Nurses’ Guide to Improving Communication & Creating Positive Workplaces. To learn more about her work visit: www.bethboynton.com

Beth Boynton RN and Alan Rosenstein MD contributed a critical interview for members of the Avoid Medical Errors Inner Circle. Sign up for the paid membership site at www.avoidmedicalerrors.com.

1. See Laura Sofield, MSN, APRN, BC’s website, laurasofield.com.
2. Johnson, Carrie, “Bad Blood: Doctor-Nurse Behavior Problems Impact Patient Care”, The Physician Executive Journal, November-December, 2009, (this and related articles: .
3. Hurley, J., “Nurse-to-Nurse Horizontal Violence: Recognizing it and Preventing it.”, NSNA Imprint. September/October 2006.
4. The Joint Commission Guide to Improving Staff Communication, The Joint Commission Resources, 2005.
5. See note 4
6. See The Joint Commission’s website, tab-Topics, Sentinel Event-Sentinel Event Alert, www.jointcommission.org.
7. Preventing Medication Errors: The Quality Chasm Series, National Academies Press, 2007, (report summary press release: http://www8.nationalacademies.org/onpinews/newsitem.aspx?recordid=11623).

This article originally appeared in Avoid Medical Errors Magazine.

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3 Responses to “Bullying Among Doctors and Nurses: An Alarming Patient Safety Issue”

  1. Covert abuse is among the most difficult to catch. That’s why video cameras in facilities and homes where vulnerable patients are receiving care are critical protective measures to catch and prosecute these covert abusers. Here’s a perfect example:

    http://www.cbs8.com/story/19604621/2-men-accused-of-abusing-autistic-man-plead-not-guilty

    http://www.nbcsandiego.com/news/local/Caregivers-Caught-on-Tape-Abusing-Autistic-Man-Valley-Center-170444546.html

    http://www.hlntv.com/video/2012/09/27/caught-tape-autistic-man-allegedly-abused-caregivers

    http://transcripts.cnn.com/TRANSCRIPTS/1209/27/ddhln.01.html

  2. Covert abuse is among the most difficult to catch. That’s why video cameras in facilities and homes where vulnerable patients are receiving care are critical protective measures to catch and prosecute these covert abusers. Here’s a perfect example:

    http://www.cbs8.com/story/19604621/2-men-accused-of-abusing-autistic-man-plead-not-guilty

    http://www.nbcsandiego.com/news/local/Caregivers-Caught-on-Tape-Abusing-Autistic-Man-Valley-Center-170444546.html

    http://www.hlntv.com/video/2012/09/27/caught-tape-autistic-man-allegedly-abused-caregivers

    http://transcripts.cnn.com/TRANSCRIPTS/1209/27/ddhln.01.html

  3. Covert abuse is among the most difficult to catch. That’s why video cameras in facilities and homes where vulnerable patients are receiving care are critical protective measures to catch and prosecute these covert abusers. Here’s a perfect example:

    http://www.cbs8.com/story/19604621/2-men-accused-of-abusing-autistic-man-plead-not-guilty

    http://www.nbcsandiego.com/news/local/Caregivers-Caught-on-Tape-Abusing-Autistic-Man-Valley-Center-170444546.html

    http://www.hlntv.com/video/2012/09/27/caught-tape-autistic-man-allegedly-abused-caregivers

    http://transcripts.cnn.com/TRANSCRIPTS/1209/27/ddhln.01.html

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