Disruptive Behavior in the Healthcare Environ

hisincontrol
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Disruptive Behavior in the Healthcare Environ

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Working While Impaired: Disruptive Behavior in the Healthcare Environment

Florence Nightingale has been quoted as saying: “I attribute my success to this – I never gave or took any excuse” (BrainyQuote, n.d.). It would appear that her measurement of success has fallen by the wayside for today’s nurses. Disruptive behavior among nurses and the excuses made regarding its perpetuation linger in today’shealthcare environment. The Center for American Nurses (the CENTER) cites: “The culture of the healthcare setting has been historically populated by images of the nurse as a 'handmaiden' in a patriarchal environment. The balance of power has not been in the nurse’s favor” (the CENTER, 2008). Behavior that interferes with the ability of a clinician to perform his or her duties or undermines patient confidence is also considered disruptive. A serious negative impact has been associated with the presence of disruptive behavior in the healthcare environment. The impact is experienced by not only the caregiver but within the patient care environment as well.

Disruptive behavior is defined as, “Anything a clinician does that interferes with the orderly conduct of hospital business, from patient care to committee work…” (Porto & Lauve, 2006). Disruptive behavior comes in the form of: profane or discourteous language; demeaning behavior; sexual comments or overtone; inappropriate touching, sexual or otherwise; racial or ethnic jokes; outbursts of anger; throwing instruments, charts, or other objects; criticizing other caregivers in front of patients or other staff; comments that undermine a patient's trust in other caregivers or the hospital; comments that undermine a caregiver's self-confidence in caring for patients; failure to adequately address safety concerns or patient care needs expressed by another caregiver; intimidating behavior that has the effect of suppressing input by other members of the healthcare team; deliberate failure to adhere to organizational policies without adequate evidence to support the alternative chosen; retaliation against any member of the healthcare team who has reported an instance of violation of the code of conduct or who has participated in the investigation of such an incident, regardless of the perceived veracity of the report (Porto & Lauve, 2006).

Disruptive behavior in the healthcare enviroment has been prevalent for many years, although tracking the trend is difficult due to lack of historical data. In 2008, a rise in prevalence reporting created a need for the Joint Commission to conduct a survey of more than 1,500 providers. All of which responded via an e-mail questionnaire. Of the 1500 surveyed, three-fourths said they had been the target of unprofessional, intimidating or inappropriate behavior within the last 24 months (Clark, 2009). Further, the results indicated that two-thirds of those surveyed had considered leaving their job because of this behavior; while, 41% indicated that they had left the profession altogether (Clark, 2009). Ultimately disruptive behavior lends itself to ineffective nursing communication and errors.

As a consequence of the study, a parallel in the relationship between the prevalence of disruptive behavior and sentinel event occurrence was identified. Another study performed by the Joint Commission indicates that nearly 70% of sentinel events can be traced back to an error in communication (Joint Commission, 2009). Further, the Joint Commission cites a strong correlation between bad behavior and the occurrence of untoward results. Intimidation creates a reluctance to voice concerns when he or she witnesses what they perceive as an incident or possibility of something about to go wrong.

In direct response to behaviors that undermine a culture of safety, the Joint Commission issued Sentinel Event Alert #40. In this alert, the Joint Commission purport that rude language and hostile behavior among health care professionals pose a serious threat to the safety of the patient and the overall quality of care (Joint Commission, 2009). In 2009, the Joint Commission introduced standards which required more than 15,000 accredited health care organizations to create a code of conduct that defines acceptable and unacceptable behaviors and to establish a formal process for managing unacceptable nursing behavior.

So, why does it still happen? Could it be that it is easier to reassign the whistleblower than to deal with the bigger problem? The problem exists because many facilities still do not have a solid action plan in place. There are policies that address the issue of disruptive behavior without a team assigned to undertake a cultural transformation. Addressing the problem of disruptive clinician behavior requires more than simply adopting policies and educating staff. The problem requires promotion of an atmosphere of respect and collaboration and shifting away from a model that identifies physicians as customers. Further, healthcare leadership must be committed to preventing and tolerating disruptive behavior by doing the work necessary to effectively manage and eliminate it.

By: Nancy Bellucci, BSN, RN, CNOR
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