Doctors and Nurses and the Problem of Their Disruptive Behavior
One group of nurses banded together to try to get a physician unfairly disciplined, while another encouraged fellow nurses to disobey doctors' orders outright. A surgeon told his staff that monkeys could be trained to do what scrub nurses do, while another doctor told a patient that the nurse in the room didn't know what she was doing.
A nurse witnessed the onset of complications in an intensive care patient but refused to contact the on-call physician for fear of his temper -- a delay at least one observer thought contributed to the patient's death.
This excerpt is from November 16, 2009 American Medical Association News, amednews.com
The article is all about what is happening now in hospitals, clinics and other healthcare facilities around the United States. It is all about disruptive and intimidating behavior of physicians and nurses which has been going on for years but now, starting about a year ago, the Joint Commission which certifies hospitals and other institutions for government reimbursement in the interest of patient safety declared that these institutions must present evidence of “zero-tolerance” for these unprofessional behaviors which potentially can impact negatively on the care and safety of the patients. However, there still is a lot still missing in institutional and personal compliance to the Joint Commission’s order.
A 2009 study of behaviors "Bad Blood: Doctor-Nurse Behavior Problems Impact Patient Care," American College of Physician Executives 2009 Doctor-Nurse Behavior Survey,Physician Executive Journal, November/December showed the following:degrading comments and insults comprised 84.5% of the behaviors followed by yelling 73.3%,cursing 49.4%, inappropriate joking 45.5%, refusing to work with colleague 38.4%, refusing to speak to colleague 34.3%, trying to get someone unjustly disciplined 32.3%, throwing objects 18.9%, trying to get someone unjustly fired 18.6%, spreading malicious rumors 17.1%, sexual harassment 13.4%, physical assault 2.8% and others 10%.
However, what is happening is that there seems to be a difficulty in separating disruptive speech and actions from honest attempts in certain situations to protect patients and to disclose to hospital administration of weaknesses in the hospital’s healthcare system or in the harmful behavior of certain physicians or nurses—that is, “whistle blowing”. Unfortunately, these actions may be considered disruptive, not constructive and behavior which must be suppressed to keep to the Joint Commission’s rule and it is the “whistle blower” who is accused of being disruptive. Further, staff may be reluctant to report on behavior of superiors or other colleagues in fear for personal repercussions.
Obviously, much more has to be done besides hospitals simply writing a policy about these matters. Read the full article and the linked references there and return and give your opinion about the issue and any disruptive behavior you have witnessed, but please give no names. ..Maurice.
Graphic: Photograph, taken by me, of a painting ("Self-portrait, Yawning, Joseph H. Ducreux, 1783 from the Getty Museum, Los Angeles)but modified with Picasa3. Basis for selection of this graphic for this thread: Somehow, the painting looked to me like a disruptive yelling rather than a benign yawn. What do you think?
posted by Maurice Bernstein, M.D. @ 9:55:00 PM
10 comments
10 Comments:
Ultimately,the physician is
responsible for the patient's outcome.I've seen many nurses
exceed the scope of their license
and this essentially occurs in
intensive care units.
At any one time an intensive
care patient may have several and
sometimes three physicians over
seeing their care. Many intensive
care nurses are agency and travelers and as such no real
loyality to the hospital.
Here today,gone tomorrow is their attitude and with many
icu patients recieving substandard
nursing care one can see how
easily frustrated attending
physicians can get.
PT
PT, you raise an interesting point. Those registry nurses are probably unfamiliar with the hospital protocols and the physicians attending their assigned patients. The physicians likewise are unfamiliar with the nurses and this combination can lead to physician dissatisfaction and probably it would be easy for an upset physician to bellow at one of these nurses rather than a permanent employee. ..Maurice.
Bellow may be a strong word perhaps
to describe the communication from
physician to nurse. I don't think
it reaches that level. I believe
its the reluctance on nursing to
do their job.
Everyone in healthcare knows how
lazy nurses are and thats no secret
even among nursing. Its all part of
the eat their young mentality. Its
about more control than anything
and often at the expense of the patient.
Here is my example that I once
saw. Young pediatric patient presents to trauma for an mva. The
protocol for pediatric traumas at this facility is pediatric nursing
from the floor responds to all
pediatric trauma cases rather than
trauma nurses.
Pediatric nurses respond and
stand around patient in a cirle
and not allowing any one in the trauma to see and evalute patient.
Even the attending and 3rd year
trauma resident made a point of
complaining. Not sure how that all
played out eventually. All the
pediatric nurses were female and
trauma surgeon and resident were
male.
In conclusion,there was a study
done and I'll make reference to
the site which involves the turmoil
that exists when female nurse/male
physician and female nurse/female
physician. The study found that
turmoil and that may not be the term used,however,tended to reside
with female nurse/female physician.
Now apparently there are other
dynamics involved yet my take is that its still about control involving nursing,a predominately
female industry.
PT
The fact that I have no respect for nurses and only follow the orders my doctors give me might cause problems between them. I follow doctors orders to the letter so whenever a nurse likes to sway something towards her way of thinking I don't accept her way unless it is exactly what the doctor says. This often starts the nurse throwing a temper tantrum.
I've been reading these posts with a real sense of fascination. Open hostility between medical and nursing staff seems to culturally determined. Horizontal violence (as its referred to in the literature) occurs more in Western hospitals than it does in Asian hospitals, I believe largely due to Asian culture encouraging nurses to be more submissive. Having said that, submissive nurses result in more patient deaths than argumentative ones! I think the conflict between senior nurses and doctors keeps the doctors on their toes. Reality is, most nurses DO know more about the patient. With a doc spending most of their working day checking out internet porn or playing golf, the well-being of the last Anon poster would be the least of their concerns.
Charles, you are quite right, of course, writing "most nurses DO know more about the patient", however unlike the physician preoccupations you noted, I think the real reason is the brief duration once daily rounding on the hospital patient and the most of the day attending to patients in their offices or within the operating rooms. ..Maurice.
You don't find much discussed about this aspect of the topic: I wonder to what extent any "disruptive" or hostile behavior between doctors and nurses filters down to the patient. Not necessarily consciously, but just as a result of an unhealthy environment. I wonder if any research has been done in this area -- If the working environment is healthy and doctors and nurse work well together, how does that affect patient well-being. And what's the effect on the patient if the environment is not healthy? Basic common sense says this will affect the patient. But has it been quantified?
MER
I offer the cited website for consideration of the premise that litigious doctors are a subset of disruptive doctors. https://tryingourpatients.wordpress.com/category/doctor-lawsuits/
Doctors who sue patients for leaving bad reviews, complaining to state medical boards, or contacting the hospital that grants privileges can put a patient or family members through years of costly, overwhelming litigation. Such patients and their entire families boycott the host hospital; and when the patient wins dismissal - sometimes from the State Supreme Court - the resulting precedent reflects as poorly on the host hospital and professional body as it does on the litigious doctor.
It seems there are doctor who just "can't take it" either from nurses or even their patients. Could something be going on in those physician's home life? ..Maurice.
Retired nurse, now a publishing editor/proofreader.
Having worked in both Australia and Malaysia, these problems that are being described are not unique to the US. We see similar problems with horizontal violence and its impact on patient care in Australia (although perhaps less so here in Malaysia).
While I'm an advocate of increasing the scope of nurses professionalism and being seen as a distinct career path apart from medicine, I'm inclined to wonder if this departure from the "handmaiden" role and the pursuit of professional independence is what is really behind these problems.
After migrating to Malaysia and teaching nursing for a couple of years, I was shocked by how docile the local nurses were: They still embrace the role of handmaiden of the doctor and do not see themselves as possessing a body of knowledge that is unique from medicine.
At the same time, I've also seen doctors (in Australia) who have been institutionalised into the antiquated idea that nurses are their subordinates. As such, there are failures on both sides of the medical-nursing divide to appreciate one another's changing professional roles.
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