Doctors Aren't the Sole Problem
by Alexandra Wilson Pecci; healthleadersmedia.com; 8/13/13
Nurses verbally abused by doctors are more likely to verbally abuse their nurse colleagues, study data demonstrates. That should make all hospital leaders—not just CNOs—sit up and take serious notice.
Nastiness breeds nastiness, even among individuals whose position it is to be caregivers.
That's one of the critical takeaways from a review by the RN Work Project, a program of the Robert Wood Johnson Foundation, which surveyed 1, 328 recently licensed registered nurses (NLRNs) about how frequently they were verbally abused by doctors and the character of the abuse.
The study uncovered a great deal of issues that nurses who've been on the receiving end of workplace verbal mistreatment probably don't need a study to tell them:
But one finding in particular ought to make all hospital leaders—not just CNOs—sit up and take serious notice: Nurses who are verbally mistreated by physicians are more likely to verbally abuse each other.
To paraphrase "verbal abuse is infectious," study coauthor Carol Brewer, PhD, RN, FAAN, teacher at the School of Nursing at the University at Buffalo, said in a statement. Those nurses who experienced the most repeated abuse also identified poor collegial relations between RNs and physicians, inadequate workgroup cohesion, and more work-family conflict.
"Disruptive physician conduct is the issue that just won't go away," says Barry Silbaugh, MD, of the American College of Physician Executives a statement after that group's own survey [PDF] was released not long ago. That's an understatement.
"One potential reason is that negative actions exhibited by one member of a party spills over to other people of the group and hurts the group dynamic," Brewer said. "We likewise see that in a stressful atmosphere, including one in which there is doctor-to-RN abuse, there is more likely to be RN-to-RN mistreatment, as well."
In June, I had written concerning another study by the same research group which observed that new nurses who are verbally abused by nursing colleagues report lower job satisfaction, negative perceptions of their work environment, and greater intent to get away from their current jobs. In that column, I wrote that "if your organization hasn't taken the time to train its nurse leaders in conflict resolution, now's the time to do it."
But RWJF study shows that training nurse management isn't sufficient, particularly when part of the issue seems to be abusive doctors.
"Physicians' verbal mistreatment of nurses is a long-standing challenge and one we need to do much more to tackle," Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing at New York University said in a statement.
Like a disease that spreads if left without treatment, verbal abuse has the potential to sicken a complete organization, and nurses seem to know this already. Readers of this column have left a comment on the web about the "cycle" of intimidation and abuse and observed that "cultures which have suffered oppression are highly likely to turn on each other."
Another reader observed that older nurses who engage in verbal abuse are "frequently disrespected" themselves, adding, "People who are happy and fulfilled don't usually take on bullying" behaviors.
In feedback about the preceding study, the authors say hospitals need to implement mandatory company-wide programs for all employees about the effects of verbal abuse and other disruptive behaviors, as well as zero-tolerance guidelines. That suggestion certainly applies here, also. And it goes without saying that it should apply to doctors just as much as it applies to nurses.