Conduct Unbecoming

The topics for my editorials are often based on current events, either political or professional; some of them reflect the “disease of the month.” Whatever the issue, it is one that strikes me as something about which I think our consciousness must raised, even one that has outraged me. While the political events of this past month could be the topic for this editorial, it is the societal events that have raised my moral outrage.

The multitude of radio and TV news stations bombarding us with “all news, all the time” has turned me into a “headlines-only” consumer of the news. Unless the story is especially interesting, I am usually quick to change the station and search for something a bit more pleasant to my eyes and ears. A sudden awareness of this response caused me to pause and wonder whether I had become inured to what was happening around me. That fear was mitigated when a recent news story so unsettled me that I sat in astonishment, listening to the newscasters repeat story after story about violence in our schools and in the workplace.

I am sure that you have either read or heard stories of nurses being struck by patients or being physically or verbally assaulted by family members. I have no doubt that many of us have experienced similar events throughout our professional careers.

Several years ago, I may have excused these behaviors as reactions to stressful, emotional situations. But there is one instance in which I have never accepted or excused outbursts. That is when professionals intimidate their colleagues by acting out in a violent manner.

In 2008, the concern about workplace violence had become so great that the Joint Commission issued a statement requiring hospitals to adopt a “zero tolerance” policy with regard to disruptive behavior.¹ Historically, it has been physicians who were the perpetrators of the “bad behavior.”

Perhaps the basis for that was an imbalance of power: Physicians stood firmly on the pedestal where society had placed them, and from that vantage point, they saw all other health care providers as beneath them.

One specific incident in my career brought this problem to life for me—and stopped me dead in my tracks as I walked by the people involved. A physician was berating a female colleague, and besmirching her mother’s reputation. Not only were his language and tone of voice offensive to me, but when I saw the anger in the man’s face and the expression of fear and embarrassment on the woman’s face, I was compelled to speak up.

Firmly and through clenched teeth, I told the man, “You may speak to your mother, your sisters, your wife, and your daughters that way, but under no circumstances may you talk to anyone here in that manner.”

I’m not sure which one of us was more surprised by my response—I surely hadn’t planned it—but the physician never raised his voice, or was anything less than professional and gentlemanly from that day forward. I have not had occasion to use that little speech since, but I lend it to anyone who has the need for it, with my permission to modify the genders as necessary.

However, I submit that it isn’t only physicians who have been guilty of this kind of destructive behavior. I have seen such intimidation among all health care professionals. All who are perceived (or who perceive themselves) as being “better” because of their clinical expertise, specialty, or years in practice have been guilty, to one degree or another, of intimidating a colleague. Whether this takes the form of verbal abuse, throwing an instrument, or quietly refusing to cooperate, the behavior can have devastating, far-reaching results. In addition to affecting the people directly involved in these interactions, their sequelae can include a devastating impact on the patient.

Data reflecting the negative effects of disruptive behaviors have been well documented in research by Rosenstein and colleagues.^2-4 The investigators found disruptive behavior to be linked to adverse events, medical errors, compromised patient safety, impaired quality of care, and patient mortality.² In addition to patient care issues, another consequence of inappropriate behavior—nurses leaving the workplace—is increasing shortages in nurse staffing,^3,4 which only compounds the risks to patient safety.

In today’s health care world, quality care and patient safety are held in the highest regard, and the concept of working together as a team is being applied. One effect of these team-building efforts is that the disruptive behaviors of the past are slowly disappearing. Health care providers have come to embrace the realization that there must be respect among all the team members, or the ability to provide safe patient care will be challenged.

The cooperative approach to teaching professionals to identify and manage disruptive behaviors, put forth by the American College of Physician Executives and the American Organization of Nurse Executives, is commendable. As a result of their efforts, bolstered by the implementation of the Joint Commission’s new leadership standard,⁵ which addresses disruptive and inappropriate behaviors and emphasizes respect and professional etiquette, all our health care facilities will soon be healthier environments for everyone who enters their doors.

Have you ever been intimidated or abused by a patient, a patient’s family, or a colleague? Have you ever caught yourself on the verge of being the abuser, reacting in anger or frustration toward a colleague? I’d be very interested to hear about your experiences. You can reach me at [email protected].

The topics for my editorials are often based on current events, either political or professional; some of them reflect the “disease of the month.” Whatever the issue, it is one that strikes me as something about which I think our consciousness must raised, even one that has outraged me. While the political events of this past month could be the topic for this editorial, it is the societal events that have raised my moral outrage.

The multitude of radio and TV news stations bombarding us with “all news, all the time” has turned me into a “headlines-only” consumer of the news. Unless the story is especially interesting, I am usually quick to change the station and search for something a bit more pleasant to my eyes and ears. A sudden awareness of this response caused me to pause and wonder whether I had become inured to what was happening around me. That fear was mitigated when a recent news story so unsettled me that I sat in astonishment, listening to the newscasters repeat story after story about violence in our schools and in the workplace.

I am sure that you have either read or heard stories of nurses being struck by patients or being physically or verbally assaulted by family members. I have no doubt that many of us have experienced similar events throughout our professional careers.

Several years ago, I may have excused these behaviors as reactions to stressful, emotional situations. But there is one instance in which I have never accepted or excused outbursts. That is when professionals intimidate their colleagues by acting out in a violent manner.

In 2008, the concern about workplace violence had become so great that the Joint Commission issued a statement requiring hospitals to adopt a “zero tolerance” policy with regard to disruptive behavior.¹ Historically, it has been physicians who were the perpetrators of the “bad behavior.”

Perhaps the basis for that was an imbalance of power: Physicians stood firmly on the pedestal where society had placed them, and from that vantage point, they saw all other health care providers as beneath them.

One specific incident in my career brought this problem to life for me—and stopped me dead in my tracks as I walked by the people involved. A physician was berating a female colleague, and besmirching her mother’s reputation. Not only were his language and tone of voice offensive to me, but when I saw the anger in the man’s face and the expression of fear and embarrassment on the woman’s face, I was compelled to speak up.

Firmly and through clenched teeth, I told the man, “You may speak to your mother, your sisters, your wife, and your daughters that way, but under no circumstances may you talk to anyone here in that manner.”

I’m not sure which one of us was more surprised by my response—I surely hadn’t planned it—but the physician never raised his voice, or was anything less than professional and gentlemanly from that day forward. I have not had occasion to use that little speech since, but I lend it to anyone who has the need for it, with my permission to modify the genders as necessary.

However, I submit that it isn’t only physicians who have been guilty of this kind of destructive behavior. I have seen such intimidation among all health care professionals. All who are perceived (or who perceive themselves) as being “better” because of their clinical expertise, specialty, or years in practice have been guilty, to one degree or another, of intimidating a colleague. Whether this takes the form of verbal abuse, throwing an instrument, or quietly refusing to cooperate, the behavior can have devastating, far-reaching results. In addition to affecting the people directly involved in these interactions, their sequelae can include a devastating impact on the patient.

Data reflecting the negative effects of disruptive behaviors have been well documented in research by Rosenstein and colleagues.^2-4 The investigators found disruptive behavior to be linked to adverse events, medical errors, compromised patient safety, impaired quality of care, and patient mortality.² In addition to patient care issues, another consequence of inappropriate behavior—nurses leaving the workplace—is increasing shortages in nurse staffing,^3,4 which only compounds the risks to patient safety.

In today’s health care world, quality care and patient safety are held in the highest regard, and the concept of working together as a team is being applied. One effect of these team-building efforts is that the disruptive behaviors of the past are slowly disappearing. Health care providers have come to embrace the realization that there must be respect among all the team members, or the ability to provide safe patient care will be challenged.

The cooperative approach to teaching professionals to identify and manage disruptive behaviors, put forth by the American College of Physician Executives and the American Organization of Nurse Executives, is commendable. As a result of their efforts, bolstered by the implementation of the Joint Commission’s new leadership standard,⁵ which addresses disruptive and inappropriate behaviors and emphasizes respect and professional etiquette, all our health care facilities will soon be healthier environments for everyone who enters their doors.

Have you ever been intimidated or abused by a patient, a patient’s family, or a colleague? Have you ever caught yourself on the verge of being the abuser, reacting in anger or frustration toward a colleague? I’d be very interested to hear about your experiences. You can reach me at [email protected].

The topics for my editorials are often based on current events, either political or professional; some of them reflect the “disease of the month.” Whatever the issue, it is one that strikes me as something about which I think our consciousness must raised, even one that has outraged me. While the political events of this past month could be the topic for this editorial, it is the societal events that have raised my moral outrage.

The multitude of radio and TV news stations bombarding us with “all news, all the time” has turned me into a “headlines-only” consumer of the news. Unless the story is especially interesting, I am usually quick to change the station and search for something a bit more pleasant to my eyes and ears. A sudden awareness of this response caused me to pause and wonder whether I had become inured to what was happening around me. That fear was mitigated when a recent news story so unsettled me that I sat in astonishment, listening to the newscasters repeat story after story about violence in our schools and in the workplace.

I am sure that you have either read or heard stories of nurses being struck by patients or being physically or verbally assaulted by family members. I have no doubt that many of us have experienced similar events throughout our professional careers.

Several years ago, I may have excused these behaviors as reactions to stressful, emotional situations. But there is one instance in which I have never accepted or excused outbursts. That is when professionals intimidate their colleagues by acting out in a violent manner.

In 2008, the concern about workplace violence had become so great that the Joint Commission issued a statement requiring hospitals to adopt a “zero tolerance” policy with regard to disruptive behavior.¹ Historically, it has been physicians who were the perpetrators of the “bad behavior.”

Perhaps the basis for that was an imbalance of power: Physicians stood firmly on the pedestal where society had placed them, and from that vantage point, they saw all other health care providers as beneath them.

One specific incident in my career brought this problem to life for me—and stopped me dead in my tracks as I walked by the people involved. A physician was berating a female colleague, and besmirching her mother’s reputation. Not only were his language and tone of voice offensive to me, but when I saw the anger in the man’s face and the expression of fear and embarrassment on the woman’s face, I was compelled to speak up.

Firmly and through clenched teeth, I told the man, “You may speak to your mother, your sisters, your wife, and your daughters that way, but under no circumstances may you talk to anyone here in that manner.”

I’m not sure which one of us was more surprised by my response—I surely hadn’t planned it—but the physician never raised his voice, or was anything less than professional and gentlemanly from that day forward. I have not had occasion to use that little speech since, but I lend it to anyone who has the need for it, with my permission to modify the genders as necessary.

However, I submit that it isn’t only physicians who have been guilty of this kind of destructive behavior. I have seen such intimidation among all health care professionals. All who are perceived (or who perceive themselves) as being “better” because of their clinical expertise, specialty, or years in practice have been guilty, to one degree or another, of intimidating a colleague. Whether this takes the form of verbal abuse, throwing an instrument, or quietly refusing to cooperate, the behavior can have devastating, far-reaching results. In addition to affecting the people directly involved in these interactions, their sequelae can include a devastating impact on the patient.

Data reflecting the negative effects of disruptive behaviors have been well documented in research by Rosenstein and colleagues.^2-4 The investigators found disruptive behavior to be linked to adverse events, medical errors, compromised patient safety, impaired quality of care, and patient mortality.² In addition to patient care issues, another consequence of inappropriate behavior—nurses leaving the workplace—is increasing shortages in nurse staffing,^3,4 which only compounds the risks to patient safety.

In today’s health care world, quality care and patient safety are held in the highest regard, and the concept of working together as a team is being applied. One effect of these team-building efforts is that the disruptive behaviors of the past are slowly disappearing. Health care providers have come to embrace the realization that there must be respect among all the team members, or the ability to provide safe patient care will be challenged.

The cooperative approach to teaching professionals to identify and manage disruptive behaviors, put forth by the American College of Physician Executives and the American Organization of Nurse Executives, is commendable. As a result of their efforts, bolstered by the implementation of the Joint Commission’s new leadership standard,⁵ which addresses disruptive and inappropriate behaviors and emphasizes respect and professional etiquette, all our health care facilities will soon be healthier environments for everyone who enters their doors.

Have you ever been intimidated or abused by a patient, a patient’s family, or a colleague? Have you ever caught yourself on the verge of being the abuser, reacting in anger or frustration toward a colleague? I’d be very interested to hear about your experiences. You can reach me at [email protected].