Prelude - A game of discovery and learning.

Hospital Bullying

May 15, 2011

The NY Times Opinion Page recently featured an editorial on the rampant bullying of nurses by doctors. It was written by Theresa Brown, an oncology nurse and author of “Critical Care: A New Nurse Faces Death, Life and Everything in Between.”

“While most doctors clearly respect their colleagues on the nursing staff, every nurse knows at least one, if not many, who don’t…. That said, the most damaging bullying is not flagrant and does not fit the stereotype of a surgeon having a tantrum in the operating room. It is passive, like not answering pages or phone calls, and tends toward the subtle: condescension rather than outright abuse, and aggressive or sarcastic remarks rather than straightforward insults. And because doctors are at the top of the food chain, the bad behavior of even a few of them can set a corrosive tone for the whole organization. Nurses in turn bully other nurses, attending physicians bully doctors-in-training, and experienced nurses sometimes bully the newest doctors.”

The author presents survey findings  from the Institute for Safe Medication Practices. More than 2,000 healthcare professionals, including nurses, pharmacists, and other providers participated. The survey shows “workplace bullying posed a critical problem for patient safety: rather than bring their questions about medication orders to a difficult doctor, almost half [49%] the health care personnel surveyed said they would rather keep silent … Even when the prescriber was questioned about safety, almost half (49%) of respondents felt pressured into dispensing a product or administering a medication despite their concerns.” Almost half of respondents reported being the recipients of strong verbal abuse (48%) or threatening body language (43%) at least once during the last year … Sixty-nine percent said a prescriber had at least once in the last year responded “Just give what I ordered,” when faced with a question … Furthermore, 7 percent of the respondents said that in the past year they had been involved in a medication error in which intimidation was at least partly responsible.”

The problem is so dire that the “the Joint Commission, the primary accrediting body for American health care organizations, has warned of a distressing decline in trust among hospital employees and, with it, a decline in the quality of medical outcomes.” Issue 40, July 9, 2008 states: “The presence of intimidating and disruptive behaviors in an organization, however, erodes professional behavior and creates an unhealthy or even hostile work environment – one that is readily recognized by patients and their families. Health care organizations that ignore these behaviors also expose themselves to litigation from both employees and patients.”

It’s worth noting that the same solutions are being proposed in hospitals for professional staff as in schools. That is, this requires a cultural shift and improvement in overall climate to reduce bullying. It must start at the top of the hospital hierarchy. The good news is that developing positive social and emotional skills is not difficult or costly.