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Q: What is physician disruptive behavior and why does it exist?

A: There are many reasons for abuse by physicians including an abundance of self-esteem, and a lack of understanding of nurses' real role in patient care. But please see research and reports by others, and some news items that we have done that contain references to this phenomenon.

Original Research: Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention, by Alan H. Rosenstein MD, MBA, American Journal of Nursing, June 2002, Volume 102 Number 6, Pages 26 - 34.

We quote from the article: "An analysis of...1,200 responses from nurses, physicians, and hospital executives suggests that daily interactions between nurses and physicians strongly influence nurses' morale. All respondents were very concerned with the significance of nurse-physician relationships and the atmosphere they create...The findings suggest that the quality of nurse-physician relationships must be addressed as facilities seek to improve nurse recruitment and retention."

Also see an inspiring editorial "MD-RN: A Tired Old Dance" by American Journal of Nursing editor-in-chief Diana Mason, RN, Ph.D., FAAN on dealing with physician disruptive behavior.

September 6, 2006 -- A study found that 84% of medical students report being belittled and 42% said they were harassed by their physician mentors.

September 3, 2009 -- A Vanderbilt Center for Patient and Professional Advocacy study found that 85% of health workers experience offensive and disruptive behavior in the workplace. Forty one percent said it caused them to leave their jobs and two-thirds said such incidents made them consider leaving their jobs.

July 9, 2008 -- "Behaviors that undermine a culture of safety," by the Joint Commission.

Please notify us if you know of research that belongs on this page. Thank you.

 

Angry surgeon; Theresa BrownThe weather in my head

 
The most common way people give up their power

is by thinking they don't have any.

                        Alice Walker

March 16, 2013 -- This month major press entities ran pieces addressing the ongoing problem of conflicts between nurses and physicians in clinical settings. On March 4, The Washington Post published a long article by Sandra G. Boodman about the growing use of anger management programs to deal with "out-of-control doctors" in hospital environments that are increasingly team-oriented and less tolerant of abuse and tantrums. The piece is good as far as it goes, conveying lots of helpful information about why the abuse happens, programs to address it, and how it can affect patient care. But the focus is overwhelmingly on the perspectives of the physicians themselves, with only one nurse consulted briefly, and there is no real effort to explore what the actual victims of the abuse think or experience. Instead, readers get a long section in which an abusive surgeon provides a slew of reasons/excuses for her conduct, mainly how much she herself suffered in her brutal training. And today, Theresa Brown, RN, posted a well-written blog entry on the New York Times site about the choices nurses face when they disagree with a physician's care plan. Brown briefly discusses how nurses can protect patients in a world in which the nurses have less practical power than physicians--and in Brown's view, a world in which nurses fall below physicians in a "legal, established hierarchy" that must be obeyed. But in fact, nurses do not report to physicians. The two groups practice distinct professions. In hospital settings, they have separate management structures. And nurses are legally and ethically bound not to accede to physician wishes that threaten patients. Of course, Brown is right that nurses who stand up to physicians face risks; they range from bullying to assaults to being fired by nurse managers who fear the physicians' power as revenue generators. But there is no formal "hierarchy" between the professions, just different scopes of practice and a longstanding power disparity. Brown seems to argue that physicians should have final authority over all clinical decisions, possibly because of a view that one type of health professional has to be in charge of everything, an idea that is regressive and untenable in the highly diverse, patient-focused modern health care environment. Brown recommends interprofessional education programs, and we agree that they improve relations between the professions. But simply trying to persuade physicians not to abuse their power, while meekly embracing a subservient professional status, is not enough to protect patients--or nurses. Nurses need collaboration and autonomy.  more...

 

Who dares tell me to place a used syringe in the proper bag? I will crush you like a tiny bug! M'wa-ha-ha-ha-ha-ha!

Times of India logoDecember 10, 2004 -- Today's Times of India carried a short unsigned piece, "Doctors, nurses clash at NRS hospital," about the fallout after a nurse pointed out to a junior physician that he had failed to place a used syringe in the proper receptacle at a local hospital. This "simple lesson in hospital hygiene" apparently motivated offended junior physicians to "start a fight" with the nurses. Police were reportedly called in to restore order. more...

 

Can we get cultures on that?

June 2009 -- A recent article in the Colorado Springs Gazette highlighted the continuing problem of physician abuse of nurses in some care settings. John Ensslin's June 26 piece was "Nurse sues Memorial, claims surgeon threw human tissue at her." The story reports that in mid-2008, Bryan Mahan, the chairman of cardiac and thoracic surgery at Memorial Hospital, allegedly threw and hit operating room nurse Sonja Morris with a 4-by-6-inch piece of bloody tissue (the pericardium), and committed other physical assaults on her. Morris says she complained to the hospital with no result, then filed a gender discrimination claim with the U.S. Equal Employment Opportunity Commission. Morris says hospital administrators soon transferred her from the heart surgery team to the main operating room, which is considered less prestigious. She finally filed suit in federal court against the hospital--but not Mahan--on the grounds that she was demoted for complaining about the abuse. Commentary from local nurses posted on the Gazette's web site in response to the story suggests that physician abuse of nurses has been tolerated at the hospital, and that one reason for such tolerance is money. Since physicians are viewed as vital revenue generators, there is a strong incentive to ignore or excuse their misconduct. Of course, patients could not survive surgeries without nurses, and physician abuse of nurses is a major threat to that survival as well, since it is difficult for abused nurses to perform their work as effectively. In addition to economics, the historic power imbalance between the two professions, and between the two genders, would seem to play a role in the cycle of abuse and impunity as well. The Gazette might have provided more context and detail, but we thank the paper and the nurses who responded for drawing attention to these important issues. more...

 

Impunity

July 16, 2005 -- Today the Trinidad & Tobago Express ran a short piece by Louis B. Homer on evidence presented to a local Commission of Enquiry about verbal abuse by physicians and other problems nurses face at a local hospital. The article, "Nurses at Sando hospital cry abuse from doctors," underlines the threat such abuse poses to nurses and patients, as well as the lack of resources and opportunities that are driving nurses abroad and contributing to nursing shortages in the developing world. more...

 

Kids with guns

July 17, 2005 -- Today the Miami Herald published a fairly good piece by John Dorschner about recent efforts to deal with the continuing problem of abusive physicians. The article, "Nurses and staff stand up against uncivil doctors," suggests that social changes, liability concerns and the nursing shortage are helping nurses combat the problem. The piece probably understates the ongoing severity of the problem. It does not seem to get that such conduct is a factor in the nursing shortage (not simply something the shortage is forcing hospitals to address), and it could have made clearer the extent to which disruptive conduct has a negative impact on patient outcomes. But the piece still deserves credit for an in-depth look at the problem and a promising new counseling program that reportedly has had success in improving the conduct of physicians referred to it. more...

 


McPherson cartoonMy Life As a Dog

or

Bad Nurse, No Donut

November 4, 2004 -- Tonight's episode of NBC's "ER," physician Lisa Zwerling's "An Intern's Guide to the Galaxy," was in most respects a standard one. It focused on the training of new physicians, showing physicians doing tasks that nurses do in real life, and suggesting that nurses are peripheral to important ED care. But one thing really caught our attention: the episode's lighthearted but repeated suggestion that an intern might purchase more responsive work from nurses by periodically feeding them sweets, as if nurses worked for physicians and their patient care was akin to the tricks a dog might perform for treats. The silliness of this plotline is matched only by its contempt for nursing. Woof! Woof! more...

 

The State of the Profession: "Code White: Nurse Needed"

March 1, 2005 -- Today The State newspaper, of Columbia, South Carolina, ran the final installment of a massive, three-part special report by Linda H. Lamb about the nursing shortage, "Code White: Nurse Needed." The report addresses the causes of and potential solutions to the shortage, and it has many excellent elements, notably extensive examinations of the problems with nursing's public image, issues related to men in nursing, and aspects of the training of new nurses. Perhaps the most glaring problem is the report's failure to mention what many believe is the primary immediate cause of the current shortage, namely the managed care-driven hospital budget cuts of the 1990's which led to the dangerous nurse short-staffing that has driven many nurses from the bedside. The piece gives the impression that any short-staffing is merely an effect of the shortage, rather than a leading cause of it. In addition, a short sidebar on the growing use of foreign nurses in the U.S. fails to mention the devastating effect such migration is having on the health systems of many developing nations. more...

 

Minneapolis Star Tribune: "Nurses brainstorm cures for job issues"

February 20, 2004 -- Today, the Minneapolis Star Tribune reported on a promising campaign by the Minnesota Hospital Association and the Minnesota Organization of Leaders in Nursing to encourage nurses to take the lead in improving their working conditions. The article, written by H.J. Cummins, explained how teams of nurses from three of the seven Minnesota participating hospitals created and implemented solutions to key problems. Ideas included improving career ladders and nurses' involvement in discharge planning, and making good interpersonal skills "a part of every job description." more...

 

National Post's Blatchford: Bring back the handmaidens

June 26, 2003 -- Christie Blatchford's column "Militant angels of mercy" in the June 7 issue of Canada's National Post, mounts a bizarre attack on the modern nursing profession, as she yearns for the good old days when nurses were "kind" and "loved, if not always respected." more...

 

Research on increasing communication leading to decreased morbidity and mortality

Forte PS. (1997). The high cost of conflict. Nurs Econ. 1997 May-Jun;15(3):119-23. From the abstract:

Clinical environments marked by nurse-physician conflict (and nurse withdrawal related to conflict avoidance) have been proven to be counterproductive to patients. Clinical environments with nurse-physician professional collegiality and respectful communication show decreased patient morbidity and mortality, thus enhancing outcomes.


Arford PH. (2005). Nurse-physician communication: an organizational accountability. Nurs Econ. 2005 Mar-Apr;23(2):72-7, 55. From the abstract:

Dysfunctional nurse-physician communication has been linked to medication errors, patient injuries, and patient deaths. The organization is accountable for providing a context that supports effective nurse-physician communication.

 

More on disruptive workplace behavior and managing conflict between the professions.

 

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