NEW YORK NURSE: October/November 2008
by Mark Genovese and Thomas J. Lowe
It seems as though every healthcare facility has one: a physician, manager, or nurse who feels they can chastise colleagues at will, manipulate others, and defy orders.
A survey published this summer indicates that this kind of behavior creates more than just personality conflicts; it’s a danger to patients. The Joint Commission has taken the issue seriously. Starting next year, it will require participating healthcare facilities to establish processes for identifying and managing disruptive staff behavior.
Studies show that disruptive behavior such as verbal hostility, throwing objects, or slamming doors sharply increases employee stress – even if the outburst isn’t directed at them. Such stress can weaken the effectiveness of the patient care team by causing errors that lead to adverse outcomes.
Any behavior that disrupts the process of patient care creates a hostile work environment, which sharply reduces on-the-job satisfaction, increases turnover, and makes it difficult to retain good staff. It also harms the facility’s reputation and can lower patient satisfaction. It may even result in lawsuits.
In response to these facts, the Joint Commission has issued a sentinel event alert on “behaviors that undermine a culture of safety.”
Starting on Jan. 1, 2009, applicants for accreditation will be required to address “intimidating and disruptive behaviors” by healthcare workers and, to comply with this mandate, must have “zero tolerance” policies and procedures in place. Facilities must provide education for employees, takes steps to prevent physical and emotional abuse, and provide confidential diagnosis and treatment.
The commission will assess whether a healthcare facility has a code of conduct defining “acceptable and disruptive and inappropriate behaviors,” and whether it has a process for managing such events. The evaluation will include interpersonal skills and professionalism as two of six “core competencies” to be addressed in the medical staff credentialing process.
Facilities must ensure that codes of conduct, policies, and procedures will apply to all categories of staff. This means that implementing and enforcing a uniform policy on disruptive behavior may be different for staff that are employed at the facility, such as nurses, and those who are employed by outside practice groups, such as physicians. But the bottom line is: disruptive behavior is not acceptable from any staff!
According to the Joint Commission, policies must include a process for reporting, investigating, and correcting the causes of disruptive incidents. They should ensure that those who report incidents are protected from retaliation and also provide safeguards for staff who are falsely accused. The policy should clearly describe criteria for imposing progressive levels of disciplinary action and the parties responsible for implementing them.
Fixing disruptive behavior goes beyond setting policies, however. Hostile staff reactions may be a symptom of stress caused by the working culture at a facility. Organizational stressors may include poor staffing patterns, mandated expectations of service excellence without the resources to deliver on the expectations, and failure to involve staff in decision-making on issues that affect their work. When staff members are victimized by organizational stress, which is outside their control, some of them are more likely to display disruptive behavior.
There’s a difference between constructive criticism and verbal assault. But all too often, healthcare administrators (and fellow staff) look the other way. According to a survey by the Institute for Safe Medication Practices, 40% of clinicians surveyed “admitted to keeping quiet or remaining passive during a staff intimidation incident.” According to a statement by the Joint Commission, healthcare organizations have an obligation to protect patients from harm, adding, “Organizations that fail to address unprofessional behavior are indirectly promoting it.”
Thomas J. Lowe, RN, is NYSNA’s Occupational Safety and Health Representative.