More than three quarters (86 percent) of nurses who participated in the
survey and almost half (49 percent) of physicians said they have witnessed
disruptive behavior. Research also revealed that disruptive behavior between
nurses is prevalent. Sixty-eight percent of nurses and 47 percent of
physicians who responded said they have witnessed disruptive behavior between
nurses and from nurses aimed at other hospital staff.
"The findings of this new research are alarming and yet not new," said
Diana Mason, RN, PhD, FAAN, of the American Journal of Nursing. "A VHA study
conducted in 2002 uncovered disturbing physician behavior towards nurses;
however, this new study intensifies the urgency of this issue by revealing
what happens to patients, which is sobering and distressing."
The study, titled Disruptive Behavior & Clinical Outcomes: Perceptions of
Nurses & Physicians, was conducted by Alan H. Rosenstein, MD, vice president
and medical director at VHA, and Michelle O'Daniel, director of member
relations for VHA. The study was initiated to assess perceptions of the
impact of disruptive behavior on nurse-physician relationships and to
determine what physicians, nurses and hospital administrators believe to be
its effects on patient care. Surveys were distributed to 50 VHA member
hospitals in more than 12 states and results from more than 1,500 participants
The survey found that most respondents (94 percent) believe disruptive
behavior impacts adverse events, medical errors, patient safety, patient
mortality, quality of care and patient satisfaction. Sixty percent of the
respondents were aware of potential adverse events that may have occurred from
disruptive behavior. Seventeen percent of the respondents reported that they
knew of a specific adverse event that occurred as a result of disruptive
behavior and 78 percent of the respondents felt the adverse event could have
"The survey suggests a serious problem within and across disciplines,"
said Rosenstein. "Disruptive behavior needs to be addressed at the organizational level. Hospitals need to invest time and resources into performing self-assessments, increasing staff awareness of the issue, opening lines of communication and creating greater
collaboration between peers. If hospitals don't do this, the problem will
continue to grow and patients will continue to needlessly suffer. Disruptive
behavior also establishes an environment for ineffective and inefficient
The survey also found that disruptive behavior affects nurses' and
physicians' stress levels (94 percent), frustration levels (94 percent),
concentration (83 percent), communication (92 percent), collaboration (90
percent), information transfer (87 percent) and workplace relationships (91
percent). Each of these psychological and behavioral variables can directly
impact a patient's outcome.
For the purposes of the study, disruptive behavior refers to any
inappropriate behavior, confrontation or conflict, ranging from verbal abuse
to physical and sexual harassment.
"The comments we captured from respondents were incredible and they define
the issue. Disruptive behavior impacts all levels, including hospital
operations and clinical practice," said O'Daniel, co-author of the study.
* "I have caught myself in the middle of mislabeling specimens after
confrontations that have been upsetting."
* "Delay in patients receiving medications because RN was afraid to call
* "Communication between obstetrician and delivery nurse was hampered
because of physician behavior. Resulted in poor outcome in newborn."
* "RNs did not want to call MD after the IV ran out. No antibiotic
therapy for four days. RN afraid to call MD. Patient expired."
Because of the importance of this study to nurse managers, it is being
published simultaneously in Nursing Management, another LWW journal.
VHA Inc. is a national cooperative of leading not-for-profit
healthcare organizations that work together to improve the health of the
communities they serve.
Founded in 1900, The American Journal of Nursing is the
official publication of the American Nurses Association and the largest and
oldest circulating nursing journal in the world. It is published by
Lippincott Williams & Wilkins, a unit of Wolters Kluwer Health, a leading
provider of information for professionals and students in medicine, nursing,
allied health, pharmacy and the pharmaceutical industry.
Source: VHA Inc.