New VHA Research Finds Disruptive Behavior Frequently Occurs in Hospitals and Directly Affects Patient Outcomes

IRVING, Texas -- New research conducted by VHA Inc. has found that disruptive behavior between physicians and nurses occurs frequently and affects patient outcomes.  As a result of this behavior, these providers report that patients are experiencing pain or prolonged pain, receiving medications or antibiotics late, being mistreated or misdiagnosed, or dying.


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

were evaluated.


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

been prevented.


 "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.


Comments included:

     *  "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.