Chain of Command: Teaching the Next Generation How to Deal With Disruptive Behavior

Saturday, 23 February 2019

Patricia K. Schrader, MSN, RN, CMSRN
College of Nursing, University of Houston, Sugar Land, TX, USA

Purpose: The purpose of this pilot project was to equip senior nursing students with strategies to address disruptive behavior, teach chain of command, and tackle negative emotions resulting from incivility.

Introduction: Incivility continues to plague healthcare and negatively influence interprofessional collaboration and patient outcomes globally (Trepanier, Fernet, Austin & Boudrias, 2016). The impact of incivility on patient outcomes is alarming and still undetermined (Spence Lashinger, 2014; Samson-Mojares, 2017). However, research supports the fact that incivility tends to escalate when dealing with patients with high acuity (Oja, 2017). Incivility in the workplace causes nurses to question their career choice (Brewer, Kovner, Obeidat, & Budin, 2013) and often damages self-confidence especially when dealing with disruptive behaviors.

Methodology/Implementation: Bandura’s self-efficacy model was used as the conceptual framework for this pilot project. A convenience sample of 70 nursing students were exposed to a simulation involving a disruptive provider refusing to acknowledge a nurse’s request to diagnose an advanced elderly patient experiencing crushing chest pain. Students received one hour of just in time training to deal with disruptive behaviors. Then students, playing the role of the primary nurse, were responsible for notifying this same provider for a patient with a deteriorating condition in high-fidelity simulation. Students completed a pretest and posttest quiz on chain of command, survey, and simulation evaluation.

Evaluation/Results: Study results include statistical analysis of survey and evaluation data as well as rich qualitative comments from students noting “I am terrified that this will be me someday soon” when exposed to the disruptive behavior simulation. Results also included rave reviews of the simulation and comments requesting more practice with “hostile providers.”

Conclusions: Senior nursing students are fearful of workplace incivility and are eager to learn and practice strategies to equip them to deal with vertical and horizontal incivility. The value of practicing strategies to deal with disruptive behavior among healthcare providers cannot be overstated. The students overwhelmingly expressed the benefits of practicing the chain of command protocol to advocate for the patient in this pilot project.

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