Disruptive Behavior and its Effects on Workplace Safety: What Can Nurse Leaders Do?

Purpose: Disruptive behavior between nurses and physicians in healthcare interferes with care delivery and negatively affects patient safety and outcomes.  Throughout the three year process of building a culture of safety at a five hospital system, considerable attention and focus was devoted to educating staff and physicians on error prevention tools and minimizing the power gradient that has been recognized as a major obstacle in speaking up for safety by nurses with physicians.  Following the completion of error prevention training of over 10,000 employees and physicians, staff across the system continued to express reluctance in speaking up for safety when it involved a physician and a perceived power gradient issue.  Based on this feedback, one system nurse executive and one vice president for medical affairs from the same hospital developed and submitted a proposal to the system IRB for approval to replicate a survey on disruptive behavior between nurses and physicians previously conducted by the American College of Physician Executives in partnership with the American Organization of Nurse Executives.

Methods: Following approval from the system IRB, an announcement of the survey was sent to all nurses and physicians in the system.  An e-mail blast followed the next week including a consent form and a link to the survey. Protection of subject confidentiality was maintained throughout the online survey process with limited access to data.  A reminder was sent to all nurses and physicians across the system during the data collection phase.

Results: Seven hundred and eighty six nurses and physicians from across the system participated in the online survey and verified that disruptive behavior occurs on a regular basis with physicians identified as the most frequent cause of the disruption. Yelling was identified as the most frequently occurring disruptive behavior.

Conclusion: Disruptive behavior continues to occur in the system with a lack of significant change despite the education and focus on use of error prevention tools in daily practice.  The 'power gradient' between nurses and physician remains an issue and contributes to the reluctance to speak up for safety.