Disruptive Behavior Between Physicians and Nurses: The Role of the Physician Leader

Purpose: Disruptive behavior interferes with building a culture of safety and teamwork. Physicians and nurses play a major role in patient outcomes. Physicians often view their role as providing care solely for a patient, rather than as a collaborator, partner or member of the healthcare team. As part of a culture of safety program, physicians within a hospital system were educated about error prevention tools with specific emphasis on understanding the power gradient and how it negatively affects safety, teamwork and the work environment. The education included role play and group discussion of a clinical situation that involved disruptive behavior. Discussion focused on strategies needed to build collaborative relationships among the healthcare team in order to ensure quality outcomes and a safe environment for patients and staff. Measurement of changes in behavior related to the training was of interest.  The Vice President of Medical Affairs and Vice President of Patient Care Services who had been involved in physician nurse collaboration processes decided to use an established survey related to disruptive behavior as a method to collect baseline data from physicians and nurses across the system and assess the current environment. The results are being used to improve safety and communication.  

Methods: The 2009 American College of Physician Executives (ACPE) survey related to disruptive behavior was replicated following approval of the system IRB in March 2013. A blast e-mail announcing the survey was sent to all nurses and physicians across the system and then the online survey was launched the following week, including directions for informed consent.  

Results: Seven hundred and eighty six physicians and nurses participated in the survey with participants recorded from all five hospitals. Using the 2009 ACPE survey for comparison, survey findings were similar in type of disruptive behavior and frequency of occurrence, with yelling as the primary disruptive behavior followed by degrading comments and insults.  The respondents from both the 2009 ACPE study and the 2013 study indicate that the problem of disruptive behavior still overwhelmingly exists in their organizations. 

Conclusion: Disruptive behavior continues to affect patient safety and the work environment. Findings from this survey are being used to identify and address nurse-physician relationship issues that negatively influence patient care and the work environment.