Nurse Physician Disruptive Behavior: Building a culture of safety and quality

Purpose: The purpose of the study was to raise the awareness of disruptive behavior in healthcare using the American College of Physician Executives survey tool to measure the recognition of disruptive behavior by physicians and nurses within a five hospital healthcare system and whether it had changed over a two year period. Because disruptive behavior has serious effects on patient safety and the work environment, it is important that nurses and physicians address this issue in a timely, effective and efficient manner and this study was aimed at providing data to initiate and sustain ongoing discussions about the occurrence in one system.

Methods: This study was first approved by the healthsystem Institutional Review Board in 2013 and re-approved in 2014.  The tool developed and used by the American College of Physician Executives and administered by them in 2004 and repeated in collaboration with the American Organization of Nurse Executives was used.   Additional questions were approved and added to the original tool during the second survey.  A mailed survey method was used and an announcement was sent to all physicians and nurses who practiced in the five hospital system.   Two reminders were also mailed out during the three week data gathering process.  Confidentiality was maintained throughout the process with demographic information limited to roles and place of practice.

Results: Results from both the 2013 and 2014 survey indicated that the occurrence of disruptive behavior across the five hospitals remained high with an improvement in the frequency.   The major source of disruptive behavior remained about the same with both nurses and physicians identified as a major source.  Feedback from the additional questions provided specific areas of conflict regarding the specific reasons for disruptive behavior by both physicians and nurses.

Conclusion: Disruptive behavior in healthcare remains an important issues and requires attention by leaders and other key stakeholders.  When the findings were shared across the healthsystem with physician and nurse leaders, they were not surprised by the results and were disappointed that despite ongoing education and coaching about patient safety and "having each other's back" that there situations that were disruptive and had a negative effect on the individual and the work environment.  Additional education was recommended with specific emphasis on interprofessional collaboration and partnership conducted as part of the ongoing culture of safety educational process.