Physician Nurse Disruptive Behavior: How a Physician Champion Changes Outcomes

Purpose: The purpose of the study was to improve patient safety and promote a postive work environment through addressing issues caused by disruptive behavior between physicians and nurses.  A partnership between a physician and nurse leader was the framework for development of this study with the goal of using the data to initiate discussion with physician and nurse leaders across a health system and integrate the findings with building a culture of safety education and strategies.

Methods: A replication of a study using the tool "Disruptive Behavior between Physicians and Nurses" developed by the American College of Physician Executives (ACPE) in 2004 was the method.   This tool was first administered by ACPE to its members in 2004 and then repeated with their members and with the members of the American Organization of Nurse Executives in 2008.   After securing approval from ACPE in 2013 and from the heath system Institutional Review Board, an announcement of the study, its purpose and process was e-mailed to all physicians and nurses across the health system.   One week later another announcement and the link to the study was sent to all physicians and nurses.    A reminder was mailed to all possible participants was mailed during the three week open period as well as announcements at staff meetings and other forums.  The study was replicated in 2014 with Institutional Board approval again secured with their endorsement of adding a set of customized questions based on open ended comments from the first study in 2013.

Results: The results from the study from both 2013 and 2014 indicated a significant level of incidence of disruptive behavior reported by both physicians and nurses.  While the frequency varied between the two professions the results reflected that strategies used in the past did not effectively address the issues nor were they confident that leaders and others would be able to be successful in problem solving in the future. 

Conclusion:    These findings have important implications for action by system and hospital physician and nurse leaders.  Using the data as part of the system's building a culture of safety initiative is the responsibility of physician and nurse leaders and will lead to improvement of physician nurse communication, shared accountability and partnership.   Sharing the open ended comments from more than half of the survey participants will begin discussion with nurses and physicians about ideas for improvement and effective problem solving.