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Disruptive Behavior and Clinical Outcomes: Perceptions of Nurses and Physicians
PA PSRS Patient Saf Advis 2006 Sep;3(3):26. 
 

Editor’s Note: This article was abstracted from: Rosenstein A, O’Daniel, M. Disruptive Behavior and Clinical Outcomes: Perceptions of Nurses and Physicians. Nursing Management 2005; 18-29.

Disruptive behavior from nurses, physicians and hospital administrators in clinical settings can put patients at risk. In a recent survey conducted by Rosenstein and O’Daniel, 1,509 healthcare workers gave their perceptions of disruptive behavior in nurse-physician relationships and negative effects on patient care. Surveys were distributed to 50 Veterans Health Administration member hospitals across the country, ranging from large teaching hospitals to small community hospitals.

Seventeen percent (17%) of the survey respondents knew of an adverse event that occurred as a result of disruptive behavior, and most of them (78%) thought the event could have been prevented. The study defined disruptive behavior as any inappropriate behavior, confrontation, or conflict whether it is verbal, sexual or physical.

The survey found the following: 

  •  Several variables were measured such as: stress, frustration, loss of concentration, and reduced communication. Depending on which variable was measured, between 83% and 94% of healthcare workers indicated that disruptive behavior has an effect on these psychological and behavioral variables.
  • Between 53% and 75% of healthcare workers saw a strong link between disruptive behavioral variables and negative effects on patient safety, the quality of  care, and patient satisfaction. One in four respondents saw a link between disruptive behavior and patient mortality.
  • On average, respondents said that nurse disruptive behavior occurs at their hospital 1 to 2 times per month, while disruptive behavior from physicians occurs between 1 and 5 times a year.
  • Most respondents reported that disruptive behavior had a significant negative impact on levels of stress, frustration and concentration, team collaboration, information transfer, communication and nurse-physician relationships.

Some strategies the authors suggested to help mitigate disruptive behavior included:

  • Conducting organizational self-assessments to determine the extent of the problem and identify areas where attention is needed.
  • Improving staff relations by creating a culture in which respect is valued and unacceptable behavior is not tolerated.
  • Increasing staff awareness by informing them of the severity of the issue.

Courses focusing on communication, team building, phone etiquette, and conflict management have also helped improve relationships among co-workers.

 
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THE PENNSYLVANIA PATIENT SAFETY AUTHORITY AND ITS CONTRACTORS  
PSA LOGO The Pennsylvania Patient Safety Authority is an independent state agency created by Act 13 of 2002, the Medical Care Availability and Reduction of Error (“Mcare”) Act. Consistent with Act 13, ECRI Institute, as contractor for the Authority, is issuing this publication to advise medical facilities of immediate changes that can be instituted to reduce Serious Events and Incidents. For more information about the Pennsylvania Patient Safety Authority, see the Authority’s Web site at www.patientsafetyauthority.org .      
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