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Free webcast about ending bullying and toxic behavior in nursing

A live, free, 60-minute webcast, A Conversation with Kathleen Bartholomew: End Bullying and Toxic Behavior Once and For All, is being offered by HCPro Tuesday, October 4, 2011, 1:00-2:00 p.m. (Eastern).

Bartholomew is a visionary nurse leader who dared to ask the question: How can a profession that is based on caring include such uncaring behaviors? Her research exposes the toxic relationships and bullying behavior that cause nurse burnout and threaten patient safety.

During the presentation Bartholomew will share her experiences through true stories about the struggles she has faced and overcome and give listeners the tools and strategies to end disruptive behavior once and for all.

Click here to learn more about this program.

Due to the inspirational nature of this program, HCPro is placing no limits on who can attend. Invite your staff, friends, or colleagues. Forward information to a friend now.

Commanding respect from disrespectful physicians

by Wendy Leebov, Ed.D.

“I work days and try to have everything ready when the doctors come in (labs in charts, vitals done, etc.). But they are immediately demanding everything at once, not giving me a minute to collect my thoughts and focus on the patient in question. Then, they treat me like I’m stupid when I don’t give the answers almost before they ask the question!”

Alan Rosenstein did a revealing study about nurse-physician relationships.

A few findings that struck me:

  • More than 92% of nurses had witnessed disrespectful and/or disruptive behavior by physicians.  The most common behaviors cited include yelling, raising the voice, condescension, berating colleagues, berating patients, and use of abusive language.
  • Common generalizations about abusive behavior on the part of physicians make it seem as if most physicians are “abusive.”   However, in Rosenstein’s study, nurses clarify that very few physicians are abusive. The vast majority are not. I think that’s VERY important to remember.

Still, the instances of abuse stick in the craw of not only the people on the receiving end, but also on people who witness it.  So, it’s important to address this behavior, so that it doesn’t erode morale, teamwork and patient outcomes. Of course, that’s not so easy, because many caregivers feel intimidated about speaking up to stop respectful or abusive behavior because of fear of retaliation, lack of assertiveness, and/or a sense of hopelessness that the person’s behavior will ever change.

What to Do?

There’s a lot an organization can do, and should do, such as:

  • Commit to and make explicit a code of conduct and link it to your vision, values and standards. Highlight the impact of teamwork, collaboration and communication on quality, patient satisfaction, risk reduction, safety, and outcomes.
  • Zero tolerance. Institute and enforce a zero tolerance policy about coworker disrespect.
  • Adopt a “respect” signal. Decide on something anyone can say when they witness inappropriate behavior—a signal that means “You have crossed the line.”  Stopped in their tracks, many people become more aware of their behavior and more accountable for it.  My favorite signals:

o     “Time out.”

o     “How about a cup of coffee?”

  • Physician-nurse rounding.  Have physicians and nurses round on patients together and provide training to support effective communication during these rounds.
  • Provide personal coaches for individuals who behave in an outrageous way.
  • Adopt-a-Doc: Have nurses each adopt a physician with whom they will deliberately build a positive relationship and for whom they will act as an advocate.
  • Provide assertiveness training for nurses! This is critical!
  • Discussion forums: Provide forums in which physicians and nurses talk to each other!

BUT, while the organization can work to reduce abusive or disrespectful behavior between nurses and physicians and among colleagues in general, in my view it is essential that the individual who perceives the behavior takes responsibility to address and handle it effectively, one situation and one person at a time.

What can the individual do?

In one of my roles years ago, I was in a position to field physician frustrations every day.  My friends called me the LIVER of the organization, because so many toxins flowed through me.  In my early years, in the face of a hostile physician, I would get defensive or cower.  Both approaches seemed to increase the behavior I was hoping to eliminate.  Then, after spending about $5 million on therapy, I learned other MUCH more effective techniques, and I have had a less stressful life ever since, because these techniques WORK.

Tips from my experience:

  • Alter your own inner monologue. These are the statements you say to yourself.  Look within:  What do you say to yourself when someone is abusive to you?  “This jerk!  How awful!  Poor me!  I hate this!  I don’t deserve this!”  If your inner talk makes you angrier or more defensive, change it.  You CAN decide to think something different, such as, “This is not about me,”  “I deserve respect,” “I don’t have to react,”  “I can stay calm and help this person,”  “I can take the high road here.”
  • Don’t respond in kind. It’s human nature to want to strike back when attacked.  Resist.  Handle the inappropriate behavior respectfully.  Stay on the high road, since this will make you most effective and also enable you to feel good about yourself at the end of the day.  CALMLY SAY, “What is happening is not okay.”
  • Give direct feedback without anger.  “I saw you do this….” or, “I don’t appreciate your tone,”  “I would appreciate your keeping your voice down,”  “When you belittle me in front of our patients, I resent it and it makes it hard for me to support you.”
  • When someone is verbally attacking, instead of getting defensive, make explicit your positive intent. Instead of saying, “WHOA!  Hold it a minute” say, “You know, I really want to help you.”  Then if they persist, say that over and over in a sincere tone, “As I said, I really DO want to help you.” And then wait until they have vented enough to allow them to calm down and address the facts of the situation with you.
  • Use the caring broken record.  In the face of persistent disrespect, repeat your bottom line message each time with caring.  “I hear how frustrated you are, and I really want to support you,”  “I realize you’re under extreme pressure, and I really do want to provide the support you need,”  “I’m sorry this isn’t what you wanted.  I really do want to help.”
  • If the abuse continues, remove yourself from the situation. “I’m hanging up now.  Please call me back when you’re ready to talk with me in a respectful way about this.  I really do want to help you.”
  • “There you go again.” If you’ve addressed the behavior over and over and it still hasn’t changed, when it happens next, say very calmly, “There you go again.  I want to discuss this with you when we can both be respectful.”  And do that EVERY time it happens again.

And with your TEAM:

Talk about the elephant in the room. Work together with your team to identify great ways to respond to the disrespectful or inappropriate behavior you handle most often.  I’ve provided a worksheet to guide your discussions.  You can be sure you’re not alone.  So, the activity will help everybody.

Healthcare environments are inherently stressful and it’s upsetting to think about the times when colleagues add to this stress instead of relieving it.  To be effective and to do your part in altering an atmosphere of disrespect, it takes courage and caring — backbone and heart.

For helpful resources about handling disrespectful behavior, click here.

Who is running the care of the patient?

A friend of mine went into labor with her first child a few months ago and accounted that while she was receiving her epidural, the administering doctor and nurse were arguing over the proper way to insert it, and who was most fit for the job.  She described it as an “ego battle,” full of frustrated sighs, snide remarks, a few eye rolls, and what appeared to be a complete lack of attention to the fact that the patient was in the room, let alone on the receiving end of their needle.

Like any relationship, the one between physicians and nurses isn’t always smooth, but it’s definitely one that shapes many aspects of the healthcare environment.  Perhaps the most important one in this scenario: patient care.


Taking the pulse of nurse-physician relationships

Taking the pulse of physician relationships is a good starting point for change. Doing so allows you to dissect the current relationships in your facility and make sense of the problems you face. Five categories can be broken down to define the types of relationships:

  1. Collegial: Relationships between the nurses and physicians have mutual respect and power. Because of this, both parties feel empowered. When both nurses and physicians have power, they are better able to recognize the value in each other’s education and experience. With this environment, physicians and nurses consult each other frequently and seek each other’s advice, to the full benefit of patients.
  2. Collaborative: Physicians and nurses participate together in the plan of care to produce positive outcomes for patients. The nurses and physicians have a mutual respect for each other. The key difference is that the power is not equal between nurses and physicians. The power difference does not interfere with the working relationship, and both parties are able to work together for the benefit of the patient.
  3. Teacher-student: The physician or the nurse takes on the role of mentor. Typically, the physician educates the nurse. Often, however, nurses are in a position to teach physicians what they have learned from their experiences.
  4. Neutral: These kinds of relationships evoke only indifference. Such relationships originally cropped up in healthcare when, in an effort to increase productivity, hospitals decided to move patient charts from the main nursing station to outside patients’ rooms. Now, physicians can come to the floor, write orders, put up the yellow flag on the chart rack, and never speak to anyone.
  5. Negative: Nurses report that negative patient outcomes occur more frequently when nurses interact with difficult physicians. After physicians establish a negative reputation for themselves, nurses will go out of their way to avoid them. The critical common thread in every disturbing physician-nurse interaction is that the patient loses.

How does your facility deal with difficult relationships between nurses and physicians?

Source: Kathleen Bartholomew, RN, RC, MN. Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication

Nurses and their relationship with patients

As writers and editors for healthcare, there is a great deal of time spent writing about the realities of being a nurse today. But sometimes, our personal and professional lives cross paths and we get to experience the realities of nursing today from a firsthand perspective.

Recently, my personal and professional life intersected when I spent the day in and out of the hospital, interacting with nurses and physicians on different levels than I had expected.

Set the tone for nurse-physician collegiality

by Kathleen Bartholomew, RC, RN, MN

Imagine that a nurse has come to you complaining about a physician who talked to him or her rudely and arrogantly. The nurse feels humiliated. The very next day, you see this physician on the unit. What do you do?

It is vital that nurse managers role model zero tolerance for any kind of disruptive, intimidating, or verbally abusive behavior. Research shows that 1-3% of physicians are disruptive, yet this group causes exponentially devastating effects on morale, retention, and patient safety (Rosenstein & O’Daniel, 2005). Managers must take the necessary actions to demonstrate to nurses and physicians the standard of acceptable behavior and set the tone for collegiality on the unit. [more]

Benchmarking report explores state of nurse-physician collaboration

The nurse-physician dynamic has been found to shape various aspects of the healthcare environment. Research has uncovered that nurse-physician collaboration can affect patient care, patient satisfaction, hospital costs, and turnover. But as a nurse, how do you see it affecting your facility?

HCPro, Inc., recently surveyed 67 nursing professionals in the healthcare industry about the issue of nurse-physician collaboration within facilities of various sizes and settings nationwide. Participants responded to questions about nurse-physician collaboration barriers, strategies facilities are using to improve nurse-physician collaboration, and the influence poor nurse-physician collaboration has on stress. Take a look at some of the results:

  • 91% of nurses that rated their facility as having “excellent” nurse-physician communication came from organizations that employed fewer than 100 nurses
  • 82% of nurses surveyed said positive steps have been taken at their facilities to create work environments with better nurse-physician collaboration
  • 80% of nurses said poor nurse-physician collaboration brought stress to the workplace
  • 75% of nurses admitted to knowing other nurses who have vacated positions due to poor nurse-physician collaboration

What are your first impressions of these results?

View the rest of the results from this benchmarking report

Don’t let Dr. Jekyll turn into Mr. Hyde

Is there a physician, possibly your medical director, who has been non-supportive behind your back?

You know who these people are. At a meeting or in front of your boss, they are supportive and, at times, encouraging of your work and efforts. But once the meeting is over and everyone goes their own way, they are completely different. You would think it was a “Jekyll and Hyde” experience!

This is not to take away from all the providers we collaborate with who are ethically strong and committed to being part of a team. This hot topic is not about them; we are grateful for strong collaboratives with many providers we work with.

But believe it or not, some people are unhappy when they see your successes. Now that I spurted that out, think about it. You already knew that, but most people won’t say it. You are that multi-tasking, confident, caring, empowering nurse leader and some folks out there want to burst your bubble.

How do they burst your bubble?

  • Going behind your back and planting seeds among those who look up to you. What are they planting seeds for? They are hoping to grow their own cheerleaders and take your squad away from you.
  • Relaying misinformation about what you said or wrote
  • Discouraging staff from following policy or procedure
  • Verbally defaming your ability to perform your role
  • Identifying staff members vulnerable to getting on their bandwagon

How would you approach this professional? Or, if you have already faced a situation similar to this one, how did it go?