Nurse Bullying and Patient Safety: Understanding the 3 P’s of Safe Patient Care

Disruptive behaviors in healthcare capture the attention of patients, providers, and even the community. You might think I’m talking about workplace violence, which is a concern in healthcare settings. However, I’m referring to bullying and other disruptive behaviors between professionals. 

While most of the information shared about nurse bullying and incivility is linked back to the effects on the workforce, it’s critical we understand the impact of disruptive behaviors on patient outcomes. According to an article published in FierceHealthcare, a 2013 study in the UK reported that one in four doctors and surgeons and one in three nurses said bullying has caused them to behave in ways that are bad for patient care.

A national survey conducted by the Institute of Safe Medication Practices (ISMP) revealed that disruptive behaviors in the healthcare setting might happen more often than you think. In fact, when asked about these behaviors, practitioners reported that they are met with a reluctance to work collaboratively or follow safety practices 66% of the time and a reluctance or refusal to answer questions or return calls 77% of the time. In an industry where communication is one of the most essential tasks required, this can be disheartening.

Nurse Bullying

Make no mistake about it – bullying and incivility are threats to patients. The impact of these disruptive behaviors in healthcare falls squarely on the most important person in the care equation – the patient. As a healthcare leader, you need to understand the impact that nurse bullying can have on the three P’s – patient safety, patient quality, and patient satisfaction.

Here’s what you need to know and a few strategies to eliminate disruptive behaviors in your organization.

Patient Safety

Meet Jessica, a new nurse in the ICU. She’s been having difficulty with Holly, the charge nurse on her shift, who is abrasive, intimidating, and always finds fault with her.

After performing safety rounds one afternoon, Holly approached Jessica to inform her that she’s writing her up for not placing the call light within Mr. Rossi’s reach. Holly confronted Jessica about this in the nurses’ station and described Jessica’s actions as “compromising patient safety,” because Mr. Rossi has a tracheostomy and could have suffered negative consequences if he couldn’t reach someone for help.  Jessica was mortified and went home in tears. As she was driving home, she couldn’t help but think that she had placed Mr. Rossi’s call bell right next to him.

When Jessica went to work the next day, she’s asked to meet with her boss. The unit manager explained that Jessica had indeed placed the call bell within Mr. Rossi’s reach. She then told Jessica that Mr. Rossi reported that Holly came into his room while he was lying in bed with his eyes closed and moved his call light away from him. When the manager confronted Holly about this accusation, she admitted to moving the call bell deliberately so that she could get Jessica in trouble.

In this scenario, Mr. Rossi’s safety was in jeopardy because one nurse felt the need to bully another. Luckily, Mr. Rossi wasn’t harmed. However, this illustrates the impact of nurse bullying on patient safety.

Patient Quality

Multiple studies report that acts such as yelling and open criticism between colleagues affects the performance of witnesses for the next four hours. The healthcare environment is more complex today than ever before, leaving no wiggle room for distractions or poor performance that can impact patient quality. 

In a study conducted with physicians and nurses, 71% of doctors and nurses linked incivility to medical error, and 27% tied it to a patient’s death.  And, 99% of 800 physicians polled reported that bad behavior negatively impacted patient care.

Elements essential to patient quality include effective teamwork, communication, and collaboration. Disruptive behavior in healthcare influences the way you communicate and collaborate with other healthcare providers. A lack of these elements can lead to errors poor outcomes, and diminished patient quality.

Patient Satisfaction

Humans remember negative events over positive ones. Your hippocampus, or memory center in your brain, is studded with cortisol receptors. Cortisol is released when you’re stressed because your body senses a threat. So, when you’re the witness to disruptive behaviors,you go into a sort of fight or flight reaction and your brain stores that memory away for safe keeping.

Now, imagine being ill, tired, and in pain…

You’re lying in a hospital room, alone at 1 am. Through the silence, you hear yelling coming from the nurse’s station. You overhear the nurses discussing patient information, criticizing a fellow nurse for giving the wrong medication, and then talking about an upcoming meeting with a supervisor that apparently none of the nurses like.

Two months later you’re at home and receive your patient satisfaction surveys. What do you think you will remember – the two nurses who cared for you like you were a family member or the event at the nurses’ station?

Science tells us that in this scenario your hippocampus will trigger your negative feelings over the positive ones and rate your experience in the hospital based on that 1 am encounter.

Action Steps

Healthcare leaders must empower employees to keep patients safe, provide high quality care, and deliver a positive patient experience. If nurse bullying or incivility is a common occurrence in your workplace, these outcomes will be compromised.

Here are a few ways you can take action to end disruptive behaviors in the healthcare setting:

Link Disruptive Behaviors to Outcomes

When you counsel employees about their behaviors, don’t just tell them that the disruptive behavior needs to stop. Instead, describe how the action directly or indirectly impacted patient outcomes.

Infuse Safety, Quality, and Satisfaction into Meetings

If you want to change the culture of your workplace, lead your activities with this one question – “What are we doing today to communicate in a way that improves patient safety?” Provide education during staff meetings on topics such as effective communication. If you have shared governance, be sure to address professional development needs in addition to clinical issues.

Hold Employees Accountable

As a leader, you must know when to address behaviors and when to give a little grace. If you observe disruptive behaviors in the healthcare setting, ask yourself if it had the potential to impact patient safety, quality, or satisfaction. If it does, address the behavior without berating the employee.Remember, it’s the behavior you don’t like – not the employee.

Nurse leaders have an obligation and an ethical responsibility to address any behaviors that directly or indirectly impact patient safety, quality, or satisfaction.

Isn’t it time to step up and speak up when you see these behaviors on your unit?

For more information on equipping your leaders with the skills to cultivate a healthy workforce, contact us at wecare@rtconnections.com.

Be kind. Take care. Stay connected.

Renee Thompson
About Renee Thompson

Dr. Renee Thompson is a keynote speaker, author and professional development/anti-bullying thought leader. Renee spends the majority of her time helping healthcare and academic organizations address and eliminate bullying behavior. To find out how you can bring Renee to YOUR organization or nursing event, visit www.healthyworkforceinstitute.com

There are 2 comments on this post
  • Renee Thompson
    Jan Lee
    Dec 11, 2018 Reply

    I witnessed an RN supervisor at the Pa Dept of Health verbally abuse and bully our older male secretary. I was appalled and offered to help him fight back. He refused out of fear. He was retiring soon and didn't want "problems." Until the top leadership takes responsibility in reprimanding, disciplining and possibly terminating those in positions of power....most victims of bullying will be silent and will suffer. Administrators have the power to make anti- bullying a priority. I was bullied and had no recourse at the Health Dept. The "top dogs" were the bullies. Again, I will also suggest that what we do in our minds when bulied is very important and we can reprogram what we do ( hypnosis) for bullying to stop.

    • Renee Thompson
      Renee Thompson
      Dec 11, 2018 Reply

      Yes Jan! Addressing disruptive behaviors starts at the top! We need authentic leaders to stop using silence as a strategy and take action to stop bad behavior. They also need to be the role models for professionalism!!!

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