No one wants to be berated and belittled at their place of work, especially those fresh out of school and still on their training wheels. It would seem to be common sense that verbal abuse of nurses fosters an unhealthy work environment and speeds their departure. Yet, mistreatment of nurses by physicians continues.
The Robert Wood Johnson Foundation recently released a study finding that newly licensed nurses who were verbally abused by doctors reported lower commitment to their organizations, lower intent to stay at their workplace, and an overall lower quality perception of the work environment. The conclusions echo numerous other reports and discussions on the topic, including a 2008 Joint Commission sentinel event alert warning that disruptive and intimidating behaviors can lead to medical errors, lower patient satisfaction and preventable adverse outcomes.
Carol Brewer, R.N., co-director of the foundation's ongoing RN Work Project and an author of the study, says it's long past the time for clinicians to abandon the idea that health care is a high-stress field and a certain bit of cruelty comes with the territory.
"Everybody reacts to stress differently, and if you know your co-workers, you'll know when somebody is having a bad day and you can relate to that person differently than being nasty back," says Brewer, who is also associate dean of academic affairs at the University of Buffalo School of Nursing. "But that's the culture you have to determine on your unit. You can't say that 'This is health care, so it's nasty.' That's not acceptable."
Foundation researchers surveyed about 1,300 newly licensed nurses and found that nurses were likelier to be verbally abused by doctors if they were young, working in a hospital, on the day shift, or in an understaffed unit. Meanwhile, nurses who worked at magnet hospitals — which routinely track nurse satisfaction and carry the expectation of a healthy work environment, says Brewer — reported lower levels of abuse. Other ill effects from verbal abuse included poor work group cohesion, more work-family conflict and poor relations between nurses and physicians, according to the study, which is scheduled to be published in the November/December issue of Nursing Outlook.
As the work environment becomes more unpleasant, the number of verbal-abuse incidents goes up. But it's unclear, Brewer says, which one creates the other.
"The chicken or egg question here is: Is it the environment, is it the difficulty of the working conditions that causes people to become stressed and unhappy and therefore lash out in what then is perceived as verbal abuse?" she says. "Or is it, in fact, a few people who are just congenitally unpleasant and take it out on their fellow employees of one stripe or another? That's a question we simply can't answer."
Theresa Brown, R.N., who practices nursing in Pennsylvania and writes a column for the New York Times, says hospitals must take a two-pronged approach to address nurse mistreatment. It starts with a policy with teeth that actually addresses abuse in the workplace. Plus, hospitals must strive for an empathetic understanding of why doctors are lashing out, rather than just saying, "You're a jerk, stop acting like a jerk." Changing your culture is key, say both Brown and Brewer.
Above all, clinicians need to remember that their work is about the patient, and not their egos, she says. Brown was disturbed by some of the comments from physicians on one of her recent columns on this topic, which scolded her for calling out a doctor in front of colleagues.
"We're there to give health care to a patient. Everyone taking care of that patient should know what's going on. It's not a competition. It's about communicating," she says. "It was really disturbing to me that people said, 'You humiliated the doctor by asking a question like that in public. This is a clash of egos.' No, this is about the patient."
How is the doctor-nurse dynamic at your hospital? Have you had issues with verbal abuse? And why do you think this problem persists, despite all the discussion about the topic? Share your thoughts in the comment section below.