Editor's Note
Zero
Tolerance
Nurses
should send a message that verbal abuse is unacceptable
Beth Ulrich, Ed.D.,
RN, South Central Editor
February
20, 2001
I doubt
if there’s a nurse among us who has not been verbally abused
or watched it happen to a colleague. I don’t mean the verbal
abuse we sometimes get from stressed, scared or out-of-control
patients and families. I mean the kind that comes from people
we work with.
For
many years, we have rationalized that verbal abuse comes
from older physicians who "really don’t mean it."
We have written it off to these doctors having been reared
in the "old school" when nurses stood up and gave
up their chairs when a doctor entered the room. We have
fantasized that as younger physicians graduated and more
women entered medicine, the abuse would significantly decline.
Nothing
could be further from the truth. Studies continue to document
the pervasiveness of verbal abuse and its negative contribution
to retention rates.
It’s
time for zero tolerance. Verbal abuse is about a lack of
respect, not just for nurses as nurses, but for nurses as
people. It is unacceptable under any circumstances.
Boards
of trustees/directors ultimately govern the policies of
the organization. CEOs carry out the policies of the board.
In policy and actions, they must be clear that respect for
each individual is an absolute requirement for anyone who
works in or admits patients to their organization.
Virtually
every board member and CEO will agree with this as a value
and concept. However, the time will come when the board’s
and CEO’s commitments are tested– when a physician
who brings a lot of money or fame to the organization verbally
abuses a nurse. This, as the saying goes, is where the rubber
meets the road.
Processes
established ahead of time to investigate the incident(s)
and act, if necessary, go a long way to reaching a mutual
win-win solution. Without such processes, the organization
will lose either the abuser or the abused.
To replace
the money or fame brought in by an abusive physician is
costly, but replacing an experienced nurse costs a minimum
of $50,000, if you can quickly hire an adequate replacement.
The cost is higher if you have to close beds because no
replacement can be found. One hospital in our cover story
lost five nurses because of the verbal abuse from one physician.
Total cost: at least $250,000.
Nurses
also have a responsibility to stop the abuse. Allowing it
to occur without responding to it or reporting it only enables
the abuser.
The
Irish Commission on Nursing uses the term "bullying"
when talking about abuse in the workplace. How appropriate!
How
do you treat a bully? You gang up on him or her. You never
let the bully corner you when you’re alone. Colleagues watch
each other’s backs. The response, of course, must be professional
and not interfere with patient care. It also must be consistent
for the message to get through. The abuser will look for
the weakest link. Every nurse must respond in the same way
every time verbal abuse occurs.
The
majority of physicians are not verbally abusive and we need
to reinforce the behavior of these physicians who do respect
us as their colleagues. They are our best allies in changing
the behavior of the bullies.
The
incentives are high. When nurses and physicians collaborate,
patients receive better care and have better outcomes. Organizations
run more efficiently and productivity increases. Morale
improves and nursing turnover rates decline. When nurses
are verbally abused, the downhill slide begins.
In the
final analysis, the organization with the fewest bullies
wins.
