 |
 |
      |
||||||||||||||||
 |
|||||||||||||||||
   |
|||||||||||||||||
|
Raging
bullies |
|||||||||||||||||
|
|||||||||||||||||
|
|||||||||||||||||
|
Mary, RN, began to feel uneasy the day she started her job at a hospital in California’s Central Valley. Seasoned nurses in the unit warned her to avoid a particular surgeon and to make sure she had a more senior nurse with her whenever she worked with him. Mary (not her real name) quickly discovered why. She was shocked to see the physician yell at nurses, often using profanity. At first, other RNs protected Mary, but that lasted only a couple of months. Sometimes, he’d point a finger 1 inch from her face as he shouted. She was constantly looking over her shoulder to see if he’d entered the unit. "During a code situation, he would become out of control," Mary said. "I was incapable of thinking. We’d freeze, and then he’d become more angry." She began to have nightmares and felt anxious even outside of work. Twice, he was so angry he threatened to kill someone. "It terrified me," Mary said. Research suggests that Mary’s experience is not uncommon for nurses throughout the country. Helen Cox, Ed.D., MSN, RN, and Laura Sofield, MSN, RN, each surveyed hundreds of nurses about their experiences with verbal abuse. Cox conducted her study in 1991, Sofield in 1999. Both researchers found that more than 90 percent of nurses experienced verbal abuse, and most encountered an average of five incidents per month. Cox and Sofield agreed that the most disturbing finding was that their results were remarkably similar, which led them to believe that verbal abuse is not on the decline. The majority of respondents named physicians as the most common perpetrators. The surveys also revealed that verbal abuse has consequences. The majority of nurses in both surveys said the abuse increased turnover rates and contributed to the nursing shortage. Most participants also reported that poor interactions with physicians caused an increase in the number of errors on the job. Although the statistics may be discouraging, some hospitals are pioneering strategies to improve physician-nurse relations. One facility encourages nurses to speak up by allowing anonymity for those who report incidents. El Camino Hospital in Mountain View, Calif., has physician-nurse counseling teams that act as liaisons between employees on each unit. Other nurses are battling the issue with a change of demeanor. Several RNs said verbal abuse incidents dropped when they learned to speak firmly to physicians who had a habit of yelling. Cox and Sofield would like to see their studies encourage more hospitals to acknowledge that verbal abuse is a problem. Cox, executive associate dean of nursing administration at Texas Tech University, surveyed 1,168 nurses nationwide in 1991, and 97 percent said they’d experienced verbal abuse in their careers an average of five times a month. Eight years later, Sofield, who worked on the study with Susan Araujo, MSN, RN, sent out a variation of Cox’s survey to nurses nationwide and received 461 responses. About 94 percent said they encountered verbal abuse with an average of five to six incidents per month. "The most shocking thing was that the data stayed the same," said Sofield, practice manager at the Meridian Institute for Aging in Lakehurst, N.J. "What it shows is that the problem hasn’t gone away, and it needs to be addressed more thoroughly." Cox said tense interactions are prevalent in nursing in part because medical work is stressful. She found that more than two-thirds of her respondents said the abuse followed a stressful situation. Another key ingredient in the recipe for verbal abuse is the hierarchy in hospitals. "Physicians realize they report to no one, and they can’t blame a patient when something goes wrong, so they sometimes blame it on a nurse," she said. But Sofield suggested in an Advance for Nurses article in July that nurses also may have a role in perpetuating the cycle of abuse. "Nurses continue to accept verbal abuse because they feel that they do not have the power to change it. They view physician power as higher than that of nursing … Nursing, a predominantly female profession, has been conditioned to accept behavior from those they view as powerful. Women have been socialized to be passive in communication and relinquish power." John Bondi, MD, a physician for more than 20 years at Valley Medical Center in Kent, Wash., said he’s not surprised that verbal abuse plagues hospitals. Physicians have become more frustrated in general as insurance companies increasingly limit what physicians can do to treat patients, Bondi said. Physicians commonly have to slog through an insurance company’s phone system only to talk to an agent who does not have the medical training needed to answer a question, he said. "I think physicians are disillusioned as insurance companies fail to treat us as professionals and with respect," he said. Although he believes there is no excuse for verbal abuse, Bondi said physicians’ frustration can leak out and be directed toward nurses. He suggested that the nursing shortage also contributes to the risk of negative interactions between physicians and nurses. Physicians more frequently are working with new nurses who are not RNs. "If you take charged communication and get rid of the personal aspect, it’s a setup for trouble," Bondi said. The causes of verbal abuse may be complex, but Sofield said hospitals lose out by ignoring the issue. It’s expensive for facilities to replace nurses and train new hires, but she found that 35 percent of the nurse respondents left their jobs because of verbal abuse. Poor physician-nurse interaction also compromises patient care, according to survey respondents in both studies. At least 70 percent said a blowup with a physician increases errors, and nearly as many said it decreases productivity on the job. Mary said she, too, struggled to make sound decisions when she worked with the abusive surgeon. "You couldn’t think the way you normally would because you were so worried about him blowing up," said Joyce (not her real name), another RN who worked in Mary’s unit. Mary reported incidents to the hospital several times, but the surgeon’s behavior didn’t change. She considered resigning, but she enjoyed everything about her job – except the interactions with the abusive physician. Then, one day, he threw something. Mary and the majority of the floor’s staff decided to report the incident to the hospital as a group. Mary, who had worked at the hospital for 12 years, said the administration seemed to do nothing to discipline the physician. The yelling continued. Finally, Mary and four other nurses quit. All five have stayed in nursing but transferred to other hospitals. Although Mary’s hospital had procedures to report workplace violence, she said this was not enough to change the surgeon’s behavior. She believes these systems are not effective unless administrators are willing to discipline physicians who are abusive and protect nurses who report the incidents. In Sofield’s study, only about half of the nurses who had experienced verbal abuse reported it. Debbie, an RN in Florida who did not want to give her last name, admits that she didn’t report incidents for fear that it would jeopardize her job. One of the most painful interactions happened when she asked the charge nurse for a change of schedule. The nurse responded with, "Most women can’t hack things anyway. Most of you are bi-polar." Debbie took the problem to her manager, who also was abusive and known for using profanity. He responded by telling Debbie that most people in the unit didn’t like her anyway. Rather than file a report, she simply left after six months. Cox said nurses such as Debbie are at risk of resigning because verbal abuse is particularly discouraging when it comes from a nursing supervisor. Staff nurses lose hope of promotions and raises when their managers yell and criticize employees, so they leave to cut their losses, Cox said. Linda, an RN at Twin Falls Clinic and Hospital in Idaho, quit when she worked for a volatile nursing manager. "I just didn’t like the way things were handled," she said. "There was a lot of favoritism." Yet now that she is a nurse manager, she finds herself yelling occasionally. "Sadly, I do [yell] sometimes, but I go back and apologize," she said. "I try hard not to." Even though many nurses may have horror stories to tell, hospitals are working to find new ways to tackle temper problems among physicians. USC University Hospital has discovered a method that encourages nurses to report physicians who exhibit destructive behavior. The facility has an ethics hotline where employees can anonymously call with concerns, and the issues are taken to hospital administrators. A spokeswoman for the hospital said the hotline has been successful. A Franciscan hospital in New York took a different approach. When a physician continued to be verbally abusive, nurses suggested installing a system in which an employee could page a certain code number over the intercom when the yelling began. Then other nearby staff members could fill the room to diffuse the situation. The physicians opposed this idea, according to a former employee who did not want to give her name or the name of the hospital. Then the physician went too far, she explained. He shook a nurse. The idea of a policy was revisited. The hospital decided that a nursing supervisor would follow the physician throughout his day until the problem subsided. His behavior improved, except for flare-ups in the operating room. At El Camino Hospital, physicians become directly involved when a fellow physician needs to be reprimanded. In the early 1990s, the facility started a program in which a physician and nurse work together as a counseling team for each unit. When nurses need to report verbal abuse, they can approach their unit’s nurse manager, who then discusses the incident with the unit’s physician counselor. Saul Eisenstat, MD, a general surgeon at El Camino Hospital, is the counselor for his unit. He has no qualms about talking to physicians who have been reported. "Usually it only takes a phone call from me to solve the problem," he said. Twin Falls Clinic and Hospital has dealt with the issue by imposing fines against physicians who continue their outbursts even after warnings. Last year, one physician was fined $10,000 and was required to attend anger management classes for one week, said Wendy Somerset, human resources manager for the hospital. Physicians own the facility, and they subtracted the fine from the physician’s salary and redirected the money back to the hospital. "But $10,000 is hardly a punishment for a physician who makes $400,000," Somerset admitted. Yet the physician has changed his ways and no longer is abusive, she said. Linda, an RN at the same hospital who did not want to give her last name, said the best antidote she’s found for verbal abuse is learning to defend her actions with confidence. "Earlier in my career, it was more common for me to get yelled at because I was timid and didn’t stand up to physicians," she said. Linda said she reached a turning point one day when a physician criticized her. "I was fed up," she said. Instead of cowering, though, she firmly explained why she had made the decision and the result of her action. She was surprised when the physician was satisfied with her explanation and never again spoke condescendingly to her. Now that Linda is a nurse manager, she encourages her nurses to stand up to physicians when they believe they are right. Jimmie Harris, MS, FNP, RN, an associate chief nurse at the Dallas Veterans Administration Medical Center, has experienced a similar transformation. When she was a budding nurse manager, a physician told her in front of her staff that she wasn’t doing her job. "I was crushed," Harris said. "It made me question if I wanted to be a nurse manager. The problem was that I was new and lacked confidence." To convey self-assurance, she now introduces herself to new physicians as soon as she begins working with them. She explains that they can come to her whenever they have problems. Joyce and Mary chose another route to take a stand against verbal abuse. They and three other nurses filed a lawsuit against the abusive surgeon. They also filed a grievance with the hospital. Both cases still are unresolved, but Mary is confident that it has been well worth the effort. "I can look at myself in the mirror and know I did the right thing," Mary said. "Nurses have to stand up for each other, and I want to make a difference in nursing culture." |
|||||||||||||||||
 |
|
NEWS
AND TRENDS | CAREER
CENTER | EDUCATION
|
|
||||||||||||||
