Physician Hostility - page 10
by blake 19,987 Views | 94 Comments
Why are so many physicians threatened and hostile toward NPs? What are the strategies in dealing with these types of professionals,and in what ways can we make it easier to practice together?... Read More
- 0Mar 5, '04 by NP'sspouseQuote from Hellllllo Nursevery interesting and rather disturbing....i think i would be looking for a job somewhere else if i was in an environemnt like that....http://www.nursingworld.org/AJN/2003/march/health.htm
Health & Safety
American Journal of Nursing - March, 2003 - Volume 103, Issue 3
Verbal Abuse in the Workplace
How to protect yourself and help solve the problem.
By Vicki Carroll, MSN, RN
A few doctors at my facility verbally abuse the nurses. As a result, some nurses suffer from stress-related illnesses and find it difficult to come to work. How can we address this problem and protect ourselves from more abuse?
Verbal abuse in the workplace must not be tolerated. Violence often begins with verbal abuse and escalates to physical abuse. In surveys over the past several years, nurses have said that patients, physicians, and other health care workers yell, swear, intimidate, demean, publicly scold, and sexually harass them. In addition, 82% to 90% of 1,000 nurses surveyed in at least seven states included verbal abuse in their definition of workplace violence.
Alan Rosenstein’s report on the nurse–physician relationship (AJN, June 2002) indicated that daily interactions with physicians strongly influenced nurses’ morale. Carol Farina, a Denver psychiatric clinical specialist who has facilitated communication for health care teams, states, “When nurses experience abusive treatment by physicians and feel unsupported by administration . . . they are left feeling powerless to respond appropriately. Staff members may harbor resentments for being treated disrespectfully, which can manifest as any one of a number of psychological symptoms, including anxiety and depression, as well as somatic complaints such as GI symptoms and headaches.”
Verbal abuse can lead to staff turnover. An analysis of the first 1,200 responses from nurses, physicians, and hospital administrators in the Rosenstein study indicated that all respondents directly linked disruptive physician behavior and nurse satisfaction and retention. Verbal abuse can also affect the quality of patient care. Research since the 1980s has indicated that when collaboration between nurses and physicians is promoted, patient care improves, often with fewer costs.
What can you do? Try not to react emotionally to arrogant, hostile, or condescending behavior. Remain courteous and professional, and concentrate on the issue. One helpful question to ask is: “If we were looking for a solution to this issue, what would we be doing?”
Report the incident in writing as soon as possible to your immediate supervisor. If the incident is not addressed satisfactorily, consider filing a formal complaint with the peer review committee. In 2001 the ANA released its Bill of Rights for Registered Nurses, which states: “Nurses have the right to a work environment that is safe for themselves and their patients.” Cite these rights when asking your administrators to address the issue of verbal abuse. Ask them to offer training in the management of aggressive be*havior; institute a conflict resolution program; and develop a disruptive conduct policy, which should have a formalized peer review system and outline clear consequences for unacceptable behavior. Consider eliminating “zero tolerance,” which translates as arbitrary, unfair, and without the opportunity for reasonable and careful decisions. Instead, consider posting policies or “no violence” signs.
Nurses and physicians must be able to relate to each other with respect and professionalism. To be part of the solution, nurses must not excuse or tolerate abuse. Use these and other strategies to make your workplace safer and healthier and to enhance patient outcomes and professional satisfaction.
See Issues Update on page 65 to learn how the ANA’s Commission on Workplace Advocacy and nurses are addressing verbal abuse. To order the ANA Bill of Rights for Registered Nurses poster and user guide, go to www.nursesbooks.org or call (800) 637-0323.
Vicki Carroll is a clinical instructor at the University of Northern Colorado School of Nursing, a consultant in the area of health care workplace violence, and a member of the Colorado Nurses Association and the ANA Commission on Workplace Advocacy.
our best friends are both physicians and they would never do anything like that.....and my spouse has never been in a situation like that and she has been practicing awhile...
- 0Mar 11, '04 by zenman GuidePosted by tjjs: In our nursing class, not NP but RN, we had a man who was a DR, who taught A&P, Patho, etc at the university who wanted to be an RN.
- 0Mar 11, '04 by PA-C in TexasQuote from zenmanReminds me of Wilfried Rappenecker, a German M.D. who now primarily practices Zen Shiatsu which we all know is preferred over allopathic medicine and nursing!
Hi all. I came over here to this board because I wanted to try and foster a better image of PA's and medicine in general with some of the nurses. I honestly never knew that there was this much hostility between nursing and medicine before I attended a state NP meeting and heard all of the vitriolic garbage about the conflict between the two groups. It seems that this also goes on in medical circles judging from some of the posts in this forum from other boards. Honestly, it had never occurred to me that there was so much conflict because I have NEVER experienced it in my years of school or practice.
I never denigrate the education of NP's because I believe they have an important role in health care. However, I often hear PA education referred to in a way that conjures up images of driving up to DeVry Institute and having them throw a diploma in the back end of your pick-up truck. That is neither fair nor accurate. In Texas, the length of PA curriculum exceeds that of NP students by an average of three months. In addition, the average amount of clinical time exceeds that of Texas NP programs sometimes as much as four-fold. This is not to say that NP's have lesser education. They are almost all RN's before they attend a master's degree program, and so the longer PA program is used to compensate for that even though almost all persons accepted into PA programs are either paramedics, respiratory therapists, nurses, or something related.
I do not have the knowledge base of a physician and neither do any NP's that I have ever known. Does that make our skills less valuable? No, but I am not so bold to believe that I can ever replace the physician as the ultimate authority in medicine. I feel I could practice independently (I pretty much do anyway) and do just fine, but I am not so eager to abandon the physician/mid-level relationship as some of you are. Many of you speak of physician hostility, but I am curious whether MSN programs foment this hostility on the nursing side. If you look at an M.D. or D.O. as someone who is holding you back, it is easy to create tension and anger, but if you look at them as a resource who probably is more informed than you are, and treat them with the respect that you wish to receive, productive relationships can evolve.
I chose medicine because I believe in the medical model. Some of that is probably a function of working in emergency medicine before becoming a PA. Feeling someone's pain really does not help them when they are in asystole due to hyperkalemia and you are trying to set up an emergency hemodialysis, but patient education is something that physicians don't usually do very well.
For all of you who claim physicians are holding you back or are rude, etc., remember that when they look at you, they see someone who wants to play the same game but not do the time, and the situation is never going to improve if the 'holier than thou' attitude continues on both sides. I will diagnose and treat pneumonia just the same as the rest of you, but for some reason, we choose to focus on distinctions rather than commonalities.
- 0Mar 12, '04 by zenman GuideAloha PA-C. Your comments, while valid, do not go with my quote. I was making the point that both you guys(NPs and PAs) are not the only game in town! I'm not a doctor nor a NP/PA and I have no idea why there is so much hostility among the groups. As I've said before (in jest) "I'm not racist, I hate everybody!" The medical model is another story alltogether...well our entire healthcare system...and one that really needs reworking. I'm now more interested in Eastern modalities and their focus; the Western model is just too boring for me after 30+ years. Of course, I've had the scapel applied to me several times and that is why I think both systems need to work together. If I need cutting on I prefer the Western model; for keeping myself in shape and avoiding the need for the Western model or for chronic conditions I prefer the Eastern model. Maybe now would be a good time for you NPs and PAs to discuss how you are similar and how you look at a patient. Then when you are stumped or your patient does not get better...just call me...Dr. (Hon) Feelgood!
- 0Mar 15, '04 by PA-C in TexasQuote from zenmanSorry. You are right. I just hit that little reply button in the bottom right hand corner and it quotes the last post.Aloha PA-C. Your comments, while valid, do not go with my quote. I was making the point that both you guys(NPs and PAs) are not the only game in town! I'm not a doctor nor a NP/PA and I have no idea why there is so much hostility among the groups. As I've said before (in jest) "I'm not racist, I hate everybody!" The medical model is another story alltogether...well our entire healthcare system...and one that really needs reworking. I'm now more interested in Eastern modalities and their focus; the Western model is just too boring for me after 30+ years. Of course, I've had the scapel applied to me several times and that is why I think both systems need to work together. If I need cutting on I prefer the Western model; for keeping myself in shape and avoiding the need for the Western model or for chronic conditions I prefer the Eastern model. Maybe now would be a good time for you NPs and PAs to discuss how you are similar and how you look at a patient. Then when you are stumped or your patient does not get better...just call me...Dr. (Hon) Feelgood!