Abusive behavior by physicians linked to nursing shortage, studies show

  1. http://www.nursingpower.net/abuse/ve...buse_docs.html

    U.S. NEWS & WORLD REPORT
    Copyright 2002 U.S. News & World Report ~ June 17, 2002
    SECTION: HEALTH & MEDICINE; Vol. 132 , No. 21; Pg. 54
    HEADLINE: Nursing Wounds
    BYLINE: By Josh Fischman
    HIGHLIGHT: When arrogant docs drive nurses away, patients suffer

    Irate doctors hurling surgical clamps at nurses are admittedly rare. So such acts, as outrageous as they are, can't really be blamed for the severe nursing shortage now hobbling hospitals. Nor is it low pay, says nurse Nicola Smith, an 11-year veteran working at UC-Davis Medical Center in California: "It's a matter of disrespect."

    Nurses like Smith describe an accumulation of insults. "I've been told to give up my seat for doctors at some hospitals," she says, "and I've been yelled at by a doc who didn't like the way I put on a dressing." Angela Vandorn, a nurse at Hoag Hospital in Newport Beach, Calif., adds: "I've had them hang up on me when I've tried to give them patient information." Such anecdotes are adding up to a crisis. Last week, in an American Journal of Nursing survey of 1,200 nurses and other hospital staff, nearly a third said they knew of a nurse who had left a job because of physician abuse. "That number isn't surprising to me, unfortunately," says James Goodnight, chief of surgery at Davis. "I've seen the yelling and a few things thrown around." Hospitals now have 12 percent fewer nurses than they need, and abusive behavior is one of the big reasons why.

    Patients get hurt by this, too. A shortage of nurses is associated with higher rates of internal bleeding and infections and a higher risk of death, according to a disturbing study published two weeks ago in the New England Journal of Medicine. "Nurse turnover is clearly related to these problems, and we see it throughout our organization," says Lillee Gelinas, chief nursing officer for VHA, a chain of 2,200 hospitals and clinics that holds a third of all patient beds in this country.

    Fortunately there are solutions. Several hospitals have put "zero abuse tolerance" policies into effect over the past few years and have seen nurse turnover rates drop. They've also seen medical complications dip. "We all work as a team here now," says Smith. "That helps the patients, the doctors, and it helps me. If you offered me a $10,000 raise to work across town, I wouldn't go."

    Escaping abuse. Nursing is not about the money, trite as that may sound. In the American Journal of Nursing survey, "we found that workplace environment was an even stronger factor than compensation when it came to satisfaction," says internist Alan Rosenstein, author of the study and medical director of VHA's West Coast division. In fact, salaries aren't altogether bad, says Diana Mason, editor of the nursing journal. "As a new nurse, at a New York City hospital, you can start at $60,000." Some hospitals elsewhere are offering signing bonuses of $30,000. "It doesn't matter," says Mason. "We won't stay in a place that's abusive."

    What Rosenstein found in his research was that more than 90 percent of his respondents had witnessed yelling, public berating of nurses (and even patients) by doctors, and abusive language. Perhaps more alarming, he also found that doctors don't think such abuse is a big deal. At times, this is because doctors, facing an urgent situation, focus on speed and need rather than their people skills. Still, nurses have had to devise defenses, like announcing "Code White Coat" over the hospital intercom: Nurses hearing the code move to the beleaguered nurse's side and stare at the doctor, making it clear there are witnesses.

    Yet hospitals often seem reluctant to discipline wayward doctors. "They bring patients to the hospital, and that's a source of revenue," Rosenstein says. "Executives can be reluctant to confront them." Couple this with the stress of today's hospitals, where only the sickest patients requiring the most intensive care are admitted. Add to that mix a large group of older nurses who are retiring and young people who don't want to go into this profession, and you have all the ingredients for a shortage--and a shortfall in patient care.

    Hospital administrators are waking up to the dimensions of the crisis. "We decided we have to change our culture," says Al Stubblefield, CEO of Baptist Hospital, a 480-bed facility in Pensacola, Fla. In the mid-1990s, Baptist ranked in the bottom fifth in national surveys of patient satisfaction. "We knew we had a problem. There was a lot of finger- pointing." So Baptist started trying some new things. Physicians were told there would be no more abusive behavior. Nurses were given power to change the way their wards operated. One thing that changed was the ER, says Diane Wilbanks, vice president of patient care services. A triage nurse replaced a receptionist, reducing waiting times. Nurses also started voting for an outstanding physician each week, and doctors soon began competing for the designation by spending more time teaching nurses.

    "When I first heard about this, I thought, 'Yeah, yeah, sure,' " says Wilbanks. "But it's made a big difference." Patient satisfaction ratings shot up. Nurse turnover dropped from 24 percent annually to 14 percent. Rates of patient bedsores, blood and urinary tract infections, and other problems dropped as well.

    UC-Davis has also reduced turnover. "We have more say at this hospital," says Smith. Nurses now go on patient rounds with physicians at Davis--a practice that is benefiting the bedridden. For example, nurses have been able to teach tradition bound doctors a new and more effective way to treat bedsores--an innovation that would never have occurred under the old system. Happier nurses are not, of course, a panacea for all ills. At

    Davis, for instance, some infection rates have gone up. One possible explanation is that while the hospital staff was learning to get along, the hospital became a referral center for the region, treating much sicker patients sent from other facilities. But even these patients feel they are getting better care. Davis is one of about 50 "magnet" hospitals with high nursing standards identified by the American Nurses Association; research has shown these have better patient outcomes than nonmagnet hospitals. So when doctors and nurses mix it up, it's to share information, and it's the patients who benefit.




    *See also:


    Study says disruptive physician behavior has contributed to nurse shortage


    Study says disruptive physician behavior has contributed to nurse shortage
    http://www.expresshealthcaremgmt.com...ational1.shtml

    As healthcare staffing studies continue to paper the industry with startling statistics, yet another one is highlighting what could be a big problem for nurse retention: doctors.

    Despite relying on nurses for important caregiving functions, physicians may be driving them away from the profession, according to a new study by healthcare alliance VHA. And if Irving, Texas-based VHA is right, the exodus of dissatisfied nurses comes as a healthcare workforce shortage reportedly grows.

    Citing as one of the factors that contributes to low morale among nurses, the study said 30 per cent of nurse respondents reported knowing of a nurse who had quit because of poor treatment by a physician.

    Like the American Hospital Association and other groups that have addressed the staffing problem with studies and strategic recommendations, the VHA believes its study on the physician-nurse relationship helps to identify root causes of the nurse shortage that are often difficult to discuss or even recognize. Rosenstein said he had trouble finding information on the possible link between physician behavior and nurse satisfaction. Seeking answers, he launched the study in part to develop policies to deal with it.

    The VHA report reflects responses from 1,200 nurses, physicians and healthcare executives at VHA hospitals. Rosenstein said 92 per cent of respondents said they had witnessed disruptive physician behavior, such as inappropriate conflict involving verbal or even physical abuse of nurses. All the respondents identified a direct link between such behavior and nurse recruitment and retention challenges. Yelling and condescending behavior constituted the vast majority of the abuse doctors inflict on their nurse colleagues, Rosenstein told Modern Healthcare. Nurses who have seen such behavior in their daily work weren't surprised to hear that it can affect nurses' satisfaction with their jobs, and even whether they decide to stay. Nurses aren't (physicians') subordinates (who) they can treat with disregard when they're having a bad day, said Erin Murphy, executive director of the 16,000-member Minnesota Nurses Association. nce nurses say this is not right, I think the physicians will change. Murphy, a former practicing nurse, said degrading and insensitive behavior is all too common among physicians, who tend to view themselves as the leader of the healthcare team and think other team members should be able to deal with their outbursts.

    The study also cited a disconnect between nurses and physicians, saying that when physicians think their behavior is acceptable or improving, nurses don't necessarily view it that way. Long-held habits, healthcare team. It is a team, but it's hard for some of the older physicians to adapt to that because they're used to just giving orders and leading the floor, said Peter Halford, M.D., chief of staff at Queen's Medical Center in Honolulu.

    Halford, who reviewed the VHA study, said the collaboration necessary to prevent disruptive behavior is much easier said than done. The relationship between doctors and nurses is like a marriage, Halford said. You have to continually look at what you can do to promote communication, which translates into safer, better, more efficient care. Halford cautioned that although the VHA study highlights an important problem, physicians' treatment of nurses is not the only factor in their diminishing morale. Nursing, he said, doesn't pay what it should given the amount of work and stress involved, and the physical and mental demands. It's a tough job. You have to be on your toes.

    With nationwide staff shortages haunting health system executives, VHA earlier this year released another study suggesting the workforce shortage is unlike any before it, and that hospitals must address the problem to prevent sinking morale from negatively affecting financial performance, quality of care, customer satisfaction and market position. The study is similar to one conducted earlier this year by the AHA, which found 84 per cent of hospitals were experiencing a registered nurse shortage. VHA's report characterizes the healthcare workforce shortage as not a short-term blip, but a long-term crisis.

    (Source: Modern Healthcare Magazine)
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  2. 42 Comments

  3. by   skicheryl
    And about time this information started being published in medical journals! Wake up call to admin and docs as to what part the docs have in the huge exodus of nurses from acute care hosptials!
  4. by   Jailhouse RN
    If You Believe That Nurses Or The Supposed Shortage Is The Cause Of A Doctor's Bad Behavior You Need Help. The Doctor, Just Like The Nurse Must Control Him Or Herself. Here We Go Again Taking All The Blame......that Is Pure B.s.
  5. by   hipab4hands
    Quote from Jailhouse RN
    If You Believe That Nurses Or The Supposed Shortage Is The Cause Of A Doctor's Bad Behavior You Need Help. The Doctor, Just Like The Nurse Must Control Him Or Herself. Here We Go Again Taking All The Blame......that Is Pure B.s.
    I think that the 2 doc's that I've reported for verbal abuse and the one that had a temper tantrum and threw a pillow at me, have learned learned their lesson--
    Admin. had a quiet "talk" with them and told them they were "bad boys" and not to do it again. No written reprimand or disciplinary action was taken against them.:angryfire

    Until the docs are given conseqences for their actions, the abuse will continue.
  6. by   Hellllllo Nurse
    Quote from Jailhouse RN
    If You Believe That Nurses Or The Supposed Shortage Is The Cause Of A Doctor's Bad Behavior You Need Help. The Doctor, Just Like The Nurse Must Control Him Or Herself. Here We Go Again Taking All The Blame......that Is Pure B.s.
    Jailhouse RN, you got it backwards. The researchers are saying that the bad behavior of physicians is one of the causes of the nursing "shortage."
  7. by   breeann
    In the hospital I work, on a daily basis doctors are verbally abusive. Doctors have hung phones up on us when asking for a order. They have written things in patient's charts' such as " don't be so stupid nurse". A doctor even throw a chart at a unit clerk. All of the above the doctors have not been written up for or even verbally disciplined for. Our hospital's response to it is we have to get along with them because they are our income. Needless to say it continues.
  8. by   CapeCoralNurse2be
    I have to agree with this article. I myself almost decided against nursing because of the abuse I received from doctors, and the abuse I witnessed. I thought there is no way, I can't do this. I changed my major in school to pre-vet. Life got in the way and I ended up being a stay at home mom for 7 years, but am now ready to go back to the idea of nursing and have started to go back to school. I just hope over the years I have learned how to stand up for myself when it comes to these docs that act like idiots. The problem is they know in most cases they can get away with it.

    :angryfire :lol_hitti
  9. by   lindarn
    Quote from breeann
    In the hospital I work, on a daily basis doctors are verbally abusive. Doctors have hung phones up on us when asking for a order. They have written things in patient's charts' such as " don't be so stupid nurse". A doctor even throw a chart at a unit clerk. All of the above the doctors have not been written up for or even verbally disciplined for. Our hospital's response to it is we have to get along with them because they are our income. Needless to say it continues.
    Nurses need to take a proactive approach to this and make it a habit to write up physicians when they act like this, make a copy for yorself, and send it to administration, Risk Management, and the State Board of Medicine. The Board of Medicine cannot discipline them if they don't have a "paper trail" to follow and document. I would keep a journal and document if and when you call on call physicians, and the response that you get. I would also document in my notes every time you called, the time, and what the physician said when they responded. Make a copy of the nurses notes, as well. documentation is imperative.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
  10. by   Hellllllo Nurse
    Quote from Jailhouse RN
    If You Believe That Nurses Or The Supposed Shortage Is The Cause Of A Doctor's Bad Behavior You Need Help. The Doctor, Just Like The Nurse Must Control Him Or Herself. Here We Go Again Taking All The Blame......that Is Pure B.s.

    Please make sure you actually understand what you read before making rude comments. You just put your foot in your mouth.
  11. by   jayrelic
    The only way this type of abuse can continue is if those on the receiving end do nothing about it. If you're too weak, too afraid, too intimidated, then you shouldn't be working there, or dare I say in the field of nursing at all.

    It's one thing to be on the receiving end of constructive criticism, but to be on the end of abuse is completely different. If you allow that to happen to you and do nothing about it, first of which should be standing up for yourself, secondly, pulling the physician aside after both parties have cooled off to explain you will not tolerate abouse from anyone, and third, let those in a position of authority over the physician know about it, then I have no empathy for you.

    It's up to you to empower yourself. Don't let others dictate how you feel. I see all too often people letting others control their thoughts, feelings and attitudes. I have learned from them, and I do not allow it to happen to me. Nor should any of you.
  12. by   RNtoJD
    Quote from CapeCoralNurse2be
    I have to agree with this article. I myself almost decided against nursing because of the abuse I received from doctors, and the abuse I witnessed. I thought there is no way, I can't do this. I changed my major in school to pre-vet. Life got in the way and I ended up being a stay at home mom for 7 years, but am now ready to go back to the idea of nursing and have started to go back to school. I just hope over the years I have learned how to stand up for myself when it comes to these docs that act like idiots. The problem is they know in most cases they can get away with it.

    :angryfire :lol_hitti
    Wow. I am lucky enough to work with some decent docs. Honestly, I have had more problems with other nurses than I have had with the docs. There is also the occasional problem resident. I mentioned to one of our attendings that most of our doc problems tend to be with residents. His response: "That is because most of us either went to med schools that stressed respect for nurses OR we were a**holes to nurses as residents and VERY quickly learned what a BIG mistake that is."
    Nurses in my dept, on the other hand, tend to engage in the typical "nursier than thou" petty behavior.
  13. by   Ginger35
    Unfortunately, I find this article to be soooo true. I have seen physicians scream at nurses for things that are not even nursing related, I have seen physicians belittle nurses in front of patients, visitors basically God and the world - not to mention the many hoops us nurses have to jump through with a grumpy doc just to get an order for a patient. I think the worst thing I have seen a doc do is actually throw a scalpel and it ended up in one of the nurses thighs. (dirty scalpel that is).

    The culture not only needs to change universally - however, I don't see it happening in the near future.
  14. by   Tweety
    Interesting. Thanks for sharing.

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