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.
Study says disruptive physician behavior has contributed to nurse shortage
Study says disruptive physician behavior has contributed to nurse shortage
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)