Bullying, intimidation, verbal abuse—these behaviors negatively affect self-esteem, feelings of competence, and workplace morale. And they can devastate hospital professionals and their patients.
When 2,095 healthcare providers (1,565 nurses, 354 pharmacists, and 176 others) responded to an Institute for Safe Medication Practices (ISMP) survey on intimidation in their healthcare setting, remarkable data were collected.1
Perhaps the most alarming statistic in the 2003-2004 study was that 7% of respondents (n=147) reported they had been involved in a medication error allowed to occur partly because the respondents were afraid to question the prescriber’s decision. At a large urban trauma center in the northeastern United States, nurses listed intimidation as one of the barriers to implementing a sharps safety program.2
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Nurses’ Perceptions
Research over the past decade has spotlighted intimidation in healthcare.3
“Bullying and harassment still happen in many areas of medicine,” says David M. Pressel, MD, PhD, hospitalist and director, Inpatient Service, Division of General Pediatrics at Alfred I. duPont Hospital for Children in Wilmington, Del. “The question is, how do you monitor yourself to make sure you aren’t falling into that hierarchical frame of mind that could intervene in great teaching and learning and great patient care?”
Dr. Pressel and his partner, David I. Rappaport, MD, also a pediatric hospitalist at duPont, have focused on the literature pertaining to nurse-physician relationships. Research shows that intimidation impedes nurse recruitment, retention, and satisfaction. In one study, 90% of nurses reported experiencing at least one episode of verbal abuse.4 A 1997 study examining the effects of intimidation on 35 pediatric nurses over a three-month period found that 25 (71.4%) of them reported being yelled at or loudly admonished. Sixteen (45.7%) had been victims of insults. Thirty (85.7%) were spoken to in a condescending manner. One-third of nurses believed that such behavior was “part of the job.”
Although studies have differed as to the most common source of this abuse—patients and families or physicians—a study of pediatric nurses reported a similar incidence from both sources.5 And, nurses are often guilty of verbally abusing each other.6
When the duPont pediatric hospitalist team began performing more family-centered rounds, they began to appreciate the nurse-physician relationship. “We have worked hard to have a charge nurse and oftentimes the bedside nurse with us when we round,” Dr. Rappaport says. Speculating that rounding with hospitalists allowed nurses to feel more part of the team, Dr. Rappaport says know the medical plan, consolidate efforts such that pages to residents were reduced, and generally improve communication. They heard from participating nurses that it made a tremendous difference. This prompted them to conduct their research.