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Bad Manners in Medicine

In nursing, the issue of unanswered call lights is still far from resolved.

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Modern health systems spend a great deal of time and money on creating patient-centered environments, but most patients remember only the most unprofessional healthcare workers they encounter.

In any industry, there's always that co-worker who spends disproportionate amounts of time on cell phones or online, spreads conflict among staff or refuses to perform certain aspects of the job. Healthcare is different in that lackadaisical behavior by one member of the patient care team can affect outcomes or cause a safety issue.

Ignoring Patients

As anyone who's spent time in a hospital bed knows, few situations are as demoralizing as pushing the call button repeatedly to no avail.

Despite the most advanced nurse alert systems that are often routed to the clinician's cell phone and the emergence of hourly rounding in many facilities, the issue of unanswered call lights is still far from resolved.

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Resolving Workplace Conflict

Conflict interferes with successful clinical outcomes, as well as with personal and professional satisfaction.

Margaret Chizek, MBA, RN, FNP, AAS, of Charism ElderCare Services in suburban Chicago, sees evidence of this behavior when she distributes communion for the sick at local hospitals.

"The doctors and nurses don't know anything about me," she said. "The call light will be going for 15 minutes and they don't leave to answer. They say, 'it's not my patient.' The real shame is that the vast majority of questions don't require a doctor or master's-prepared nurse, and these patients can be helped so easily by putting the bed down or providing some comfort."

Because of the direct correlation with patient falls, hospitals are launching call light answering initiatives throughout the country. Healthcare workers counter that high ratios and the lack of time prevent them from responding quickly. Even so, Chizek thinks the onus is on the clinician.

"Somewhere along the line, we've forgotten the human factor in our responsibilities," she said. "We are still professionals and are paid as such. Part of earning your keep as a professional is going beyond basic competence."

Kathleen Pagana, PhD, RN, author and keynote speaker, thinks the association between unanswered call lights and poor patient satisfaction scores means hospitals will continue taking a hard line on responsiveness.

"Hospitals are so much more on top of this than they were a few years ago," Pagana noted. "I've even heard of facilities that place a tracking device on nurses so administration can follow up on complaints that nobody answered the call light and review the nurse's exact location at the time."

Disruptive Behaviors

In addition to disregarding call lights and patient concerns, arguing with colleagues and other disruptive behavior is a common problem in healthcare settings.

It's more than just a work annoyance. According to a joint study conducted by the Studer Group and the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center, Nashville, Tenn., three in four healthcare providers experienced some kind of disruptive or intimidating behavior in the course of the work.

A full 66% of respondents stated they have considered leaving their jobs and 41% transferred out of a department as a result of unprofessional behavior. The problem spans the entire spectrum of clinical and non-clinical workers and medical staff.

Chizek recalled helping a senior deal with a mix-up in getting her medications in preparation for an upcoming colonoscopy. After reporting to the hospital for the procedure without the required preparations, the patient was sent home but still charged for the colonoscopy.

Adding to the drama, a nurse told the patient that her manager had lied, knowing that she had neglected the pre-op prep work.

"We treat each other very unprofessionally," Chizek stated. "If that's how we treat our peers, patients are right to wonder what kind of response they'll receive."

Bullying and in-fighting have an effect on recruitment as well. When she was a nurse educator, Pagada remembers hesitating to take new nurses or students on floors with a notoriously mean staff. "This is finally being addressed and workers are starting to be fired for the way they treat each other. They should be fired because it can impact the way they care for patients and it makes the work environment difficult, especially for new grads."

The Facebook Factor

The advent of social networking has introduced a whole new level of unethical behavior. Last year, an Oregon nursing assistant spent a week in jail for posting graphic photos of elderly or disabled patients to her Facebook profile. Four staff members in California were fired in 2012 for a similar offense and related cases seem to be springing up throughout the country. Three medical centers in southern California have faced investigations in recent years after employees improperly accessed patient records, including some for celebrity patients, according to a series of articles in the Los Angeles Times.

In response to these cases, staff is increasingly being asked to sign social media agreements concerning such sites as MySpace, Zoho and Eventful, among others, that note the information disclosed on social networking sites may not identify that patient even if the name and medical record number are eliminated. This was sparked by Facebook updates like "I just cared for a cop killer" or other links to higher profile cases, Pagada said.

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Most hospitals have stringent policies against personal cell phone use on the job but those are sometimes ignored. Forever in Chizek's memory is the recollection of the nurse she found texting her kids from the isolation room before proceeding to take the then-contaminated phone to other rooms.

For every reason to point to these cases as further evidence of decline of polite society, there's evidence of bright spots on the healthcare horizon. One such reason for hope is the higher education levels common among younger clinicians.

"There's a gap between what's taught in school and the skills necessary to function in the workplace. MBA students have always been taught etiquette in business school," Pagada said. "Traditionally, there's never been time in nursing school. Now there are lots of tools for nurses to learn these skills and the sooner etiquette is mastered, the more effective you'll be in healthcare."

Robin Hocevar is on staff at ADVANCE. Contact:

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Excellent article and an especially important one for nursing students as well as nurses seeking new positions to heed. The successful units I've worked with during my 28 year nursing career have been ones where patient/family education and quality outcomes were highly regarded virtues. Now more than ever teaching expected, and perhaps more importantly "unexpected" outcomes should start from admission. Our patients and their caregivers need to be empowered to be their own advocates.

Mariah Edgington,  RN,  The Ross Heart Hospital January 25, 2013
Columbus, OH


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