Things Doctors Say

A recent study by the RN Work Project, a program of the Robert Wood Johnson Foundation, revealed that high levels of physician verbal abuse on newly licensed registered nurses are closely associated with more negative work environments.

Renee Thompson, a nurse keynote speaker and bully expert will be speaking on this very topic at a physician leadership conference this winter.

“Numerous studies show the connection between the way we communicate with each other and how it impacts patient outcomes,” she says. “Bad behavior is bad behavior – [it] doesn’t matter who is the disruptor. It all impacts patient outcomes.”

Alicia Spitz, BSN, RN, CAHIMS, clinical Supervisor at Maxim Healthcare Services, thinks it is easier for an experienced nurse with more confidence to be less intimidated by a doctor.

“I also think the younger doctors are nicer. They are more respectful and less arrogant these days. But every once in a while you get that really mean doctor who will not change,” Spitz says. “Just accept him, tell your supervisor, let him know you don’t like the way he is speaking to you and just take good care of your patients.”

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RN Work Project Study

The RN Work Project study analyzed the fourth wave of a national panel survey that began in 2006 of NLRNs licensed between August 1, 2004 and July 31, 2005, looking at 1,328 NLRN subjects who responded to a shortened six-item version of the Verbal Abuse Scale, reporting the frequency of verbal abuse by physicians in the previous three months.

The study found that RNs who were the most likely to experience verbal abuse by physicians were younger, working in hospital settings, working day shifts and working on units that were short-staffed.

Some nurses feel that male physicians and even some of the females treat male nurses with a whole different set of standards than the females.

“It also seems that verbal abuse is contagious. One potential explanation is that negative behavior exhibited by one member of a group spills over to other members of the group and hurts the group dynamic,” she says.

“We also see that in a stressful environment, including one in which there is physician-to-RN abuse, there is more likely to be RN-to-RN abuse, as well.”

The study found that nurses who experienced high (more than five times in the last three months) or moderate (one or more times in the last three months) levels of verbal abuse by physicians had:

 

  • less favorable perceptions of their work environments;
  • lower intent to stay in their jobs; and
  • weaker commitment to their organizations.

Another investigator, Carol Brewer, PhD, RN, FAAN, professor, School of Nursing, University at Buffalo in New York, offered that one of the most striking findings of the study is that higher levels of verbal abuse by physicians are correlated with poorer perceptions of the work environment across the board.

“Physicians’ verbal abuse of nurses is a longstanding problem and one we need to do much more to address,” said Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University, who served as one of the investigators in the study.

“It hurts morale, breeds further verbal abuse, and is associated with nurse intention to leave, particularly among younger nurses, Kovner added. “All of these things ultimately reduce the quality of patient care. Healthcare organizations need to do much more to create positive, healthy work environments”

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Handle With Care

Thomas Spevak, RN at Schuylkill Health System, Pottsville, Pa., feels there is a correlation between those who struggle with suppressing their egos enough to put patients’ interests first and those who exhibit hostile workplace behavior.

“I’ve witnessed doctors intimidate, insult and belittle nurses and subordinates. Unfortunately, they remain unresolved, as managers don’t always feel comfortable or empowered to address the issue,” he says.

“The reality is that if you feel like you are the most disposable person in the equation, you speculate that you would be let go – instead of the offending person being confronted because of their influence, ability to bring money in, etc.”

The researchers in the study noted methods aimed at preventing verbal abuse must be part of a holistic approach to improving the work environment.

The study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas.

Other investigators in the study were Rana Obeidat, PhD, RN, Faculty of Nursing at Zarqua University in Jordan, and Wendy Budin, RN-BC, PhD, FAAN, adjunct professor at the College of Nursing, New York University.

Spevak knows it is not always easy to speak up, but empowering yourself will not only garner respect, but will let you walk away from an exchange without feeling walked over.

“Those being badgered can limit-set, saying that you are willing to work out a solution but expect to be treated with respect. State you will end the conversation if it does not do so,” he said.

“Done with a calm, firm voice, you can set the tone. Don’t get pulled into name-calling, placing blame, trading insults, etc.”

Keith Loria is a freelance writer.

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