Doctor-Bully Epidemic Jeopardizing Both Nurses And Patients


 
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By Alexandra Robbins

The doctor-bully epidemic is jeopardizing both nurses and patients. In news reports and hospital break rooms, stories abound of physicians berating nurses, hurling profanities, or even physically threatening or assaulting them. Doctors are shoving nurses in the operating room; throwing stethoscopes, scissors, pens, or surgical instruments. In Maryland, a surgeon yelled, “Are you stupid or something?” at a nurse and hurled a bloody surgical sponge at him. A surgeon threw a scalpel at a Virginia nurse, who told me, “He was angry because I didn’t have a rare piece of equipment he needed, so he endangered me and several others by throwing a tantrum.”

Many things surprised me during the reporting for my new book, The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital, which follows the stories of four nurses and is based on interviews with hundreds of other nurses across the country.

This disturbing problem was one of the more shocking discoveries when nurses pulled back the curtain.

Most nurses have witnessed or been the victims of doctor bullying. A 2013 Institute for Safe Medication Practices survey found that in the year prior, 87 percent of nurses had encountered physicians who had a “reluctance or refusal to answer your questions, or return calls,” 74 percent experienced physicians’ “condescending or demeaning comments or insults,” and 26 percent of nurses had objects thrown at them by doctors. Physicians shamed, humiliated, or spread malicious rumors about 42 percent of the surveyed nurses.

A New York critical care nurse told me, “Every single nurse I know has been verbally berated by a doctor. Every single one.”

Nurses were to offer a doctor their chair and open the door so that he could walk through first, in chivalric reverse.

Why is doctor bullying veiled in organizational silence? Nurses may be afraid to report doctors because they believe administrators will refuse to penalize physicians who generate revenue or garner media accolades. Nurses worry they might lose their own jobs in retaliation, or they fear the stigma of being perceived by colleagues as a whistleblower.

These fears may be justified. A slew of double standards protects physicians’ jobs but makes nurses vulnerable. Some hospitals have fired nurses for reporting doctors’ inappropriate or incorrect treatment of patients while allowing the doctors in question to continue to practice. But when nurses don’t speak up, there’s a risk that people will suffer or die.

In hospitals, “intimidating and disruptive behaviors” can lead to medical errors, increase health care costs, and harm patients, according to the Joint Commission, an independent organization that evaluates and accredits health care organizations.

These consequences can occur because certain doctors refuse to listen to nurses or because some nurses are too intimidated to ask questions promptly, if at all. “Molly,” a nurse whose story I followed for a year, saw firsthand how a doctor determined to upstage a nurse repeatedly put patients’ health at risk.

The Joint Commission has found that in health care organizations nationwide, 63 percent of cases resulting in patients’ unanticipated death or permanent disability can be traced back to a communications failure.

A nurse relayed this scenario to the Journal of the American College of Surgeons, for example: “Cardiologist upset by phone calls and refused to come in. RN told it was not her job to think, just to follow orders. Rx [prescription] delayed. MI [heart attack] extended.”

At an annual meeting, researchers described similar issues among labor and delivery staff:

“When a nurse reported to the physician that her patient was highly anxious and had shortness of breath, the physician told the nurse to give the patient some Ativan [anti-anxiety medication] and take some herself. Later that evening the patient was admitted to the ICU [intensive care unit] with congestive heart failure.”

“A nurse reported that the final sponge count was incorrect after a difficult tubal ligation. The physician was sarcastic and said that an expensive x-ray would be ordered because the nurse obviously suffered from obsessive compulsive disorder. A sponge was found in the patient.”

“Doctor’s behavior has been hostile, aggressive, threatening, and escalating in the past months … including raging at charge nurses and unit director … nurses are working in a hostile environment and fear for their safety and well-being.”

Certainly, only some doctors exhibit such behaviors, and incidents should be viewed in context. Tensions run high in life-or-death situations; doctors may not have time to monitor their tone or language when their priority is saving a life. The doctors considered the worst offenders are the specialists whose work is consistently urgent and carries the highest stakes.

The hospital departments most likely to host doctor bullying are operating rooms, medical surgery units, ICUs, and emergency rooms. In the OR, surgeons are more than twice as likely as anesthesiologists and nurses to exhibit disruptive behavior.

A 2011 survey found that three-quarters of doctors are concerned about this kind of behavior; virtually all respondents said it affects patient care. Yet “despite the best efforts of many, our profession is still plagued by doctors acting in a way that is disrespectful, unprofessional, and toxic to the workplace,” CEO Barry Silbaugh observed in the report’s foreword.

Some health care providers have devised clever strategies to handle intimidation. In one surgical department, when staff members feel tensions rising, they can call out, “Tempo!” as a reminder for everyone to calm down.

In a New Brunswick, Canada, hospital, when a particular doctor bully lambasts a nurse, nurses spread a “code pink” alarm and other nurses come to her area and stand beside her in support. At another hospital, a mistreated nurse can page a “code white” to the same effect.

Still, these codes go more toward treating a symptom rather than preventing problems in the first place—perhaps fitting in an American health care model. Ultimately, these issues can be attributed to a fundamental lack of respect for nurses, who deserve much more appreciation than they get.

The physician and nurse professions, which should be considered complementary and equal, are instead too often treated as master and servant. The term nurses often use to describe the role some doctors seem to assign them is “handmaiden.”

The hierarchy is often enforced from above. When an ER doctor didn’t even try to save a man whose heart stopped in the ambulance on the way to a hospital, the nurses in the emergency room complained to the hospital’s medical director. The way the director dismissed the nurses’ complaints was both insulting and astonishing. He said, “You’re just saying that because she’s young and pretty.”

Similarly, an anesthesiologist told an Arkansas Certified Registered Nurse Anesthetist (a category of highly trained providers who may provide anesthesia autonomously), “I could teach a monkey to do your job.”

The doctor-nurse hierarchy is rooted in the past, in remembrances of outdated traditional roles. Up until the mid-20th century, nurses, almost always women, were expected to stand when a doctor, almost always a man, entered the room.

Nurses were to offer him their chair and open the door so that he could walk through first, in chivalric reverse. Nurses were expected to await instructions passively without questioning the physician. By the 1960s, nursing schools were still teaching that, as one nurse described it, “He’s God almighty and your job is to wait on him.”

In 1967, psychiatrist Leonard Stein described the nurse’s role in an essay titled “The Doctor-Nurse Game.” The object of the game, he said, was for a nurse to “make her recommendations appear to be initiated by the physician.

The nurse who does see herself as a consultant but refuses to follow the rules of the game in making her recommendations, has hell to pay. The outspoken nurse is labeled a ‘bitch’ by the surgeon. The psychiatrist describes her as unconsciously suffering from penis envy.”

Today, some hospitals perpetuate what is called a “culture of disrespect among healthcare providers” rather than treating nurses like the heroes they truly are.

At Vanderbilt Medical Center in 2013, in an attempt to cut costs, administrators risked cross-contamination by forcing nurses to perform housekeeping duties, including emptying garbage cans, changing linens, sweeping, and mopping patient rooms and bathrooms. At other hospitals, nurses told me that they are charged for parking while physicians and techs park for free.

Nurses, skilled and educated, deserve respect, appreciation, and a voice in healthcare decisions. Is it possible to have a chain of command without implied levels of superiority? To view the various scopes of practice as complementary rather than hierarchical?

By reframing doctor-nurse relationships so that providers view each other as part of a team, managers would convey that every team member deserves to be empowered as they work together toward the ultimate goal: better patient care. And then, finally, the majority of bully doctors—and projectile surgical instruments—can remain in the past where they belong.


 
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Articles in this issue:

Masthead

  • Masthead

    Editor-in Chief:
    Kirsten Nicole

    Editorial Staff:
    Kirsten Nicole
    Stan Kenyon
    Robyn Bowman
    Kimberly McNabb
    Lisa Gordon
    Stephanie Robinson

    Contributors:
    Kirsten Nicole
    Stan Kenyon
    Liz Di Bernardo
    Cris Lobato
    Elisa Howard
    Susan Cramer

  • Regarding Doctor bulling< this has gone on for years. Glad to see someone is speaking up on behalf of the nurses. Bulling has been going on in many areas of the Medical field.

  • I have worked in the OR for 35 years. I could write a novel about this subject. If anyone wants my infer please contact me.

  • This has been going on since there were nurses and doctors. I have seen a nurse hit in the head with a steel chart back in the 70s. I have been threatened by physicians in front of staff, patients and families, because he wanted something he could not have. I just figure the physician looks like an idiot, not me.

  • I have definitely been a victim of this. I\'m a nurse in the recovery room and I was humiliated by an anesthesiologist regarding something with a text page that I did not even send her. so it was a case of mistaken identity yet I suffered verbal abuse in front of my entire unit. and to top it off she did this while I was drawing up a critical medication. She literally stopped me in the middle of a medication administration to yell at me. This upset my patient\'s wife so bad that she came out and grabbed the doctor, threw her finger in her face and yelled at her saying you do not speak to him like that. I reported this incident and nothing was ever done until eight months later my manager came up to me and said that it was taken care of. Yet I have no idea what taken care of means. All I know is it was 8 months later and I never received any type of apology.this is definitely not the first time something like this happen to me although this was the worst incident I have ever experienced. Never in my life have I been spoken to like that. It made me feel less than human.

  • Florin Snipingale

    December 31, 1969 16:33 35

    The root of the problem is the construct of privilege. The traditional model is that physicians (I refuse to ascribe the term \"doctors\" to those whose profession is the practice of medicine) are not paid by the hospital. They are independent professionals who are granted the privilege to send their patients to particular hospitals. Hospitals and the physicians charge the insurance companies separately. If hospitals did not make their hospitals attractive to physicians, then physicians would not bring their patients to the hospitals. So, physicians have their own dining rooms, free meals, and close-in and free parking. These are enticements. Plus the hospital provides staff to take care of their patients when the physicians are not around. These are the Registered Nurses. Registered nurses are hospital employees. The physicians have no control over the nurse\'s evaluation or raises. To some physicians, RNs are simply chattel that is provided by the hospital for them to use. And if the physician is unhappy for some reason and frustrated, then everyone within a 20 foot radius is at risk. Even the patient. In hospitals in which physicians are all employees of the hospitals, this behavior rarely occurs. And when it does, RNs have leverage to take back to the employer and the employer has leverage to reprimand the physician. I worked in a hospital like this. Believe it or not, one of the integral members of the Practice Review Board (who looks at issues with physicians in hospitals) was the Chief Nursing Officer. When nursing is at the table, and has clout, physicians listen. Let\'s get rid of physician privilege in all senses of that word. We are all in this business for the benefit of humankind.

  • This article is so accurate! I am very fortunate to work for a hospital system who takes physician bullying seriously when it is pursued. It is a patient safety issue!! In previous positions as a Nursing Director ( L&D and Med Surg)I stood up for staff against doctors. Our system has a physician bullying policy. It takes courage and guts to stand up to that kind of behavior, but the patients and nurses deserve it. In one instance, the physician bully was given notice by our legal counsel that if it happened again at ANY of our facilities, his business privileges would be terminated. This meant that he could not come on to the hospital property. Only the medical staff can remove the medical staff privileges, but the hospital can take away the business privileges. The physician claimed that no one had ever talked with him about his behavior......I had had MULTIPLE conversations with him. The outcome? After he got his notice, he starting behaving and is still practicing in the system many years later. People can change if they want to. Those nurses are someone\'s wife, mother, grandmother, daughter----Dr., do you want your wife, mother, grandmother daughter treated that way?

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