February 20th, 2010

Abuse in the medical workplace: Fact vs. myth

Workplace Abuse in the Medical Workplace: Fact vs. Myth
By Denise Halverson for Utah Nurse

A physician demands that a prescription be filled despite proof that it has been prescribed from faulty information; an intimidated ER nurse doesn’t dare speak up when a life-threatening condition is  overlooked; a surgical team stands knowingly, yet silently by as a surgeon makes a life-threatening  error ; despite the plea of a mother, nursing staff refuse to challenge the doctor’s written order resulting in the  senseless death of a  toddler; a senior nurse refuses to assist a junior nurse  as a critically-injured patient slips away. What is the common factor in these, and  other similar and actual situations?  Workplace bullying.  In  medical environments, personnel often couch it in more benign language:  intimidating and disruptive behavior.

Workplace bullying involves repeated health-harming mistreatment usually directed toward underlings or peers, but affecting the quality of patient care and life in general.  Workplace bullying falls into one or more of  the following categories:  work sabotage, verbal abuse, or conduct that is threatening or intimidating or humiliating. Conduct that is in opposition to  the employer’s legitimate business interests, workplace bullying levies real costs, financially, emotionally, physically, and in every other way.  In the medical work place it contradicts professional ethics, including the Hippocratic Oath, for it severely compromises patient safety and quality care.

Bullying is about the bully, not the target.  The bully puts his/her personal agenda of controlling another human being above the interests of patients and the employing medical organization.  A bully’s weapons of choice often include deliberate humiliation, the withholding of critical resources or information, social manipulation, and professional sabotage.

What are the myths that allow the destructive behaviors to continue and thrive?

Myth 1:  Bullying behavior is not prevalent.

Intimidating behaviors are increasing at an alarming rate.  A survey conducted by the Institute for Safe Medical Practices (ISMP) found that 88 percent of the medical practitioners surveyed encountered condescending language or voice intonation, 87 percent encountered impatience with questions, 79 percent dealt with reluctance or refusal to answer questions, 48 percent were subjected to strong verbal abuse, 43 percent  experienced threatening body language, and 4 percent reported physical abuse.  Intimidating and disruptive behavior involves more than  one or two offending individuals in a given medical organization.  Thirty-eight percent of respondents reported that three to five individuals were involved in negative encounters and 19 percent reported that more than five individuals were involved in negative encounters.  Moreover, only small differences between male and female respondents showed up in reports, with male respondents somewhat more reluctant to confront a known intimidator, and female respondents somewhat more willing to ask for help in dealing with a known intimidator.

Myth 2:  Targets deserve or ask for abuse. Smart people don’t become targets.

Individuals most often targeted by bullies prove to be independent, skilled, bright, cooperative, nice, ethical, just and fair people.  In fact, targets are often amongst the most highly skilled, competent, and altruistic individuals.  Bullies, driven by their own personal insecurities, perceive skilled and competent coworkers as a threat.  Bullies tend to thrive in environments in which (1) there are opportunities to behave in a cutthroat, zero-sum, manner, (Note 1) (2) there is a pool of exploitable targets (typically those people with a pro-social helping orientation), and (3) negative personal consequences are negligible, and (4) perpetrators  are rewarded for their bullying behavior by those who collude with the intimidation, or those who are afraid to challenge the bully.

Myth 4:  Bullies are worth keeping around.

Bullies are exhorbitantly expensive.  Conservative estimates and  prevalent data indicates that bullying medical practitioners cost organizations over a million dollars per 50 employees per year in turnover costs alone.  Damages to organizations also include poor morale, low productivity, and difficult recruitment and retention of quality workers.  The ability of health care workers to work as a team is compromised, the quality of patient care is diminished, and lives are needlessly lost.  Medical lawsuits invariably accompany the substandard medical care produced by such sabotage, and the cost in this regard may be incalculable (Note 2) .

Negative impacts specifically on Targets and their families include damages to psychological and physical health, financial stability, social support systems, and professional growth opportunities.  In a survey conducted by Zogby International, 45percent of targets reported stress-related health complications, ranging from depression and PTSD to cardiovascular diseases and neurological compromises.  The greatest harm comes from prolonged exposure and 44 percent reported suffering from workplace abuse for more that 1 year.

Myth 5:  Employers generally recognize the harm done to their organization and deal effectively with bullying behavior.

In the vast majority of cases, bullying  stops only when the target loses his/her job either by quitting, being forced out, or transferring to stay employed.  But it’s only a matter of time before the bully identifies a new target. The bully infrequently (Note 3) endures negative consequences.  According to the Workplace Bullying Institute national scientific survey, the Target quits 40 percent of the time, the Target gets fired 24 percent of the time, and the Target transfers 13 percent of the time.  The Bully is punished only 23 percent of the time.  And 62 percent of employers ignore the problem altogether.   According to the ISMP survey, only 39 percent of medical practitioners felt that their organization dealt effectively with intimidating behavior.  Medical corporate cultures typically do not  deal effectively with workplace bullying.

Myth 6:  There are legal protections against workplace bullying in the United States.

The United States remains the last among western democracies to have no anti-bullying laws for the general workforce.  If mistreated employees who have been subjected to abusive treatment at work cannot establish that the behavior was motivated by race, color, sex, sexual orientation, national origin, or age, they will  likely find no legal protections against such mistreatment.  According to the WBI survey, workplace bullying is four times more prevalent in the United States than illegal harassment.

Myth 7:  Bullying is just part of the medical culture necessary to maintain quality patient care.

According to the ISMP survey, a remarkable 40 percent of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator. Forty-nine percent of respondents reported that intimidation had altered the way they handle order clarifications or questions about medication orders.   Forty percent simply assumed that a questionable order was correct or asked  another professional to speak with  an intimidating prescriber. Seven percent reported being involved in a medication error in which intimidation clearly played a role.

At the release of a Sentinel Event Alert by the Joint Commission establishing a zero tolerance policy, Dr. Mark Chassin, President of JCAHO, stated:  “The Joint Commission has maintained a database of serious adverse events for many years and in continuously analyzing those data, we find that failures of simple communication among caregivers underlie many, many of these adverse events. One of the most important barriers to good communication is the intimidating and disruptive behaviors we’re talking about today.

The ignoble history of tolerance and indifference to intimidating and disruptive behaviors allows this type of behavior to go unchecked.  By giving tacit permission, health care organizations are condoning workplace bullying. At last,  the Joint Commission has insisted  that enough is enough (Note 4) . Safe patient care is dependent on trust, teamwork and a collaborative work environment among caregivers. The space for intimidating and disruptive behaviors shrinks daily for workplace bullies, no matter what their reasons  and no matter who they are. Some have argued that the stress of delivering health care in life or death situations excuses the behavior of bullies. Yes, there are very real stresses in health care because the stakes are high, and health care professionals are often pushed to the breaking point mentally and physically.  But responsible professionals agree that there’s a right way and a wrong way to manage that stress (Note 5).”

Intimidating and disruptive behaviors in no way contribute to quality patient care. Rather, they undermine patient safety and devastate staff morale.

Myth 8:  There is nothing that can be done about bullying in the medical workplace.

Don’t fall into the  trap of believing that  abuse in the medical workplace is a necessary evil that cannot be addressed.  Each of us can make a difference:  First, we can support laws that make health-harming workplace violence illegal.  Second, we can support organizations in establishing and enforcing appropriate policies.  Third, we can pay attention to those around us.  There is safety in numbers and in unity.  Bullies try to divide and conquer in order to exert their will.  We can refuse to participant in their social manipulation tactics.  We can ask questions, insist on answers, and verify facts when coworkers appear to be targeted.  We can support ethical behavior.  We can treat all of our fellow coworkers with the dignity and respect that they deserve.  We as a community can and must demand that our medical workplaces become bully free zones.

Reference Notes:

[1] The Joint Commission Teleconference on Disruptive Behavior Among Health Care Professionals, Wednesday, July 9, 2008.  Contact the Joint Commission to inquire about availability.

[2] The Joint Commission (2008).  Sentinel Event Alert: Behaviors that Undermine a Culture of Safety.  Issue 40: July 9, 2008. Available online:  http://www.jointcommission.org/SentinelEvents/Sentineleventalert/sea_40.htm.

[3] Institute for Safe Medication Practices:  Survey on workplace intimidation, 2003.  Available online: https://ismp.org/Survey/surveyresults/Survey0311.asp.

[4] Intimidation: Practitioners speak up about this unresolved problem (Part I),  ISMP Medication Safety Alert!  From the March 11, 2004 issue.  Available online:  https://www.ismp.org/Newsletters/acutecare/articles/20040311_2.asp.

[5] Gary and Ruth Namie, “The Bully at Work”, Sourcebooks Inc., 2009.

Denise Halverson, PhD, is Utah State Coordinator for the Healthy Workplace Bill Legislative Campaign

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Tags: bullying in medical, Halverson, healthcare workplace abuse, Utah

This entry was posted on Saturday, February 20th, 2010 at 3:04 pm and is filed under Healthy Workplace Bill (U.S. campaign), Tutorials About Bullying. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.