No tolerance for bullies

Bad behaviors are well known in childhood or school settings but unfortunately these behaviors are not isolated from hospitals, other health care settings or even the nursing practice.

While only a very small percentage of individuals pose a problem, the actions result in profound effects within an organization. Types of disruptive behaviors such as criticism, withholding information, verbal abuse, throwing items, or clique formation affect staff morale, nursing and staff retention, and often lead to risks in patient safety and medical errors. Emerging research suggests there is a history of tolerance and indifference of these types of behaviors in health care that should be addressed. Typically, individuals that choose a health care profession, such as nursing have a strong desire to care for others.

Effective communication is an essential component to health care. Delivering safe and high quality care requires a system and environment which emphasizes respect for everyone. For example, imagine a nurse that notices a change in a patient’s condition but the last time a change was noticed and reported, the physician dismissed the concerns and criticized the nurse for calling. Or, the night nurse is concerned that the patient’s condition has deteriorated and notifies the resident in charge only to be told that they will manage the patient until morning, but before morning the patient codes and is transferred to intensive care when an earlier intervention may have averted this situation. Intimidation or negative behaviors are not isolated between the nurses to physician interaction and are often found to be a part of the nursing culture in how nurses treat other nurses.

While The Joint Commission, commonly referred to as TJC, plays a significant role in health care organizations as an accrediting body, TJC is also committed to improve the safety and quality of care by providing standards, evaluations and sentinel event alerts. The new leadership standards requirements that addressed inappropriate behaviors became effective Jan. 1, 2009. During the evaluation of the policy, it was evident in the Children’s Mercy Code of Conduct and Shared Values statements that characteristics of positive behavior were highly valued. Through the coordinated efforts of highly motivated individuals at Children’s Mercy, the policy was updated with a process for addressing intimidating and disruptive behaviors that integrated input and provided for representation of medical and nursing staff as well as administration while incorporating a zero tolerance position.

As part of Children’s Mercy’s efforts to promote and provide safe patient care, the new administrative policy titled Managing Disruptive Behavior was created and approved by administration and medical staff but is also demonstrated and supported in the Code of Conduct and Shared Values Service Excellence organizational policies.

Ginny Boos, RN, serves as Clinical Safety Officer at Children's Mercy Hospital.

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