There is a growing emphasis in healthcare on practices that keep patients safe from harm, medical errors, and preventable adverse events. Most often we think of patient safety initiatives as efforts to reduce the risk of falls, infection, medication dosing errors, and so forth. But the way healthcare professionals interact with each other is also an important factor—which is why collaborative care is an essential foundation to building a culture of safety.
Certain forms of unproductive conflict in the workplace can undermine professional collaboration, which may place patients at risk. These include:
- Lateral hostility (bullying between peers)
- Hierarchal hostility (bullying by a person who has authority over another)
- Verbal abuse, outbursts, yelling
- Passive aggressive acts (ignoring messages, refusing to answer questions, etc.)
- Unprofessional behavior (impatient or condescending attitude, eye-rolling, throwing things, sarcasm, etc.)
Because of their place in the hospital hierarchy, physicians have often been associated with disruptive behaviors, with nurses on the receiving end. But any category of healthcare worker can be involved in these acts, including pharmacists, nurses, administrators, and others. When relationships break down between providers, patient safety is threatened. For example, one survey found shockingly high numbers of providers who reported they had avoided interacting with another provider who was prone to disruptive communication—even to the point of not clarifying vague orders or feeling pressured to dispense a medication despite concerns about its safety. Let’s face it, if you know someone is going to yell at you or belittle you for asking a question or voicing a concern, you are less likely to seek that person out for a conversation. Unfortunately, our patients are at risk when we’re too intimidated to speak up. This holds true whether the intimidating person is another nurse, a physician, or a supervisor.
When conflict, bullying, and disruptive behaviors are left unchecked, nurses may leave their place of employment, or even leave the nursing profession entirely. This can also have an adverse effect on patient care and patient safety, creating a shortage of skilled nurses. Because of this impact on workplace communication and job satisfaction, the Joint Commission requires, as part of its leadership standard, that hospitals have in place both a code of conduct that defines disruptive behaviors, and a process for managing and correcting inappropriate conduct. It states that “There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care. Organizations that fail to address unprofessional behavior through formal systems are indirectly promoting it.” (Note: the Joint Commission has clarified the term “disruptive behaviors” by defining it as “behaviors that undermine a culture of safety.”)
So what does this mean for nurses? It means you should neither accept nor engage in any type of behavior that breaks down professional communication and collaboration. If you are prone to snapping at a less experienced nurse who needs direction, you may be undermining a culture of safety. If you avoid reporting workplace intimidation or harassment, perhaps from a fear of retaliation, you may be undermining a culture of safety. Collaboration is key—and to participate fully in interdisciplinary teams, nurses will need to demonstrate greater leadership abilities. One way to do this is to acquire greater educational parity with other providers, who typically have graduate-level education. When you advance your education through a BSN or MSN program, you are more likely to stand out as a respected member of a multi-disciplinary team and as a capable leader.
Develop your critical thinking skills and empower yourself with knowledge, through an RN to BSN or RN to MSN degree. American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in infection control, case management, and executive leadership.