The Eye of the Tiger Disruptive Physician Behavior Staring into

Witnessed? Have You Ever Witnessed Disruptive Physician Behavior Of nurses it was 95%

“I know it when I see it” Supreme Court Justice Potter Stewart defining obscenity

Disruptive Physician Behavior Personal Conduct, whether verbal or physical, that affects or potentially may affect patient care negatively AMA 2004

Intimidation Or Violence

Inappropriate Comments or Sexual Harassment

Inappropriate Responses

Respect

One of four respondents observed disruptive physician behavior weekly or monthly

South Dakota? Nearly one in two!

83% of the nurses said it was a nurse!

In a study of 1168 nurses, What percentage said that they had been verbally abused by a physician? D) 97% A) 12% B) 23.5% C) 50 % D) 97%

What percentage of nurses said that they had left a position due to physician behavior issues? A) 5% B) 15% C) 30% D) 42% C) 30%

On a scale from 1 to 10, how important is disruptive physician behavior as a contributing factor to nurse dissatisfaction? which was the highest score in the survey 8

YES 99% Potentially negative effect on outcomes?

Stress Impaired MD-Nurse Relations Decreased Communications

“Leaders must address disruptive behavior of individuals working at all levels of the organization………” Standard LD.3.10

The hospital has a code of conduct that defines acceptable and disruptive and inappropriate behaviors.

Have A Policy Follow The Policy

“Little is done. There is generally an acceptance of this behavior and the RN is given little support or protection. Although this is a harsh comparison it rings true: Rape victims don't report because they are made to feel they brought it on somehow and fear retribution. Nurses don't report because they are made to feel they brought it on somehow and they fear retribution. ”

“I have tried to report disruptive behavior in the past and nothing changed except increased aggressive behavior targeted at me personally.”

“I know a lot of nurses that do not report disruptive behavior because they feel as if it won't do any good. ”

Define expected behavior Define unacceptable behavior Describe when to report the behavior- reporting is expected! Characteristics of a good Policy:

Unequivocally state that retribution will not be tolerated Describe the process of dealing with the behavior- progressive Describe options available And, an important element for getting this done is………………… Describe how to report the behavior

Disordered Personality or Personality Disorder

Grandiose sense of self importance Lacks empathy Arrogant Believes that they are “special

Blaming others Fosters chaos Obstructionism Sarcasm Making Excuses Lying

“Ego and wanting to feel superior to others even the patient care is jeopardized” “It's a little of perfectionism and "my way or the highway" attitude” “Disrespect for RN role” “Both perfectionism and stress, with maybe some "God" complex “

D ominance I nfluence S teadiness C onscientiousness

Be specific, clear, brief and to the point Stick to business Be prepared with support material Expect them to be blunt Be confident

Talking about things that are irrelevant to the issue Leaving loopholes or cloudy issues Appearing disorganized Challenging them AVOID

Provide a warm and friendly environment Don’t deal with a lot of detail Ask “feeling” questions

Expect them to stray off the topic and be talkative Make them the center of attention Gently bring them back when they veer off on tangents

Being curt, cold or tight lipped Controlling the conversation Driving on facts and figures AVOID

Begin with a personal comment Present your case softly Ask “how” questions

Rushing into business Being domineering Forcing them to respond quickly AVOID

Prepare your case in advance Stick to business Be accurate Provide written data Answer their questions with facts

Being casual, or informal Pushing too hard Unrealistic deadlines Being disorganized Touching them AVOID

Remember: Each one of us is a composite Seek to understand Communicate more effectively

Expediter Communicator Administrator Planner

Direct Life Style Grid ® Indirect People Task ExpediterCommunicator Administrator Planner

Usual + Needs - Stress MetUnmet

Stress Behavior is: Defensive and negative in nature Seen as negative and unacceptable by others Inflexible Uncomfortable but natural and normal Hard to modify but controllable

Needs Stress Be logical and direct Plenty of to do Directive Scheduling Encourage Group Interaction Impatient Unfeeling “Busy” Ignores individuals Pushy

Needs Stress Encourage an Organized approach Offer an environment of trust Be consistent Specific direction/control Insistent on rules Resists change Rigid Reluctant to confront others

Needs Stress Encourage competition Broad scheduling Allow flexibility Give Varied activities Individual approval Defined authority Distracted Distrust Others Domineering Aggressive Ignores plan

Needs Stress Offer individual support Encourage expression of feelings Time for refection Direction by suggestion Ignores social convention Indecisive Sees worst possibilities Hard to take action

Fold Them Drug or Alcohol user Serious breach Patient safety issue Personal issues

Patient care is always first Factual statement of the behavior How it made you feel when this happened

What Should You Do? Identify DocumentReport

Nurses are the most frequent target of disruptive physician behavior There must be a culture where disruptive behavior is NOT tolerated Yesterday’s professionals may have accepted disruptive physician behavior, but…

Thank you! Stephen Lazoritz, MD