1. The Eye of the Tiger Disruptive Physician Behavior Staring into

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

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

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

5. Intimidation Or Violence

6. Inappropriate Comments or Sexual Harassment

7. Inappropriate Responses

8. Respect

10. One of four respondents observed disruptive physician behavior weekly or monthly

11. South Dakota? Nearly one in two!

12. 83% of the nurses said it was a nurse!

13. 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%

14. 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%

15. 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

16. YES 99% Potentially negative effect on outcomes?

17. Stress Impaired MD-Nurse Relations Decreased Communications

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

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

20. Have A Policy Follow The Policy

21. “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. ”

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

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

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

27. 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

29. Disordered Personality or Personality Disorder

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

31. Blaming others Fosters chaos Obstructionism Sarcasm Making Excuses Lying

32. “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 “

33. D ominance I nfluence S teadiness C onscientiousness

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

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

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

37. 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

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

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

40. Rushing into business Being domineering Forcing them to respond quickly AVOID

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

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

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

44. Expediter Communicator Administrator Planner

45. Direct Life Style Grid ® Indirect People Task ExpediterCommunicator Administrator Planner

46. Usual + Needs - Stress MetUnmet

47. 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

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

49. 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

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

51. 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

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

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

54. What Should You Do? Identify DocumentReport

55. 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…

56. Thank you! Stephen Lazoritz, MD staphen@lazoritz.com www.lazoritz.com