THURSDAY, June 6, 2002 (HealthDayNews) -- Physicians who scream, curse, throw surgical instruments, or exhibit other bad behavior may be at least partly to blame for the nation's growing nursing shortage.
Communication -- or the lack of it -- between hospital staff physicians and nurses has a direct effect on the nurses' job satisfaction and whether they decide to stay or leave, according to a new survey just published in the American Journal of Nursing. The survey, which will be ongoing, found that an overwhelming majority of those surveyed had witnessed disruptive behavior by doctors and that almost one-third knew a nurse who had left as a result.
The report analyzed 1,200 responses from nurses, physicians, and hospital executives who were asked about physician-nurse relationships, disruptive behavior by physicians, how institutions manage such bad behavior, and how nurses respond in terms of job satisfaction and morale and whether they stayed or left.
The findings are of interest not only to health-care professionals, but also to consumers, particularly since a recent study published in the New England Journal of Medicine found that the more contact patients get with registered nurses, the better they do health-wise.
And it's now clear that physicians can drive away nurses by their actions and words, says Dr. Alan H. Rosenstein, the medical director of VHA West Coast in Pleasanton, Calif., who conducted the survey. His outfit is a regional division of VHA, a national network of community-owned hospitals and health care systems.
"The data now shows that disruptive behavior [by doctors] is an important factor in whether nurses stay on the job or resign," he says.
And while hospital leaders may think they are controlling the problem, Rosenstein adds, the survey suggests that's not so. "Administrators thought they were supportive of managing conflict. But nurses and doctors ranked administrative support as low."
When asked whether doctors value nurse input, the average ranking of all respondents was a 6.15 out of a possible 10. (The first 1,200 respondents include 720 nurses, 173 doctors, 26 administrators and 281 who did not identify their jobs.)
Disruptive behavior by physicians had been seen by 92.5 percent of respondents. They cited yelling, raising of the voice, condescension, abusive language, and the berating of colleagues or patients.
Sometimes it's even worse, as Diana J. Mason, the journal's editor-in-chief and a former practicing nurse, notes in an editorial accompanying the article. She recounts her tale of a surgeon who would throw his instruments at nurses if the operating room temperature wasn't to his liking.
One other eye-opening finding, Rosenstein says, was that more than 30 percent of those surveyed knew of a nurse who had left a hospital because of such disruptive behavior.
This strongly suggests that the quality of nurse-physician relationships must be addressed to improve nurse retention and alleviate the shortage, he adds.
Citing American Hospital Association estimates, Rosenstein says there are approximately 126,000 nursing positions currently unfilled in the United States. Two days ago, the U.S. Department of Health and Human Services awarded more than $30 million in grants to increase the number of qualified nurses and help ease what it called the emerging nursing shortage across the country.
So what's behind the bad behavior revealed in the new survey?
The personality of the physician plays a role, says Rosenstein, noting that physicians in some specialty area -- heart or brain surgeons, for example -- have a reputation for being more difficult to get along with than others.
The stressful environment inherent in health care also plays a role. "If the physician is under stress and a nurse is under stress, it's almost a set-up for disruptive or dysfunctional interactions," he says.
Physicians-turned-administrators aren't surprised by the survey findings. "When I became chief of staff in October 2000, I was told by my former chief of staff that the toughest part of my role would be in dealing with physician behavior," says Dr. Richard Doering, a former chief of staff who is now a physician on staff at Hoag Memorial Presbyterian Hospital in Newport Beach, Calif.
Since then, Doering has set up what is viewed by Rosenstein and others as a model zero-tolerance program, one that Rosenstein hopes other facilities will replicate.
First, Doering created a document spelling out how physicians should treat nurses and how all employees should relate to each other, emphasizing a team approach.
They began inviting nurses to medical staff meetings and to give more recognition to nurses for jobs well done. But the real key, Doering says, may have been the "doctor of the month" program he launched, in which doctors who made an effort to communicate and work as partners were recognized by having their photo and a write-up displayed in the hospital.
Suddenly, he recalls, some of the worst-behaved physicians shaped up, hoping to gain the vote of nurses and other employees, and some actually became doctor of the month.
While there are no formal statistics yet on whether the new program has decreased the nursing turnover rate, Rick Martin, Hoag's chief nursing officer and vice president of patient care services, says nursing students and new hires are often telling him how supportive the staff doctors are.
Among the recommendations suggested to Rosenstein by those who took the survey were to open up communication, as Doering did, by such measures as disseminating a code-of-conduct policy.
Some of the physicians surveyed also suggested that disruptive behavior is sometimes a two-way street.
"Doctors will tell you, 'I got a call from a nurse in the middle of the night and she hadn't read the progress notes,'" Rosenstein says. "Sometimes disruptive behavior was initiated by the nurse being disruptive by not having the proper information."
In her editorial, Mason agrees that nurses must take responsibility,
too. Miscommunication is an issue across the board, she says, and improving
communication will benefit not only physicians and nurses, but also patients.
"The public ought to care [about the issue] because how doctors and nurses
communicate has an effect on patients," she says.
What To Do
For more information on the nursing shortage, see the American Association of Colleges of Nursing, this special report from CNN, or this one from Nurse Week.
