Skip to main content

Physicians Aren't the Only Problem

 |  By Alexandra Wilson Pecci  
   August 13, 2013

Nurses verbally abused by doctors are more likely to verbally abuse their nurse colleagues, survey data shows. That should make all hospital leaders—not just CNOs—sit up and take notice.

Nastiness breeds nastiness, even among those whose job it is to be caregivers.

That's one of the key takeaways from a study by the RN Work Project, a program of the Robert Wood Johnson Foundation, which surveyed 1,328 newly licensed registered nurses (NLRNs) about how often they were verbally abused by physicians and the nature of the abuse.

The survey uncovered a lot of things that nurses who've been on the receiving end of workplace verbal abuse probably don't need a study to tell them:

  • Verbal abuse makes nurses unhappy at work,
  • Abused nurses are more likely to want to find a new job, and
  • Nurses don't feel particularly loyal to workplaces where such behavior flourishes [is condoned]

But one finding in particular should make all hospital leaders—not just CNOs—sit up and take notice: Nurses who are verbally abused by physicians are more likely to verbally abuse each other.


See Also: Docs to Disruptive Patients: 'You're Fired'


In other words "verbal abuse is contagious," study coauthor Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing at the University at Buffalo, said in a statement. Those nurses who experienced the most frequent abuse also perceived poor collegial relations between RNs and physicians, poor workgroup cohesion, and more work-family conflict.

"Disruptive physician behavior is the issue that just won't go away," says Barry Silbaugh, MD, of the American College of Physician Executives a statement after that group's own report [PDF] was released recently. That's an understatement.

"One potential explanation is that negative behavior exhibited by one member of a group spills over to other members of the group and hurts the group dynamic," Brewer said. "We also see that in a stressful environment, including one in which there is physician-to-RN abuse, there is more likely to be RN-to-RN abuse, as well."

In June, I wrote about another study by the same research team which found that new nurses who are verbally abused by nursing colleagues report lower job satisfaction, unfavorable perceptions of their work environment, and greater intent to leave their current jobs. In that column, I wrote that "if your organization hasn't taken the time to train its nurse leaders in conflict resolution, now's the time to do it." 

But RWJF study shows that training nurse leaders isn't enough, especially when part of the problem appears to be abusive physicians. 

"Physicians' verbal abuse of nurses is a long-standing problem and one we need to do much more to address," Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing at New York University said in a statement.

Like a disease that spreads if left untreated, verbal abuse has the potential to sicken an entire organization, and nurses seem to know this already. Readers of this column have commented online about the "cycle" of bullying and abuse and noted that "cultures which have suffered oppression are highly likely to turn on each other." 

Another reader noted that older nurses who engage in verbal abuse are "often disrespected" themselves, adding, "People who are happy and fulfilled don't usually take on bullying" behaviors. 

In comments about the previous study, the authors say hospitals should implementmandatory organization-wide programs for all employees about the impact of verbal abuse and other disruptive behaviors, as well as zero-tolerance policies. That recommendation obviously applies here, too. And it goes without saying that it should apply to physicians as much as it applies to nurses.

To learn more about disruptive physicians, join the HealthLeaders Media webcastReining in Disruptive Docs: Strategies to Manage Risk and Reduce Turnover on Tuesday, August 27, 2013, at 1:00 – 2:30 PM ET with William "Marty" Martin, MA, MS, MPH, PsyD, CHES and Herdley O. Paolini, PhD, LP.

Alexandra Wilson Pecci is an editor for HealthLeaders.

Tagged Under:


Get the latest on healthcare leadership in your inbox.