A prominent doctor and nurse agree with the accuracy of a recent survey showing that significant behavior issues still exist between healthcare professionals, but they disagree over the extent of the problem and the progress that has been made in solving it.
Behavior problems—such as degrading comments, yelling, cursing, inappropriate joking and refusing to work with one another—were reported by more than 97% of the nurses and doctors who participated in a recent American College of Physician Executives survey. The 2009 Doctor-Nurse Behavior Survey results paint a picture of “treachery and backstabbing” as doctors and nurses try to undermine each other, often right in front of bewildered patients, according to the ACPE. The organization e-mailed the survey to some 13,000 nurse- and physician-executives, with roughly a 67% to 33% split between the two factions who got surveys; 1,428 nurses (67.2% of respondents) and 696 doctors (32.8%) responded between July 9 and Aug. 10.
The survey was sent to all ACPE members and all members of the American Organization of Nurse Executives, which is a subsidiary of the American Hospital Association.
“It's hard to argue that, when you have a survey that large, the results are wrong,” says Bruce Van Cleave, M.D., chief medical officer with Aurora Health Care, a 12-hospital system based in Milwaukee. “But there is a danger that it creates a perception that it's much more common than it really is.”
Frequency of behavior problems is mixed, with 30.9% of the survey respondents saying they occur “several times a year,” and 30% saying weekly; 25.6% monthly; 9.5%, daily; 2.9%, once a year; and 1.2%, less than once a year.
“The trend, over my career of 30-plus years, is that the communication level and teamwork have gotten much better,” Van Cleave says. “There is greater awareness now. There was time in the past when things got ignored.”
In addition to those mentioned above, other complaints included refusing to speak to each other, spreading malicious rumors, trying to get someone unjustly disciplined or fired, throwing objects and sexual harassment. Actual physical assaults, however, were reported by only 2.8% of the respondents.
“It doesn't surprise me at all, because there's a long history of having to deal with physicians who are less than polite,” says Deborah Burger, co-president of National Nurses United.
“In some areas, it seems to have gotten better, and I think things are starting to move in a positive direction, and then you see some situation or event and you think, ‘Nope, it's not.' ”
When asked who most often exhibits behavior problems, 47.9% of survey respondents said it was an even mix, 45.4% said doctors and 6.8% said nurses. Also, 61.2% reported having nurses terminated at their organization for behavior problems, while only 22.2% said the same of doctors.
According to Van Cleave, communication problems are at the root of the problem, and recognition of problems is the first step taken toward fixing them.
“It is difficult in healthcare to get everyone to communicate effectively and efficiently,” Van Cleave says. “I think there is a hierarchy problem in healthcare we have to work on because sometimes hierarchy can interfere with getting the right care to patients.”
Van Cleave is an advocate of the SBAR communication method, which is short for: situation, background, assessment and recommendation.
“With SBAR, you teach folks a pattern of communication, so you say what needs to be said,” Van Cleave says.
Although demographics are changing, most physicians are still male and most nurses are female, and Van Cleave says some problems could merely be a result of typical “men are from Mars, women are from Venus” differences in communication.
Burger disagrees strongly on that point.
“It's not a male-female thing,” Burger says. “I've seen female physicians be just as vocal, rude and intimidating as any male doctor.”
Burger, a nurse for 35 years and currently a staff nurse in gastroenterology at 117-bed Kaiser Permanente Santa Rosa (Calif.) Medical Center, did agree that hierarchy plays a role—-as does physician training.
“They're told their judgment isn't to be questioned—it isn't in any class, but it's in their culture,” Burger says, while nurses are taught to be a patient's last line of defense and to speak up if they see something wrong. But when nurses do prevent an error from occurring, Burger says, physician reaction can be the opposite of what's expected.
“It should be, ‘Thanks for saving my ass,' but instead the nurse gets blamed somehow,” Burger says. “It seems to be interwoven in the fabric, so how do you pull out that thread? I don't know.”
According to the survey, the most common complaint involved degrading comments or insults, with 84.5% (1,493) of the respondents reporting that this happened at their organization. Yelling was the next-most common, at 73.3% (1,294). A degrading comment highlighted in the survey was a physician telling a nurse: “You don't look dumber than my dog. Why can't you fetch what I need?”
“It's really kind of sad,” Burger says. “I don't know any other business where this type of behavior is tolerated among colleagues—except maybe the legislature.”
Van Cleave says modeling good behavior at the highest level of the organization is vital, and he leads by example in displaying a cooperative and nonadverserial relationship between Aurora's physician and nurse leadership.
Problems can occur, Van Cleave says, “if people are not presented with the right types of role models as you tend to do what your boss does. There's a saying ‘Your actions speak so loudly, I can't hear what you're saying.' ”
Submit a letter to the Modern Physician Reader Blog. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.