Clint Maun, CSP

Dealing With Verbal Assaults From Physicians
Take note of the strategies below:

• Set Limits. If you feel that a physician is being abusive, firmly tell them, "You're being disrespectful toward me. Don't talk to me that way!"
• Recruit Support. It's called safety in numbers. Plain and simple, you'll feel less vulnerable to attacks if surrounded by trusted colleagues. Some facilities have a special "code" when a co-worker is being verbally abused. When that code is triggered, all come to stand by the healthcare professional in support.
• Leave. If you feel that you might break down, or retaliate in an unprofessional manner, leave the room. You do not have to remain and endure unacceptable behavior.
• Be Professional. Never allow a physician to verbally attack you in front of a patient.

Perhaps you were around to experience it in person, or maybe you’ve heard about it second-hand—but as you know, there was a time when physicians basically treated nurses like handmaidens. And while great progress has occurred in regards to the nurse–physician relationship, there is still room for improvement.

A recent survey conducted by Manderino and Berkey revealed that 90% of staff nurses had experienced verbal abuse by physicians within a one-year time span. The subjects of these studies reported disrespectful treatment, criticism, attacks, and unfounded accusations from physicians. In their own words, nurses said that they were "lambasted," "thrashed," "picked on," "belittled," and "lectured."

According to a study published in the American Journal of Nursing, the quality of nurses' daily interactions with physicians has a major impact on their job satisfaction. Furthermore, the study found that disruptive physician behavior (any inappropriate behavior, confrontation or conflict, including verbal abuse), as well as institutions' responses to it, is a chief factor in nurses' morale and their decision to leave their positions.

While the research above seems to point the finger at physicians, it’s not the intention or solution to paint them as the villains. Much of this research shows that problems associated with the nurse-physician relationship are due to ineffective communication—on both sides.

No doubt about it, healthcare professionals work in a stressful, high-paced environment, and sometimes they take shortcuts in communicating because they just want the job done. While taking the shorter road may seem like an acceptable idea at the time, it’s likely that everyone will suffer as a result. For example, maybe a nurse is reluctant to call a particular physician because of a lecture or negative reaction he/she fears they might receive. When staff chooses not to call on the physician they are putting the patient at possible risk, and face even further reprimands from the physician if he/she later finds out that they weren’t called.

Feelings of anger and helplessness are understandable when a physician’s attacks is unexpected and/or unfair. However, healthcare staff must learn to cope effectively with doctor’s temperaments, not only to preserve their own self-esteem but also to prevent consequences to the patient. The illustration mentioned above is more than purely hypothetical—researchers have found that when doctors acquire a reputation for tantrums, nurses hesitate to call them about a patient or even make suggestions about the patient's care.

Maintaining a healthy nurse-physician relationship is more than just making everyone feel “warm and fuzzy” inside. It’s a serious matter. Patients’ lives and the organization’s reputation are at stake. Below are some strategies to help foster a professional as well as positive nurse-physician relationship:

Collaborate through open forums, group discussions, and workshops. For example, a small team of physicians and nurses can meet on a regular to describe what they feel is inappropriate behavior. At the meetings, members can discuss hypothetical situations that have the potential to cause conflict. For example, it could be brought up that when a doctor doesn’t respond to a nurse’s page, then that nurse feels disrespected. Or perhaps a situation could include a nurse disagreeing with one doctor’s plan of care and then calling another to alter it—this would be an example of an RN being disrespectful to the physician. Talking through these types of scenarios will not only help decide what the best plan of action would be, but it will also help members see from different points of view.

Provide training and education. Making resources available for nurses and physicians to improve teamwork and working relationships is critical. Many nurses could benefit from developing increased skills in assertiveness, bargaining, and negotiating. Perhaps subsidizing certain classes at a community college would be a worthwhile investment for the organization. Classes in speech or debate techniques can be helpful in learning how to mount an argument and deliver it persuasively. If formal classes are out of the question, bring informal education in-house. Perhaps your organization could rent a video camera. Individuals who are interested can then be videotaped doing various tasks, such as making a speech, reacting to a hypothetical situation, etc. These students could then watch themselves and learn what distracting mannerisms and habits they possess which ultimately undercut professional effectiveness.

Create/revise policy as needed. Establish a zero-tolerance policy for disruptive behavior by physicians and nurses. Let it be known that disruptive behavior will not be tolerated. Ensure that the proper procedure is in place, so that staff can fill out reports documenting any inappropriate incidents. Creating a committee to investigate complaints and take action may be a good idea. This committee should have the authority to oversee complaints as well as have the power to suspend staff, revoke their hospital/facility privileges, and report them to the state licensing board, if necessary.

Anger and conflict will always be present in the stressful healthcare delivery environment. However, intelligent management is possible. Positive working relationships with physicians, administrators, nurses, or other members of the healthcare team increase employee satisfaction, providing for a happier, more productive workplace. Above all, it’s important that each and every healthcare worker plays their part in creating this type of positive environment and ultimately, a more powerful profession.

References:

Am J Nursing. 2002;102(6):26-34
Dermatol Nurs 15(4):351-357, 2003
Nursing Forum, 31(3), 4-15.
Nursing Forum, 31(1), 22-33.
Western Journal of Nursing Research, 13(1), 97-109.