What Does Zero Tolerance of Disruptive Behavior Really Mean?
Do healthcare organization leaders really mean it when they say they have zero tolerance of disruptive behavior? Legal nurse consultants working on medical malpractice cases may hear nurse defendants describe situations of disruptive physicians. Can you relate to this situation?
Let’s say you’re working in an acute care setting at 2:00 in the morning. You’re concerned about your patient and you think, “At this point I need to call the physician.” You look on the on-call schedule and you see that the physician on-call is a physician notoriously known for screaming at nurses, and making them feel like idiots, so what do you say?
“I’m not calling him. He’s nasty.”
Let’s say a new nurse overhears you saying this. You’re influencing the new nurse so that the next time she’s in that situation, she makes the same decision.
Then the patient actually does end up in a crisis. The physician says, “Why didn’t you call me?” That nurse could be liable for that.
Liability for Not Speaking Up
LNCs know the standard of care requires nurses to make decisions based on what’s best for their patients independent of how somebody else might react. Even if somebody is going to scream at you, it’s about you speaking up to protect that patient.
Attorneys are attuned to the concept of going up the chain of command and reporting unexpected changes or concerning symptoms about a patient. The nurse has a responsibility to take action, document the phone call, define what information was conveyed and describe what the physician did. This crucial information is part of many lawsuits in which a patient’s condition deteriorated.
The legal system used to view nurses as the handmaidens of physicians. They didn’t have a critical thinking part of their performance. They basically followed orders, but that type of passive behavior is no longer accepted or endorsed in the healthcare system. Yes, the nurse can get caught up in a case in which a phone call was not made to a physician when it should have been or it could be a nurse practitioner or a physician’s assistant, somebody who is in that prescriber role who has responsibility to take action.
Zero Tolerance for Disruptive Behavior
A small percentage of physicians have disruptive behavior. The vast majority have great communication skills and are responsive to nurses. But if we look at the physicians who bully, often there is a reaction on the part of the healthcare facility administrators who say “This doctor can pick up his practice, go down the street to another hospital and deprive us of all of this influx of patients.” They have been protective of physicians even though their behavior has been disruptive.
The administrators of a healthcare facility may testify in a deposition that they have zero tolerance for disruptive behavior. But exceptions are made in some facilities for physicians because they bring in a lot of money.
That conversation is shifting. There are now more discussions about team dynamics and team communications affecting patient care. It is easier to hold the team accountable for certain behavior and the way they communicate with each other. A lot of strategies involve the team.
Some physicians resist the more to a more collaborative practice, but that is definitely shifting. When zero tolerance for disruptive behavior is the reality everywhere, we will see better communication, better team work, and better patient care.
Check out our podcast by Dr. Renee Thompson: The Corrosive Effects of Bullying in Health Care for more insight into disruptive behavior. Listen to it here.