From the Disputing Blog of Karl Bayer, Victoria VanBuren, and Holly Hayes.
The Journal of Nursing Care Quality published this month the results of a qualitative study titled “Hospital RNs’ Experiences with Disruptive Behavior”. The study describes the different types of disruptive behavior the study group of registered nurses had experienced on the front lines of patient care, identifies the triggers of this behavior, learns how nurses respond to disruptive behavior and identifies the impact of this behavior on the individual and the organization. Data was gathered through focus groups conducted with registered nurses (RNs). You may purchase the article here.
Types of Disruptive Behavior
Three themes of disruptive behavior emerged: incivility (described as rude or disrespectful behavior), psychological aggression (for example: intimidation, professional disregard or verbal aggression) and physical violence.
Triggers of Disruptive Behavior
Nurses were asked to identify the triggers of disruptive behavior and three themes emerged: intrapersonal triggers (occurring within the individual — for example, lack of competency or fatigue), interpersonal triggers (occurring between two people — for example, the use of status to control others or communication issues resulting in a lack of information to care for a patient), and organizational triggers (systems, processes or culture of an organization — for example, high census or patient flow issues).
Intrapersonal triggers were reported as the main reason for disruptive behavior. For these triggers, corrective action for the disruptive behavior often lies within the individual and requires a recognition of how the individual’s internal state contributes to the disruptive behavior. The low frequency of interpersonal triggers was an unexpected finding considering the importance of communication and teamwork in the delivery of patient care.
Response to Disruptive Behavior
Study participants identified three categories where they addressed disruptive behavior in a positive way: address the conflict constructively, analyze the situation and seek support for the behavior. Nurses on one patient care unit developed a constructive strategy by creating a penalty flag that team members could use when disruptive behavior was occurring to call a time out. This was described as empowering the staff to develop norms for acceptable behavior. Another study participant described how she steps back from the conflict and analyzes the event to help develop personal strategies for addressing these behaviors in the future. Nurses also described asking for support from peers, managers, staff assistance programs, or security or by using the organizational chain of command to deal with disruptive behavior.
Impact of Disruptive Behavior
“Disruptive behavior affects the RN, patient, and practice setting. The nurses described impacts such as being distracted from patient care, taking a physical or emotional toll on them personally, and creating conflicts for them between meeting patient care needs and meeting the operational needs of the hospital. They also expressed concerns that disruptive behavior can decrease the quality of care, create risks to patient safety, delay the delivery of care to patients, and disrupt working relationships among team members.”
Nurses also discussed the impact of disruptive behavior on retention. Forty-eight percent of participants said they knew a nurse who transferred to another unit or department because of disruptive behavior and thirty-four percent said they knew nurses who had terminated their employment because of disruptive behavior.
The authors of the study, Jo M. Walrath, PhD, RN; Deborah Dang, PhD, RN, NEA-BC; and Dorothy Nyberg, MS, RN are developing a survey instrument to be “used to conduct a systematic organizational assessment to establish the prevalence of disruptive behavior in the organization and the triggers, responses, and impacts of this behavior on RNs. Findings from this organizational assessment will ultimately determine the nature and type of interventions that will be designed, implemented, and evaluated to effectively manage this phenomenon.”
For more on disruptive behavior in health care, read our previous post here.
Reference: Jo M. Walrath, PhD, RN; Deborah Dang, PhD, RN, NEA-BC;Dorothy Nyberg, MS, RN. Hospital RNs’ Experiences With Disruptive Behavior A Qualitative Study. J Nurs Care Qual. Vol. 25, No. 2, pp. 105–116.