Workplace Bullying Contributes to Medical Malpractice

By Kristin Hayes, About.com

If you’ve never heard the phrase, “Nurses eat their young.” it’s only because you haven’t spent enough time around nurses. What does this mean? Well to be frank, there’s a lot of emotional abuse that can go on in the world of medicine. As a nurse you can often expect a good tongue lashing from your colleagues if you make a mistake, or even if you haven’t. This kind of emotional abuse, or workplace bullying, can come from other nurses, doctors or other health care professionals including pharmacists and respiratory therapists. Bullying behaviors include verbal abuse, the refusal to answer questions or take suggestions, refusal to answer pages, and even threatening physical behavior. Targets are not always wrong, are often in fact right, are often quite intelligent, and unfortunately can be intimidated to the point that they stop contributing and collaborating with the medical team which in turn can lead to poor patient care and even malpractice.

For example, imagine a nurse discovers that a doctor has made a grave error. This doctor frequently yells at her and she is intimidated by him. He has worn down her self-esteem to the point that she questions her own judgment. Rather than voice her opinion and subject herself to more emotional abuse the patient is misdiagnosed and a life threatening illness goes untreated.

According to the Joint Commission (JACHO), an organization which accredits hospitals throughout the U.S., of roughly 5,000 sentinel events (events which resulted in patient deaths or severe injury as a result of malpractice) 70 percent were caused by poor communication between staff members and a leading cause of poor communication is workplace bullying. In an ISMP Survey 49 percent of health care professionals said that intimidation had altered the way they handled order clarification or questions about medication orders.

Unfortunately, workplace bullying is accepted by many medical professionals as an inevitable part of the profession. Few of us have not been involved in workplace bullying personally or not witnessed it. Because we work in a high stress environment we are often pushed to the breaking point and although highly dysfunctional some of us take our stress out on fellow employees. Many bullies are in the upper levels of administration or physicians who bring in high revenue so companies do not feel that punishing the behavior is beneficial. Little do they know that some sources claim bullies to be extremely expensive, costing hospitals over a million dollars per 50 employees in turnover costs per year.

According to the Zogby International Survey bullies are punished only 23 percent of the time and 62 percent of employers actually ignore the problem. But, while the problem has been largely ignored by hospitals JACHO has had it with bullies. In 2009 they started requiring all accredited hospitals to issue a code of conduct – guidelines to prevent and help to remedy workplace bullying.

It’s been a long time since I’ve been the target of bullying, but as a new nurse almost ten years ago a subordinate nurse became so angry with me over a call I made on a patient that she grabbed a chart out of my hand and threw it. I never told anyone, instead I quit. Despite a witness management never learned of this nurse’s behavior. Fortunately this confrontation was not a result of and did not result in a poor patient outcome. I firmly believe that this nurse was not concerned about the patient (she certainly did nothing constructive to help the situation) but upset that a nurse that she had trained less than two years earlier (me) had risen to a superior position. Bullying is seldom about the victim and often about the bully’s own inadequacies and low self esteem. As I’ve grown older and wiser I’ve learned to be assertive. I don’t hesitate to write up physicians who behave inappropriately. When a charge nurse refused to heed my warnings about a patient’s deteriorating condition I moved up the chain of command until I found someone who would listen. And, if I see a colleague being bullied at work you better believe I’m going to speak up. Bullying is dangerous to patients and employees but I am hopeful that media attention and the efforts of JACHO will reduce the incidence of workplace bullying.

If you’re concerned about workplace bullying and its effect on medical malpractice please bring this information to the attention of your family and loved ones who are a part of the medical profession.