Do doctors, nurses, and other practitioners get along?

There are consequences when healthcare practitioners don’t get along with each other.

According to The Joint Commission, intimidating and disruptive behaviors between doctors, nurses, and other practitioners can lead to medical errors, increasing healthcare costs, and even harm to patients.

But is this an actual issue in facilities across America? We looked into it. Here’s what we found.

What the data says

Unfortunately, data on medical professionals getting along isn’t very encouraging.

The Institute for Safe Medication Practices (ISMP) interviewed 4,884 medical professionals in 2013 on disrespectful behaviors in the workplace. Though most of those interviewed were nurses (68 percent), they also spoke with pharmacists, physicians, and several other kinds of healthcare professionals.

Here are some of their findings:

• 77 percent encountered reluctance or refusal to answer questions or return calls at least once, with 13 percent experiencing it often
• 73 percent encountered negative comments about colleagues or leaders at least once, with 20 percent experiencing it often
• 69 percent encountered impatience with questions or hanging up the phone at least once, with 10 percent experiencing it often
• 68 percent encountered condescending language or demeaning comments or insults at least once, with 15 percent experiencing it often
• 66 percent encountered reluctance to follow safety practices or work collaboratively at least once, with 13 percent experiencing it often

Behaviors encountered less frequently include: shaming, humiliation, or spreading malicious rumors (46 percent); insulting or slighting an individual due to race, religion, or appearance (24 percent); thrown objects (18 percent); and physical abuse (7 percent).

Physicians and other prescribers engaged in these disrespectful behaviors more than anyone, though the study found people in all sorts of roles committed these acts. Typically, respondents experienced these behaviors from more than one person, and by people of both genders.

ISMP did this same study back in 2003 and there has been little improvement in that decade. Other studies over the years show similarly grim results.

Why this happens

According to part II of that 2013 ISMP study, there are many reasons why these disrespectful behaviors happen in healthcare facilities.

Some of the reasons include: the stressful nature of the environment; systemic failure; personal frustrations or current events influencing mood; anxiety and depression; insecurity; cultural, generational, and gender biases; substance abuse; mental illness; differences in communication styles; a sense of autonomy; and hierarchy in healthcare.

These behaviors persist because healthcare organizations fail to address them, the study stated. There are many reasons they ignore the problem, including a fear of retaliation, the stigma associated with whistleblowing, a lack of awareness, not wanting to lose a high-revenue-earning practitioner, and simply not knowing how to fix it.

With only a quarter of the study’s respondents saying their organization dealt effectively with disrespectful behavior, it’s clear that systemic change needs to happen soon.

How to personally fix this

There are things both individual practitioners and facilities can do to help fix the issue.

For individual healthcare professionals, when faced with disrespectful behaviors by a colleague, there are a number of things you can do.

According to Stephanie Stephens on Monster.com, it’s important to: keep a calm tone; not gossip about the situation to coworkers; find out the workplace policy or suggest creating one if it doesn’t exist; talk to the person yourself; acknowledge and empathize with the person’s daily stressors; or call in a trained expert if the issue persists.

Nick Angelis, BEHAVE Wellness co-owner, told Stephens in the article that it’s best not to run to HR at the first sign of trouble. 

“A hospital wants peace and uninterrupted revenue flow more than justice and equity for all,” Angelis said. “Privately telling the physician you didn’t appreciate their words and mannerisms works better than a public challenge.”

Of course, this varies by facility. Some facilities have great systems in place for reporting these behaviors, which is why it’s important to know the policies that are in place.

How to institutionally fix this

On an institutional level, facilities should undergo a number of actions to treat and prevent disrespectful behaviors in the workplace.

According to ISMP, there are eight phases that need to occur for addressing disrespectful behaviors, with steps within each phase. These include:

I. Set the stage

• Establish a committee that establishes an action plan of resolving each behavior.
• Establish a “no retribution” policy.
• Open the dialogue about disrespectful behavior via surveys and focus groups.

II. Establish a code of conduct

• Create a code of conduct (or code of professionalism) that identifies a model of interdisciplinary collegial relationships and collaboration, clearly articulating acceptable and unacceptable behaviors.

III. Establish a communication strategy

• Establish a standard, assertive communication strategy for healthcare staff in charge of conveying important information, which states the problem along with its rationale and potential solution.

IV. Manage conflicts

• Establish an escalation policy to manage conflicts about the safety of an order when the standard communication process fails to resolve an issue.

V. Establish interventions

• Develop an intervention policy that includes zero tolerance for disrespectful behaviors regardless of the offender’s standing in the organization, fairness to all parties, consistency in enforcement, tiered response to infractions, a restorative process to help people change their behavior, and surveillance mechanisms.

VI. Train staff

• Provide mandatory hospital-wide education for all staff about appropriate professional behavior and how to address, report, and resolve disrespectful behavior.

VII. Encourage reporting/surveillance

• Implement a confidential reporting/surveillance program for detecting disrespectful behavior and measuring compliance via a reporting program.

VIII. Create a positive environment

• This includes a fair and just culture, respectful management of serious adverse events, transparency, and visible leadership commitment to a respectful culture.

This is, of course, just one way of going about it, but it’s proven effective for many facilities.

The consensus

It’s unfortunately clear that healthcare professionals often don’t get along with each other. From refusing to answer phone calls to flat-out physical abuse, disrespect runs rampant in hospitals across the country. And it’s not just doctors mistreating nurses: It’s everyone.

We’ll be one step closer to unity if facilities create and enforce policies that crack down on disrespect in the workplace, individual healthcare professionals who are being disrespected follow the tips we just outlined, and everyone practices empathy. Until then, the problem will continue to spiral out of control. 

Everyone must work together to end the disrespect and get along.