Stopping the Pain: The Role of Nurse Leaders in Providing Organizational Resources to Reduce Disruptive Behavior
Yragui, Nanette, Silverstein, Barbara, Johnson, Whitney, American Nurse Today
As articles ranging from those in American Nurse Today ("Civility starts with you") to The New York Times ("When the Nurse is a Bully") illustrate, disruptive behavior and incivility in nursing are newsworthy topics and for good reason. Disruptive behavior at work can have serious consequences for both nurses and patients such as stress-related physical and mental health problems and increased medical errors.
The Joint Commission has taken notice of disruptive behavior in healthcare and directs accredited organizations to manage unacceptable behaviors and change their cultures. However, hospitals are at a disadvantage in this area because few studies have examined a broad range of organizational resources that may influence disruptive behavior in healthcare.
In this article, based on National Institute of Occupational Health & Safety (NIOSH) funded research, we describe the research results regarding organizational resources (aggression prevention climate, organizational support, supervisor support, coworker support, and supervisor support for work and family) and care provider disruptive behavior in hospitals. We provide recommendations for nursing leaders to build supportive cultures in their organizations to counter disruptive behavior.
Costs of disruptive behavior
Disruptive and hostile actions toward colleagues, hospital personnel, and patients or visitors can occur a handful of times or daily in the lives of nursing professionals. According to the Joint Commission these behaviors can take the form of:
* hostile, angry or aggressive confrontational voice or body language;
* attacks (verbal or physical) that go beyond the bounds of fair professional conduct;
* inappropriate expressions of anger such as destruction of property or throwing items;
* abusive language or criticism directed in such a way as to ridicule, humiliate, intimidate, undermine, or belittle.
These disruptive behaviors affect their direct targets as well as those who are witnesses to the victimization of others. Health researchers have noted that the impact of disruptive behavior behaviors is also costly for organizations. Disruptive behavior and incivility lead to distress among staff, undermine productivity, contribute to low morale and high staff turnover, and result in ineffective, substandard patient care, poor adherence to practice guidelines, medical errors and adverse outcomes, patient attrition, and malpractice suits.
Our study examined the link between organizational support resources and coworker disruptive behavior in psychiatric settings and found that direct-care providers with greater social support experienced less disruptive behavior and fewer negative health and work consequences due to coworker disruptive behavior.
Findings from our study
Our research used a cross-sectional study design that combined standard and validated organizational support questionnaire measures with validated measures of disruptive behavior, health, family, and work outcomes. We collected survey data from 477 direct care providers working at two psychiatric healthcare settings in the Northwest United States. Survey participation was voluntary, and respondents completed the surveys during their work time. Participants were mostly female (58.8%), with the majority in the 40-49 (25.1%) or 50-59 (35.9%) age ranges. Their average organizational tenure was 7.4 years
We analyzed our hospital survey data and found that higher levels of an aggression-prevention climate, and coworker support led to less disruptive behavior among directcare providers. This reflects the significance of organizational support toward countering disruptive behavior and reveals the varied levels within the organization from which this support can be provided.
We also found that higher levels of family supportive supervision led to less disruptive behavior. …