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Horizontal Abuse, the Malignancy of Nursing and Healthcare

Posted Dec 23 2008 9:14pm
For many years nursing has had to endure the verbal abuse from physician providers and upon occasion the physical abuse from physician providers such as throwing instruments in the operating room. Unfortunately this type of abuse is still very much present in many healthcare organizations today. While there are several physicians that are professional in their conduct there are many that have spent a career of berating other healthcare colleagues both physicians and nurses alike.

Many a healthcare leader has typically turned a blind eye to complaints from staff about inappropriate or abusive conduct from a healthcare provider, especially if it is a physician. You see physicians are instruments of revenue for a healthcare facility and nurses are an expense.

Recently healthcare leaders have demonstrated a shift in mitigating these acts from providers. The Joint Commission has also just recently come out condemning poor conduct by providers and as of next year (2009), they will be threatening hospitals with losing their accreditation for not acting to resolve poor behavior in the work place. One notable healthcare leader that is getting rid of the so called bullies is Nick Jacobs who is the CEO of Windber Medical Center in Windber, PA. Mr. Jacobs writes his own blog and has come out publically describing is zero tolerance for abusive behavior from providers whether they are nurses or physicians.

Even with the few top healthcare leaders like Nick Jacobs that are drawing the line with provider abuse there is still much that needs to be accomplished to help rid healthcare organizations of those persons that feel the need to yell, intimidate, make belittling comments, or act in an otherwise unprofessional manner with fellow healthcare team members.

While there are several accounts of physician abuse aimed at nurses which is well described in Suzanne Gordon’s book Nursing against the odds, there are countless examples of the same abusiveness towards nurses, from nurses. This cannibalistic behavior has a long history and is rooted in the beginning of nursing when nurses begin their training. Several nursing school instructors have been well known for their less than supportive comments to nursing students.

The healthcare environment is clearly one that is highly stressful and dynamic. Simply put the job is not a cake walk by any means. Sometimes people are on edge, sometimes providers are having a bad day. Be that as it may, it does not excuse those providers from being rude or unprofessional.

The cannibalism of nursing which is well known at all levels of healthcare has a uniqueness about it that transcends the normal or everyday abusiveness that can be fielded from an angry physician. It is far worse. Nurses will gossip, about other nurses. Nurses will purposely not help out their colleagues when they are busy. They will just sit back and watch them struggle. Nurses will periodically try and make things difficult for less experienced nurses. A constant criticism about what another nurse did or didn’t do in caring for a patient becomes the break room gossip. For nurses that have less experience in some clinical areas or are just new there is an enormous amount of criticism and judging made about what a nurse may not be familiar with. Nurses are notorious for gossiping about what other nurses may not know, either from lack of experience or because the procedure or clinical topic is seen infrequently. Nurses are their own worst enemy much of the time.

Today’s healthcare workplace can be difficult. The expectations and requirements that nurses must operate under are significant. Healthcare organizations are being forced to do more with less. It is in nursing’s interest to make a paradigm shift and put away the gossip and the criticism and help each other out. It is time to gang up on the bullies. Healthcare leaders at all levels are pivotal in setting the example and enforcing a work environment that is free of abusiveness. Executive healthcare leaders must be willing to take harsh action against nursing and physician providers that are abusive and if need be revoke privileges to practice despite the impact on revenue. Additionally abusive providers should have their conduct reported to their respective licensing boards so that continued abusive behavior becomes a matter of record. Until healthcare leaders take an interest in the work environment then it is unlikely that today’s healthcare workplace will change much. Healthcare needs more people like Nick Jacobs at the helm who are constantly focusing on improving the healthcare experience for patients and improving working conditions for staff.

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