Personal conflicts are inevitable among co-workers. So why should a risk manager get involved? Consider the following examples of how those conflicts directly affected patient safety. These are real responses to a confidential survey1:
- "The environment of hostility and disrespect is very distracting and causes minor errors. I have caught myself in the middle of mislabeling specimens after confrontations that have been upsetting."
- One nurse wrote that when a patient was brought to her unit for gastrointestinal bleeding, the patient saw a doctor yelling at nurses. The patient asked if that was his doctor and was told yes. The patient refused treatment and was transferred to another hospital.
- Another nurse wrote that a doctor "became angry when RN reported decline in patient’s condition and did not act on information. Patient required emergency intubation and [was] transferred to ICU. This caused family much unnecessary heartache and disruption in family grieving process."
- "In the past year, Dr. X (a female physician) has chosen to be argumentative, demeaning, and rude, not just to nurses but to [physician] colleagues. We are all a team, but unfortunately, patient care and morale have suffered. Nurses are afraid [and] intimidated to talk to Dr. X and delay that for as long as possible, sometimes avoiding Dr. X all together. I want to work in an environment where we, as a team, set patient goals and achieve them together.
- "Physicians who are disruptive are usually chronic disrupters and have run-ins with several nurses. There are also nurses who are chronic disrupters. These people are often avoided by other staff, which leads to lowered communication. I am sure that a serious incident is just around the corner."
- "Employee stress as a result of a physician yelling resulted in decreased patient safety."
- "Intimidation of RN led to lack of communication and patient intervention."
- "Delay in patient receiving meds because RN was afraid to call MD."
- "Most nurses are afraid to call Dr. X when they need to, and frequently won’t call. Their patient’s medical safety is always in jeopardy because of this."
- "Adverse event related to med error because MD would not listen to the RN."
- "RN did not call MD about change in patient condition because he had a history of being abusive when called. Patient suffered because of this."
- "Cardiologist upset by phone calls and refused to come in. RN told it was not her job to think, just to follow orders. Rx delayed. MI extended."
- "Difficult endoscopy. Physician angry, frustrated, abusive to patient and technician. Patient safety compromised."
- "Communication between OB and delivery RN was hampered because of MD behavior. Resulted in poor outcome in newborn."
- "MD yelled at RN for calling at night, patient condition not addressed, resulting in a negative patient outcome."
- "RN called MD multiple times re: deteriorating patient condition. MD upset with RN calling. Patient eventually had to be intubated."
- "RNs did not want to call MD after IV ran out. No antibiotic therapy for four days. RN afraid to call MD. Patient expired."
1. Rosenstein AH, O’Daniel M. Disruptive behavior and clinical outcomes: Perceptions of nurses & physicians. Am J Nurs 2005; 105:52-62.