An article from the Pittsburgh based KDKA discusses a Pa. state report about “disruptive behavior” in health care settings by health care workers (mostly doctors according to the article) and the dangers this type of behavior poses to patient safety. The article states the Pennsylvania Patient Safety Authority found 177 incidents of disruptive behavior by health care workers during a 31-month period ending last October. How the agency “uncovered” these events isn’t mentioned, but the agency in question studies and tracks near misses and medical errors.
The type of behavior the article discusses is the interaction between nurses and physicians. you know, that call back the admitting physician to clarify an order or to give an update and ask for further/new/changed orders for the patient……the part of our job as nurses that is called patient advocacy. As I read the article, I wondered how many more incidents occur that the agency doesn’t know about. Afterall, they rely on a system of self reporting to gather their data, and I would hazard to guess that many incidents go unreported.
The article also says the agency’s report cites a survey of “doctors and nurses that found a “fundamental lack of respect” between the two groups. Another survey of nurses cited calls to doctors to clarify orders as the main trigger of disruptive behavior; surveys of doctors indicate frustration over orders not being carried out correctly or on time.” Here again, I wondered as I read this, where this attitude stems from and how to help correct it. The “fundamental lack of respect” between nurses and physicians, I think, stems from where both groups came from and the path both have taken over time. Our history is chock full of leaders who, while advancing the knowledge and abilities of nurses, not only allowed but perpetuated that notion that nurses are dependent on the medical community (said physicians) for their orders, while at the same time pushing the premise that nursing had its own specific body of knowledge and can act autonomously. This ability to think and act independently from, yet in conjunction with physicians can create internal and external conflicts for both groups. One one hand, we carry out physicians orders. But on the other hand, we can (and are expected to) act independently of the physician………we assess the patient, care for their basic needs, teach them about their disease or condition, formulate care plans based on their level of function (both cognitively and physically), and guide their care through the health care system. At the same time, we are charged with being the patients’ voice within the system. We are supposed to be the one who stands up for their rights/wants/decisions. This means we sometimes must confront the health care team leader (i.e. the physician) about his/her treatment plans and/or orders. We are SUPPOSED to bring to their attention anything that is in direct conflict with the patients’ wishes and clarify orders to ensure proper care. This last step (ensuring proper care) not only protects OUR licenses, but also those of the physician. How many times have you caught an order that was written as “IV” when the medication comes only as a pill? And yet, when these types of errors are brought to the attention of the physician, how many times has he/she snapped at you? In other cases, how many times have you cringed at the notion of having to call Dr. ABC to clarify one of his orders, knowing full well you were well within your rights and responsibilities to do so, but knowing too that you would get snapped at for “being such a stupid nurse”? If only orders could be standardized, right? Enter electronic medical records. I think this will help alleviate at least SOME of these problems because physicians will not be able to order certain tests/medications/etc. in error. The system will catch the problem well before the nurse even sees it.
The last concern…..orders not being carried out in an timely fashion…..also leads to this lack of respect. But the direction of the outlet of frustration (from BOTH sides) is usually not toward the correct entity. Many times it is not the floor nurses fault he/she did not carry out an order as quickly as the physician wanted. Many times this is a system problem. It may be from understaffing by the facility administration, or it could be from the lack of adequate supplies on the floor for the nurses to access (thus leading to the need to call someone to get the right supplies and a delay in care). But instead of the medical staff banding together to fight FOR the nurses and get more and better staffing or supplies or whatever the need truly is, the physician snaps at the nurse or internalizes the thought of incompetency on the part of the nursing department as a whole and then berates them as they see fit. And for the nurse’s part, (s)he either doesn’t say anything to the physician or properly address the true concern (i.e. nursing doesn’t band together to stand up for proper staffing), or the system ignores the one’s who do and brands them as “mavericks”. Maybe, just maybe if both sides worked together and tried to understand the others’ point of view — at the point of care — much of this type of problem would disappear. Maybe if we, as health care providers, looked at the patient as the primary reason we are even IN the profession and truly thought about THEIR welfare first and did what was best for THEM and not stroke our own egos or allow a broken system to dictate what is proper care of how and when the care is delivered, maybe if we put our differences aside and all realized we are both fighting for the same thing………quality patient care……then maybe these problems would be properly addressed. But as long as both sides allow the system to keep us fighting each other, distrusting each other, and disrespecting each other, things will not change for the better.
