Patient Safety Threatened by Unprofessional Behavior
JCAHO (Joint Commission) has issued a Sentinel Alert based on findings that rude behavior undermines patient safety. The alert is an effort to change attitudes and promote safety by educating all health care professionals about the consequences and effects of their behavior with other health care professionals and with patients.
As of January 1, 2009, all JCAHO accredited facilities will be required to take action to create a code of conduct and establish a process for educating staff as well as identifying and managing unacceptable behaviors with a “zero tolerance” policy.
Accredited organizations will need to establish an education process to help health care professionals understand that although historically there has been a culture of tolerance of intimidating and disruptive behavior that this can no longer be.
According to JCAHO, these “intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.”
Intimidation and disruptive behaviors includes:
- Verbal outbursts and physical threats
- Passive/aggressive behaviors such as refusing to perform assigned tasks or subtly exhibiting an uncooperative attitude during routine tasks
- Refusal or reluctance to answer questions, return phone calls or pages
- Using a condescending tone or verbiage
- Showing an impatience with questions
Research conducted with physicians and nurses has revealed that this behavior is not rare and that administrators, pharmacists, support staff and therapists are also widely involved in demonstrating such behaviors. Furthermore, the problem is not limited to a small number who habitually exhibit such behavior. The fact that the behavior has not been stopped has eroded the professionalism across the board. This is a big factor in why nurses leave nursing.
Other factors such as fatigue, pressures from cost containment requirements and the need for improved productivity, fear of litigation, as well as highly emotional situations often contribute to these behaviors.
A survey conducted by the Institute for Safe Medication Practices found that 40% of clinicians admitted having remained quiet about or during an intimidating or disruptive episode rather than confront the offender.
All too often the offender is in a position of power. The behavior is never reported and therefore never addressed because of a fear of reprisal or of the stigma of being a “whistle blower.”
Most nurses, physicians, therapists and other health care professionals entered the field for altruistic reasons. They have a strong desire to care for and help others. Most conduct themselves in a professional manner. Those who don’t, are eroding the professionalism and creating an unhealthy and often hostile environment.
According to the JCAHO alert, individuals who exhibit immaturity, self-centeredness or defensiveness are most often guilty of these intimidating or disruptive behaviors. They often lack coping, interpersonal and conflict management skills. Staff education can help set the standards and improve these skills.
The alert further states that it is the behavior which threatens patient safety and not the person engaging in the behavior. This is an important point for all to remember. Behavior and skills can be modified.
In the interest of patient safety, JCAHO has issued the new requirements for January, 2009. These new mandates for educating staff, and reporting and addressing behaviors should help to remove the stigma and improve working conditions.
For further information see: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm
By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book, and is the owner/author of TheNursingSite.com
Tags: Unprofessional Behavior, unprofessional conduct in nursing