Angelite Nurses

A number of surveys and studies in the past decade suggest that bad blood - and bad behavior - between and among doctors and nurses is rampant.

Some behavior is so extreme that it could result in assault charges -- the surgeon who hurls a scalpel across an operating room in a fit of anger, the internist who attempts to stuff a nurse into a trash can or the nurse who squirts a used syringe in a co-worker's face or amends a chart to sabotage a doctor.

But, as one nurse surveyed by the American College of Physician Executives last year put it: "The worst behavior problem is not the most egregious. It's the everyday lack of respect and communication that most adversely affects patient care and staff morale."

That survey of more than 2,100 nurses and doctors - about two-thirds of the respondents were nurses - found that 98 percent of both professions had witnessed behavior problems between physicians and nurses in the past year. Ten percent said they see bad behavior every day.

The most common complaint, cited by 85 percent, was degrading comments. Seventy-three percent said they had heard yelling between colleagues. Other common problems included cursing, inappropriate jokes and refusing to work with one another.

A 2002 survey of nurses at 50 hospitals found that 94 percent had witnessed a physician acting in a disruptive manner.

But a 2004 survey that included hospital pharmacists found that while doctors were most likely to engage in intimidating behaviors such as threatening to complain to a worker's boss, nurses were nearly as likely to make threats or refuse to answer phone messages about pharmacy orders.

Of course there are outbursts and mutterings among and about co-workers on every job. But relatively few workplace dustups endanger lives and long-term health.

The nurses-only survey found that 60 percent were aware of adverse medical events that could have occurred due to disruptive behavior. And the 2004 survey, done by the Institute for Safe Medication Practice, found that 40 percent of clinicians have remained silent or passive rather than question possibly dangerous orders issued by a doctor or nurse who has a reputation for intimidation.

All this plays out in an often-stress-filled setting of odd, long shifts and charged emotions among workers, patients and their families.

One survey of emergency nurses found that half had experienced physical violence on the job that included being hit, kicked, scratched or spit on. Other surveys that have covered more hospital departments report violence rates of more than 13 percent, and 30 percent to 50 percent reporting verbal abuse from patients.

With health-care workers caught in such crossfire, it's hard to focus on quality.

But with mounting evidence that lack of a team approach to medicine is hurting patient care, organizations like the Joint Commission (the nation's main accrediting agency for hospitals and other health facilities) are taking note.

The commission early last year set a new standard that hospitals must have in place - a code of conduct that defines acceptable and inappropriate behavior and sets up a process for dealing with disruptive behavior.

Many hospitals already have codes or policies for staff conduct, but may have left enforcement to supervisors or peer committees. By putting complaints in the framework of patient safety, the commission envisions disruptive behavior being taken more seriously.

At the same time, many medical educators are trying to make doctors, nurses and other professionals better team players by setting up "shadow days" and seminars to help them understand one another's responsibilities and treat each other with greater respect.