How to handle MD bullies

Q: Dear Nurse Pagana,
There’s a doctor in our unit who is notorious for being in a bad mood…all of the time. He’s unfriendly to the patients, barely tolerates his fellow physicians and is a monster to the nurses. Fortunately for the people in his care, he’s brilliant. Unfortunately for me and the rest of the staff, he’s also a jerk. Until now we’ve just gone about our jobs, but the other day he actually threw a chart down near the feet of a nursing student and made her jump about a foot in the air. It didn’t hit her, and a technician just picked it up and handed it back to him. But now what?
—Tired of the Bad Apple

A: Dear Tired,

This is a classic example of bullying behavior. The bad news: For many of us, bullying behavior has been a pervasive aspect of our jobs. The good news: Something is finally being done about it. The Joint Commission (a national hospital accrediting agency) is now tackling the issue of negative work environments and behaviors that undermine a culture of safety and has instituted new requirements to identify, arrest and prevent this behavior.

The doctor you describe embodies almost all of the bullying behaviors described below:

• Demeaning behaviors (e.g., speaking to others in a condescending manner)
• Outburst of anger (e.g., yelling and screaming)
• Criticizing caregivers in front of others
• Disrespectful language or behavior
• Throwing charts and instruments
• Comments that undermine a nurse’s confidence in caring for patients
• Disruptive behaviors including anything that interferes with the ability of others to effectively carry out their work

A survey on intimidation by the Institute for Safe Medication Practices found that 40 percent of clinicians have kept quiet rather than question a known intimidator. This obviously has serious potential consequences for patients. These behaviors also impact staff morale, leading to decreased job satisfaction and increased staff turnover.

So, what can you do about bullying behavior? Here are some suggestions:

• Don’t tolerate it and don’t ignore it. Report it. Starting in January 2009, the Joint Commission is requiring hospitals to establish codes of conduct and create plans for dealing with inappropriate behavior. You should be able to file a report with your administrators and be protected from retaliation.
• Be assertive with bullies. For example, say, “Your negative behavior is impacting our ability to work together and provide quality patient care.”
• Attend educational programs about professional etiquette and encourage your administrators to require all staff to attend.
• Model professional etiquette in your interactions with others in person and on the phone.

Hold your team members accountable for a professional code of conduct. Beginning right now, look at your encounters with other health care professionals through a new pair of eyes. Nip bullying behavior in the bud so you can ensure patient safety and improve job satisfaction for you and your colleagues.