New VHA Research Finds Disruptive Behavior Frequently Occurs in Hospitals and Directly Affects Patient Outcomes

American Journal of Nursing to Publish Study and Raise Awareness

Jan 10, 2005, 00:00 ET from VHA Inc.

    IRVING, Texas, Jan. 10 /PRNewswire/ -- New research conducted by VHA Inc.
 has found that disruptive behavior between physicians and nurses occurs
 frequently and affects patient outcomes.  As a result of this behavior, these
 providers report that patients are experiencing pain or prolonged pain,
 receiving medications or antibiotics late, being mistreated or misdiagnosed,
 or dying.
     More than three quarters (86 percent) of nurses who participated in the
 survey and almost half (49 percent) of physicians said they have witnessed
 disruptive behavior.  Research also revealed that disruptive behavior between
 nurses is prevalent.  Sixty-eight percent of nurses and 47 percent of
 physicians who responded said they have witnessed disruptive behavior between
 nurses and from nurses aimed at other hospital staff.
     "The findings of this new research are alarming and yet not new," said
 Diana Mason, RN, PhD, FAAN, American Journal of Nursing.  "A VHA study
 conducted in 2002 uncovered disturbing physician behavior towards nurses;
 however, this new study intensifies the urgency of this issue by revealing
 what happens to patients, which is sobering and distressing."
     The study, titled Disruptive Behavior & Clinical Outcomes:  Perceptions of
 Nurses & Physicians, was conducted by Alan H. Rosenstein, M.D., vice president
 and medical director at VHA, and Michelle O'Daniel, director of member
 relations for VHA.  The study was initiated to assess perceptions of the
 impact of disruptive behavior on nurse-physician relationships and to
 determine what physicians, nurses and hospital administrators believe to be
 its effects on patient care.  Surveys were distributed to 50 VHA member
 hospitals in more than 12 states and results from more than 1,500 participants
 were evaluated.
     The survey found that most respondents (94 percent) believe disruptive
 behavior impacts adverse events, medical errors, patient safety, patient
 mortality, quality of care and patient satisfaction.  Sixty percent of the
 respondents were aware of potential adverse events that may have occurred from
 disruptive behavior.  Seventeen percent of the respondents reported that they
 knew of a specific adverse event that occurred as a result of disruptive
 behavior and 78 percent of the respondents felt the adverse event could have
 been prevented.
     "The survey suggests a serious problem within and across disciplines,"
 said Alan H. Rosenstein, M.D. and co-author of the study.  "Disruptive
 behavior needs to be addressed at the organizational level.  Hospitals need to
 invest time and resources into performing self-assessments, increasing staff
 awareness of the issue, opening lines of communication and creating greater
 collaboration between peers.  If hospitals don't do this, the problem will
 continue to grow and patients will continue to needlessly suffer.  Disruptive
 behavior also establishes an environment for ineffective and inefficient
     The survey also found that disruptive behavior affects nurses' and
 physicians' stress levels (94 percent), frustration levels (94 percent),
 concentration (83 percent), communication (92 percent), collaboration (90
 percent), information transfer (87 percent) and workplace relationships (91
 percent).  Each of these psychological and behavioral variables can directly
 impact a patient's outcome.
     For the purposes of the study, disruptive behavior refers to any
 inappropriate behavior, confrontation or conflict, ranging from verbal abuse
 to physical and sexual harassment.
     "The comments we captured from respondents were incredible and they define
 the issue.  Disruptive behavior impacts all levels, including hospital
 operations and clinical practice," said O'Daniel, co-author of the study.
 Comments included:
      *  "I have caught myself in the middle of mislabeling specimens after
         confrontations that have been upsetting."
      *  "Delay in patients receiving medications because RN was afraid to call
      *  "Communication between obstetrician and delivery nurse was hampered
         because of physician behavior.  Resulted in poor outcome in newborn."
      *  "RNs did not want to call M.D. after the IV ran out.  No antibiotic
         therapy for four days.  RN afraid to call M.D.  Patient expired."
     Because of the importance of this study to nurse managers, it is being
 published simultaneously in Nursing Management, another LWW journal.
     To learn more about this study, visit or .
     About VHA -- VHA Inc. is a national cooperative of leading not-for-profit
 health care organizations that work together to improve the health of the
 communities they serve.  VHA leverages the collective strength of the
 membership to improve clinical, operational and financial performance.
 Through the VHA cooperative, members benefit from resources that assess
 critical needs and identify best practices to create customized solutions that
 lower costs and improve clinical quality.  As a cooperative, VHA distributes
 income annually to members based on their participation.  Based in Irving,
 Texas, with 18 offices across the U.S., VHA was named one of the "100 Best
 Companies to Work For" by Fortune in January 2004, for the fifth year in a
     About AJN -- Founded in 1900, The American Journal of Nursing is the
 official publication of the American Nurses Association and the largest and
 oldest circulating nursing journal in the world.  It is published by
 Lippincott Williams & Wilkins, a unit of Wolters Kluwer Health, a leading
 provider of information for professionals and students in medicine, nursing,
 allied health, pharmacy and the pharmaceutical industry.  Major brands include
 traditional publishers of medical and drug reference tools and textbooks, such
 as Lippincott Williams & Wilkins and Facts & Comparisons, online information
 services including Ovid Technologies, Medi-Span and SKOLAR, and pharmaceutical
 information provider Adis International.
      Veronica Hunt for VHA Inc.             Sandra Godinho
      310/659-5380                           212/508-9661