1. Civility Between Doctors and Nurses
Presenters Sarah Frenette, Elizabeth Allen, Richard Woodell

2. Scenario
Theresa Browne, RN
It was morning rounds in the hospital and the entire medical team stood in the patients room.A test result was late, and the patient, a friendly, middle-aged man, jokingly asked his doctor whom he should yell at.
Turning and pointing at the patients nurse, the doctor replied, If you want to scream at anyone, scream at her.
This vignette is not a scene from the medical drama House, nor did it take place 30 years ago, when nures wehre considereed subservient to doctos.Rather, it happened just a few months ago, at my hospital, to me.
As we walked out of the patients room I asked the doctor if I could quote him in an article. (*1)
3. Scenario
Theresa Browne, RN
What do you think was his reply?
It was morning rounds in the hospital and the entire medical team stood in the patients room.A test result was late, and the patient, a friendly, middle-aged man, jokingly asked his doctor whom he should yell at.
Turning and pointing at the patients nurse, the doctor replied, If you want to scream at anyone, scream at her.
This vignette is not a scene from the medical drama House, nor did it take place 30 years ago, when nures wehre considereed subservient to doctos.Rather, it happened just a few months ago, at my hospital, to me.
As we walked out of the patients room I asked the doctor if I could quote him in an article.
Everyone knows that the nurse is always right, I was just kidding.
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You know that we work together in a very civilized manner.
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The client knows that it is the labs fault.
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Its a time-honored tradition blame the nurse whenever anything goes wrong.
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4. Scenario
Theresa Browne, RN
What do you think was his reply?
It was morning rounds in the hospital and the entire medical team stood in the patients room.A test result was late, and the patient, a friendly, middle-aged man, jokingly asked his doctor whom he should yell at.
Turning and pointing at the patients nurse, the doctor replied, If you want to scream at anyone, scream at her.
This vignette is not a scene from the medical drama House, nor did it take place 30 years ago, when nures wehre considereed subservient to doctos.Rather, it happened just a few months ago, at my hospital, to me.
As we walked out of the patients room I asked the doctor if I could quote him in an article.
Everyone knows that the nurse is always right, I was just kidding.
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You know that we work together in a very civilized manner.
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The client knows that it is the labs fault.
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Its a time-honored tradition blame the nurse whenever anything goes wrong.

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5. SKIT
Bad Example

Script Writer

Katie Walsh

Actressess

Katie Walsh
Krystal Petersen
6. Past Trends
Incivility in the Healthcare Setting Researcher Michelle Kaufman
7. Past Trends
Incivility in the Healthcare Setting Researcher Michelle Kaufman
How it was in the Past
[A nurse] must begin her work with the idea firmly implanted in her mind that she is only the instrument by whom the doctor gets his instructions carried out; she occupies no independent position in the treatment of the sick person.
McGregor-Roberston, 1902
No matter how gifted she may be, she will never become a reliable nurse until she can obey without question.The firs and most helpful criticism I ever received from a doctor was when he told me I was supposed to be simply an intelligent machine for the purpose of carrying out his orders
Sara Dock, 1917
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8. Past Trends
Incivility in the healthcare setting Researcher Michelle Kaufman
Why we should bring it to light
How it was in the Past
In a survey conducted by VHA West Coast, 78% of nurses surveyed reported that they had witnessed or personally experienced disruptive behavior by physicians.This survey also noted that 50% of physicians had witnessed their peers exhibiting disruptive behavior.
This survey also brought to light that employees who experienced uncivil behavior at work intentionally reduced their work effort and the quality of their work which then in turn decreases their effectiveness and safety.
[A nurse] must begin her work with the idea firmly implanted in her mind that she is only the instrument by whom the doctor gets his instructions carried out; she occupies no independent position in the treatment of the sick person.
McGregor-Roberston, 1902
No matter how gifted she may be, she will never become a reliable nurse until she can obey without question.The firs and most helpful criticism I ever received from a doctor was when he told me I was supposed to be simply an intelligent machine for the purpose of carrying out his orders
Sara Dock, 1917
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9. Past Trends
Incivility in the Healthcare Setting Researcher Michelle Kaufman
Why we should bring it to light
Implications if Ignored
How it was in the Past
In a survey conducted by VHA West Coast, 78% of nurses surveyed reported that they had witnessed or personally experienced disruptive behavior by physicians.This survey also noted that 50% of physicians had witnessed their peers exhibiting disruptive behavior.
This survey also brought to light that employees who experienced uncivil behavior at work intentionally reduced their work effort and the quality of their work which then in turn decreases their effectiveness and safety.
One implication is medication errors.Medication errors occur more frequently due to this incivility.According to the research of Alan Rosenstein, a leading researcher on the topic of incivility in the medical field, 60% of medication errors are related to toxic behavior or incivility.This occurs most commonly because nurses are afraid to bring up a potential error or unclear order because they are afraid to face a rude or uncivil doctor.
Stress-related responses affects focus, concentration, communication, collaboration, and the ability to transfer and interpret vital information which can also negatively impact patient health outcomes
[A nurse] must begin her work with the idea firmly implanted in her mind that she is only the instrument by whom the doctor gets his instructions carried out; she occupies no independent position in the treatment of the sick person.
McGregor-Roberston, 1902
No matter how gifted she may be, she will never become a reliable nurse until she can obey without question.The firs and most helpful criticism I ever received from a doctor was when he told me I was supposed to be simply an intelligent machine for the purpose of carrying out his orders
Sara Dock, 1917
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10. Past Trends
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11. Past Trends
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12. Current Trends
Incivility in the Healthcare Setting Researcher Tara Williams
13. Current Trends
Incivility in the Healthcare Setting Researcher Tara Williams
Intimidating Communication
Intimidating communication and ineffective teamwork can compromise patient safety.
The joint Commission states that ineffective communication is the root cause of the majority of sentinel events since 1996.This caused healthcare organizations to implement policies and procedures addressing the situation and is now mandated by the Joint Commission Sentinel Event Alert.
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14. Current Trends
Incivility in the healthcare setting Researcher Tara Williams
Disruptive Physician
Intimidating Communication
Popular belief is the hierarchy of healthcare that physicians have the most power as a result the healthcare organization caters to a physician despite their tone or attitude.
Abusive behavior by physicians is tolerated despite many institutions code of conduct.
Intimidating communication and ineffective teamwork can compromise patient safety.
The joint Commission states that ineffective communication is the root cause of the majority of sentinel events since 1996.This caused healthcare organizations to implement policies and procedures addressing the situation and is now mandated by the Joint Commission Sentinel Event Alert.
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15. Current Trends
Incivility in the Healthcare Setting Researcher Tara Williams
Disruptive Physician
Sexual Harassment
Intimidating Communication
Popular belief is the hierarchy of healthcare that physicians have the most power as a result the healthcare organization caters to a physician despite their tone or attitude.
Abusive behavior by physicians is tolerated despite many institutions code of conduct.
Can occur between a doctor and nurse or a nurse to a doctor and is inappropriate in any workplace setting.It can be grounds for a sexual harassment complaint, termination of employment, and criminal and civil penalties.
Intimidating communication and ineffective teamwork can compromise patient safety.
The joint Commission states that ineffective communication is the root cause of the majority of sentinel events since 1996.This caused healthcare organizations to implement policies and procedures addressing the situation and is now mandated by the Joint Commission Sentinel Event Alert.
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16. Current Trends
Incivility in the Healthcare Setting
Thins
Things that Irk Nurses
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Civility amongst nurses and doctors is linked to a decrease in medication errors, and an increase in patient safety.
Civility in the healthcare settin also creates job satisfaction and employee retention.
I feel that physicians dont always recognize the knowledge and experience base that nurses have and often overlook it as a resource.
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Things that Irk Nurses
On one hand, the physicians dismiss your judgment, and on the other, they expect you to remind them to place orders and follow up on patients test results.
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Things that Irk Nurses
Most physicians dont let us nurses know what their plans are for the patient.We try to explain to the patient but have to decipher illegible progress notes and make an educated guess.
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17. Current Trends
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18. Current Trends
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19. Ways to Improve
Incivility in the Healthcare Setting Researcher Ashleigh Peake
20. Ways to Improve
Incivility in the Healthcare Setting Researcher Ashleigh Peake
What do Nurses Want?
Respect, a willingness to listen, and a sense that we are on the same team!
As nurses we must take responsibility for doing everything possible to help improve relationships.
We need to collaborate and share information about mutual dissatisfaction and suggest strategies to deal with each problem to fix it.
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21. Ways to Improve
Incivility in the healthcare setting Researcher Ashleigh Peake
How to improve
What do Nurses Want?
Nurse/physician rounds to ensure both the nurse and doctor are on the same page and agree on care for the patient.
Collaborative education programs to help assist with communication and education on for both the nurses and the doctors.
Collaborative membership on hospital committees to find ways to continue improving.
Respect, a willingness to listen, and a sense that we are on the same team!
As nurses we must take responsibility for doing everything possible to help improve relationships.
We need to collaborate and share information about mutual dissatisfaction and suggest strategies to deal with each problem to fix it.
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22. Ways to Improve
Incivility in the Healthcare Setting Researcher Ashleigh Peake
How to Improve
Benefits of Improving
What do Nurses Want?
Nurse/physician rounds to ensure both the nurse and doctor are on the same page and agree on care for the patient.
Collaborative education programs to help assist with communication and education on for both the nurses and the doctors.
Collaborative membership on hospital committees to find ways to continue improving.
Improves job satisfaction, productivity, and patient safety and welfare.
This can be achieved by promoting greater nurse/physician professional respect, improving communication and collaboration educating physicians about nursing roles and skills, and addressing misconduct.
Respect, a willingness to listen, and a sense that we are on the same team!
As nurses we must take responsibility for doing everything possible to help improve relationships.
We need to collaborate and share information about mutual dissatisfaction and suggest strategies to deal with each problem to fix it.
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23. Standards for Establishing and Sustaining a Healthy Work Environment
24. Standards for Establishing and Sustaining a Healthy Work Environment
Skilled Communication
25. Standards for Establishing and Sustaining a Healthy Work Environment
Skilled Communication
True Collaboration
26. Standards for Establishing and Sustaining a Healthy Work Environment
Skilled Communication
True Collaboration
Effective Decision Making
27. Standards for Establishing and Sustaining a Healthy Work Environment
Skilled Communication
True Collaboration
Appropriate Staffing
Effective Decision Making
28. Standards for Establishing and Sustaining a Healthy Work Environment
Skilled Communication
True Collaboration
Recognition
Appropriate Staffing
Effective Decision Making
29. Standards for Establishing and Sustaining a Healthy Work Environment
Skilled Communication
Leadership
True Collaboration
Recognition
Appropriate Staffing
Effective Decision Making
30. Ways to Improve
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31. Ways to Improve
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32. SKIT
Good Example

Script Writer

Nikki Ruggles

Actressess

Marla Bezares
Olga Garcia
33. OTHER CONTRIBUTERS

Handout

Carolina
Daniel

Power Point

Jim Stangle
34. Resources
Brown, T. (2011, May 7). Physician Heel Thyself.The New York Times, p. WK8. . Retrieved from http://nytimes.com/2011/05/08/opinion/08Brown.html
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35. THANK YOU!
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