While healing patients, healthcare institutions can become hot pots simmering with conflict and heated verbal exchanges, leaving nurses and other healthcare professionals emotionally battered. Employees, hospitals and patients all suffer when verbal violence fills the workplace. But when equipped with conflict-management techniques and training, employees can help cool even the tensest of situations.
All Too Common
Unfortunately, verbal conflict is commonplace in healthcare. In Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention, a 2001 study of 1,200 nurses, physicians and executives conducted by VHA West Coast, a Pleasanton, California, healthcare cooperative, 96 percent of nurses reported witnessing disruptive physician behavior, which included yelling, showing disrespect, behaving in a condescending sion, berating patients or colleagues, and using abusive language. Other studies, such as one published in the AORN Journal in 2001, found similar results.
On-the-job conflict damages physician-nurse relationships and lowers nurses' morale and job satisfaction. The stress can cause physical illness and drive nurses from a profession already experiencing staffing shortages. In the VHA study, 30 percent of nurse respondents reported knowing a nurse who quit because of poor treatment from a physician.
Patients are affected too, since physician-nurse collaboration is key in achieving the best clinical outcome, says Vicki Carroll, MSN, RN, program director for the Colorado Nurses Association.
High Stakes, High Stress
Conflict is inevitable in a healthcare setting, says Molly Sears, senior vice president of human resources at Humility of Mary Health Partners in Youngstown, Ohio. “Hospitals are highly charged environments where people are trying to provide the best care in the safest way,” she says. “Healthcare professionals are highly experienced and highly educated, and they often feel strongly that they have more knowledge and understanding than their peers on how to best care for the patient.”
Some conflict is personality-driven, Carroll says, noting that abuse levels can vary wildly among units in the same hospital.
“Verbal abuse exists where there are those who tolerate it and those who perpetuate it,” says Carroll, who also is a former board member of the American Nurses Association's Center for American Nurses.
Just Say No
Regardless of the cause, healthcare workers need the courage to confront their abusers and the skills to manage conflict. Here are some strategies:
- Refuse to tolerate the abusive behavior. “Some people still think abuse is OK,” Carroll says. “It's not.”
- Write incident reports, even when tempted to avoid it out of fear of reprisal, hopes of reconciliation or plain fatigue. Follow up to find out how the situation is being addressed.
- Familiarize yourself with your employer's workplace violence and harassment policies. When interviewing for a new position, ask how conflict is handled.
- To avoid being tongue-tied when confronted with abuse, rehearse clear, direct statements. State, “I deserve to be treated with respect,” repeatedly if necessary, suggests psychotherapist Christine Simms, RN, of Media, Pennsylvania, who counsels nurses in private practice.
- When the abuser is on a tirade, respond with silence. “It's like arm-wrestling with no one there,” Carroll says. “The person ends up looking pretty silly.”
- If it's possible, continue the conversation in a private room. Ask the abuser, “Help me understand exactly what's wrong,” and then work on finding a solution together. Redirect the person toward the real issue by stating, “I wonder if there is a way we can change our focus to the real problem.”
- When you can't leave the room, call a “code pink,” a personal signal for other staff members to stand silently by you and bear witness to the abuse. This “remarkably stunning” technique helps employees carry on, because it responds to the victim's feelings of isolation and disconnection, says Simms, who has conducted workplace conflict groups for major hospitals.
Many healthcare employers recognize that verbal abuse is a serious problem. Some are successfully using the following techniques to reduce such conflicts:
- Achieving Magnet status from the American Nurses Credentialing Center as a way to create a workplace that values nurses.
- Empowering peer mediation committees to review grievances.
- Training employees in conflict management and communication.
- Providing counseling to victims and offenders.
- Creating a zero-tolerance environment for bullying and enforcing consequences for offenders.