Nursing Educators and Dealing With Disruptive Behavior What Is Disruptive Behavior?
Disruptive behavior in the context of nursing education and healthcare is defined as any inappropriate behavior, confrontation, or conflict ranging from verbal abuse to physical or sexual harassment (Rosenstein, 2013). These behaviors can manifest in overt actions, such as shouting or throwing objects, or more covert actions, such as gossiping or making passive-aggressive comments. Disruptive behavior includes using profane or discourteous language, making demeaning or sexual comments, telling racial or ethnic jokes, outbursts of anger, criticizing colleagues or staff in front of patients, making comments that undermine a patient’s trust, or belittling a caregiver’s self-confidence (Porto & Lauve, 2006; Joint Commission, 2008).
Impact of Disruptive Behavior on the Educational Environment
Disruptive behavior in a healthcare or educational setting can undermine a positive working environment, making it non-conducive and disrespectful. Nurses and other healthcare providers must strive to create and maintain environments that are safe and supportive of quality care delivery. Disruptive behaviors not only compromise patient safety but also hinder the ability of healthcare workers to perform their jobs effectively.
Hickson (2012) identified four critical strategies to mitigate the incidence of disruptive behaviors:
- Orientation/Residency Programs: Providing structured mentorship and guidance to foster a culture of professionalism.
- Collaborative Partnerships between Academia and Service: Aligning academic education with real-world practice settings.
- Zero Tolerance for Behaviors That Undermine a Culture of Safety: Establishing strict policies against disruptive actions.
- Addressing Negative Behaviors: Implementing measures to confront and manage disruptive behaviors.
Nursing Orientation/Residency Programs in Educational Systems
Orientation and residency programs for new nurses are crucial in fostering a positive professional culture. According to the Quality and Safety Education for Nurses (QSEN, 2014), nurses, physicians, and other healthcare professionals are expected to work collaboratively within interprofessional teams, ensuring open communication, mutual respect, and shared decision-making to achieve high-quality patient care.
Residency programs and internships show a positive correlation between the quality and duration of orientation and the satisfaction and retention of novice nurses (Scott, Keehner Engelke, & Swanson, 2008). The Institute of Medicine (2010) also recommends that nursing boards and accrediting bodies mandate the completion of a nursing residency program upon licensing or graduation from an advanced practice degree program.
Zero Tolerance for Behaviors Undermining a Culture of Safety
In response to the Sentinel Event Alert (Joint Commission, 2008), healthcare facilities are required to implement zero-tolerance policies against intimidating and disruptive behaviors. These policies define and prohibit behaviors that threaten the safety and well-being of patients and staff, including the most severe forms of disruptive behavior, such as assault and other criminal acts.
It is essential to educate students and staff about the characteristics of disruptive behavior, its effects on individuals and organizations, the processes for reporting and monitoring such behaviors, and the responsibility all stakeholders have in eliminating disruptive behavior by adhering to the organization’s zero-tolerance policy. Education on zero tolerance can be delivered formally or informally through coaching, mentoring, or precepting. An emphasis on individual accountability at all organizational levels and the adoption of a culture of civility are crucial for these policies to be effective (Clark, Olender, Cardoni, & Kenski, 2011).
How to Address Disruptive Behavior
Effective strategies must be implemented to empower both new and experienced nurses to confront, defuse, and resist disruptive behaviors in their professional practice. Griffin (2004) has outlined cognitive-behavioral techniques to address negative behaviors, focusing on educational awareness and cognitive rehearsal as specific interventions for new nurses to confront their offenders.
The Center for American Nurses (2008) identifies additional strategies, including adopting and modeling professional ethical behavior, recognizing and addressing bullying and disruptive behaviors in the workplace, reflecting on one’s behavior, communicating respectfully, participating in interprofessional initiatives to prevent abuse, and ensuring that the mission, vision, and values of their workplaces reflect the Code of Ethics for Nurses.
Organizational leaders have a significant responsibility to use their influence to promote a healthy, non-disruptive work environment, fostering an ethical practice environment desired by the nursing profession’s stakeholders. Leaders must commit to role-modeling changes in pre-existing cultures and understand the urgency of addressing the domino effect that disruptive behavior can have in healthcare settings (Hickson, 2012).
Necessity of Dealing with Disruptive Behavior
Eliminating disruptive behavior is essential for fostering a healthy workplace environment. To achieve this, nursing education and healthcare organizations must develop educational and mentorship programs that promote a culture valuing self, peers, and nursing practice organizations (Lux, Hutcheson, & Peden, 2014). Nurse educators should prepare nursing students to confront disruptive behavior effectively before entering the profession, ensuring they graduate with well-developed professional communication skills.
Della Sega (2011) proposed a three-step process for decreasing the incidents of disruptive behavior in the workplace: educating nurses who are victims of disruptive behavior to enhance their understanding, teaching interactive strategies to reframe and relate to disruptive behaviors, and using role modeling to integrate appropriate behaviors.
Outcomes of Dealing With Disruptive Behaviors
Disruptive behaviors can have severe personal and organizational consequences that cannot be ignored. The accreditation of healthcare facilities now depends on an organization’s ability to address disruptive behaviors effectively. Organizations that implement zero-tolerance policies demonstrate their commitment to a healthy work environment (Hickson, 2013).
A strong commitment from healthcare agencies, supported by cooperation from everyone in the organization, is crucial. Longo (2010) identifies several approaches to addressing disruptive behaviors, including adopting a zero-tolerance stance, developing a code of conduct that defines acceptable and unacceptable behaviors, providing education on communication skills, offering coaching and mentoring, providing mediation services to resolve disputes, and taking disciplinary action.
Rosenstein (2009) echoes similar themes as a call to action for healthcare environments to address disruptive behavior. These include strong organizational leadership, awareness and accountability, communication and team collaboration training, identifying clinical champions, enforcing policies and procedures, and implementing a reporting and intervention process.
Conclusion
Disruptive behaviors can significantly undermine the quality of care in healthcare settings and threaten patient safety and staff well-being. It is essential to create a culture that actively discourages these behaviors through education, mentorship, zero-tolerance policies, and strong leadership. By effectively addressing disruptive behaviors, healthcare organizations can create a safer, more respectful, and more productive environment for all stakeholders, ultimately leading to better patient outcomes and higher staff satisfaction.