How Deal With Disruptive Behaviors In Nursing Education

What Is Disruptive Behavior

    Disruptive behavior is any
inappropriate behavior, confrontation, or conflict ranging from verbal abuse to
physical or sexual harassment (Rosenstein, 2013). Disruptive behaviors include
overt and covert actions that are displayed by any health care worker that
threaten the performance of the health care team (Joint Commission, 2008)
Disruptive behavior includes profane or dis courteous language, demeaning
behavior, sexual comments or overtone, racial/ethnic jokes, outbursts of anger,
throwing objects, criticism in front of patients or staff, comments that
undermine a patient’s trust, and comments that undermine a caregiver’s
self-confidence (Porto & Lauve , 2006 )

Impact of Disruptive Behavior on Educational Environment 

    Health care workers are often
exposed and desensitized to behaviors that support a non-conducive and
disrespectful work environment . Nurses, as well as other health care
providers, must support, establish, and maintain working environments that are
safe and conducive to the provision of quality health care. Disruptive
behaviors not only threaten patient safety but also the ability for health care
workers to perform their job competently. Hickson (2012) identified four
significant implications to decrease the incidents of disruptive behaviors:
orientation/residency programs, collaborative partnerships between academia and
service, zero tolerance for behaviors that undermine a culture of safety, and
addressing negative behaviors.

Nursing Orientation/Residency Programs In Educational Systems

    These orientation/residency
programs are intended to provide positive mentorship and preceptorship to
support and promote a culture of professionalism and collegiality. According to
the Quality and Safety Education for Nurses (QSEN, 2014), competency nurses,
physicians, and other health care professionals are expected to function effectively
within inter-professional teams, foster open communication, employ mutual
respect, and share decision making to achieve quality patient care. 

    Nurse
residencies and internships further indicate a relationship between the quality
and quantity of nurse’s orientation and the satisfaction and retention of
novice professionals (Scott, Keehner  Engelke
, & Swanson, 2008). The Institute of Medicine (2010) suggested that the
collaboration of state boards of nursing and accrediting bodies should support
the completion of a nursing residency program upon license or advanced practice
degree program, or the transition to new clinical practice areas. 

    Collaborative
Partnerships Between Academia and Service. A collaborative vision and
partnership between academia and the practice setting can successfully
translate to increased professionalism, effective communication, optimal
patient care, and substantive working relationships.

Zero Tolerance for Behaviors
Undermining a Culture of Safety

    Based on the Sentinel Event Alert
(Joint Commission, 2008), the Joint Commission began requiring health care
facilities to implement zero-tolerance policies that defined intimidating and
disruptive behaviors. Zero tolerance includes, but is not limited to,
intimidating and/or disruptive behaviors, especially the most egregious
instances of disruptive behavior such as assault and other criminal acts (Joint
Commission, 2008). 

    It is essential to provide information and education to
students, as well as to the staff of all disciplines, concerning the phenomenon
of disruptive behavior: defining characteristics, understanding the effects
toward individuals and an organization, identifying the system for reporting
and monitoring, and the responsibility that all stakeholders hold in eliminating
disruptive behavior and adhering to the organization’s zero tolerance policy. 

    Education about zero tolerance can be offered by formal or informal means, such
as coaching, mentoring, or precepting . An emphasis on individual
accountability at all organizational levels, as well as organizational adoption
of a culture of civility, would be required for policies to be effective
(Clark, Olender , Cardoni , & Kenski , 2011).

How Do Addressing Disruptive Behavior

    Careful attention must be given to
implementing effective strategies to empower newly registered nurses or
experienced nurses to confront, defuse, and resist disruptive behaviors in
their professional nursing practice Griffin (2004) has delineated cognitive
behavioral techniques addressing negative behaviors, emphasizing educational
awareness and cognitive rehearsal as specific interventions that new nurses can
use to confront their hostile offender. 

    Strategies identified by the Center for
American Nurses (2008) include nurses adopting and modeling professional ethical
behavior, recognizing and addressing bullying and disruptive behaviors in the
workplace, reflecting on one’s own behavior and communicating respectfully,
participating in collaborative inter-professional initiative to prevent abuse ,
and working to ensure the mission, vision, and values of their work places are
reflective of the Code of Ethics for Nurses and standards set by the profession
in order to eliminate disruptive behavior.

    The burden of responsibility for
decreasing and/or eliminating disruptive behavior does not fall solely on an
individual or a group, but the organization as a whole organizational leader
should use their constitutive capacity of persuasive influence to foster
healthy and non-disruptive work environments, which ultimately create the
ethical practice desired by the stakeholders of the nursing profession. It is
not enough for the leaders to use their influence to reinforce a non-disruptive
environment but also to commit to a role-modeling change in the pre-existing
culture. 

    If organizational leaders continue to overlook the urgency of the
domino effect that disruptive behavior has within health care, they steadfastly
default on their vow of providing a culture of safety and promoting the
standards of professionalism (Hickson, 2012 ) .

Necessity of Dealing with Disruptive Behavior

    Eliminating disruptive behavior in
the nursing profession is necessary in order to support an environment
conducive to a healthy workplace. If it is to be achieved, nursing education
and health care must develop educational and mentorship programs that foster a
healthy work environment and change the culture of nursing to one of valuing
self, peers, and nursing practice organizations (Lux, Hutcheson, & Peden ,
2014) Lux et al. (2014) stressed that nurse educators must educate nursing students
about how to confront disruptive behavior before entering their profession. New
graduates must leave nursing programs equipped with well-developed professional
communication skills.

    Della Sega (2011) identified a
three-step process for decreasing the incidents of disruptive behavior in the
workplace, which can be affected by nursing educators to support the transition
of students to newly graduated nurses. The three steps are educating nurses who
are the victims of disruptive behavior about disruptive behavior in order to
improve their understanding of the phenomenon, teaching interactive strategies
to help nurses relate and re-frame disruptive behaviors, and using role modeling
to integrate appropriate behaviors.

Outcomes of Dealing With Disruptive Behaviors

    Disruptive behavior can have deleterious
effects on a personal or organizational level, which can no longer be ignored.
Accreditation of health care facilities now depends on an organization’s
ability to effectively address disruptive behaviors. Organizations that
operation and purely force zero-tolerance policies demonstrate to their
employees the promotion of a healthy work environment ( Hickson , 2013). 

    A
strong commitment on the part of health care agencies to eliminate disruptive
behaviors, along with cooperation from everyone in the organization, is
imperative. Longo (2010) identified approaches for addressing disruptive
behaviors which include the following: adopt a zero-tolerance stance, develop a
code of conduct that defines acceptable and unacceptable behaviors, provide education
regarding communication skills, provide coaching and mentoring, provide
mediation services to resolve disputes between parties, and take disciplinary
action. 

    Rosenstein (2009) echoed similar topics as a call to action for health
care environments to address disruptive behavior: strong organizational
leadership, awareness and accountability, communication and team collaboration
training, identifying clinical champion/clinical champions, enforcing policies
and procedures, and reporting an intervention process.