Warning: Conflicts may result in more vacancies
If you were asked to list a reason why nurses choose to leave their workplace, benefits, salary, or work schedule probably would come to mind. However, a recent study reveals another reason that you might not initially suspect: conflict with physicians.
VHA West Coast, a network of community-owned health care systems, surveyed 1,200 nurses, physicians, and administrators, and found that 92% had witnessed disruptive behavior by a physician, while 30% knew a nurse who had left the facility as a result.1
Continual conflict between nurses and physicians can have a terrible impact on morale, stresses Tracy Sanson, MD, FACEP, assistant medical director for the department of emergency medicine at Brandon (FL) Regional Medical Center.
"This leads to absenteeism, frequent staff turnover, and low recruitment," she says. "In turn, this impacts both patient safety and our bottom line."
There are many factors that make conflict more likely in the emergency department (ED), Sanson says, pointing to high volume, sicker patients, ED holds, poor support from other departments, frequent staff turnover, substitute nurses who fill in shifts, lack of staff, lack of breaks or meals due to staffing needs, and mandatory overtime schedules.
Here are recommendations to avoid conflicts between nurses and physicians:
• Instruct staff to be clear about their needs.
An "expectation mismatch" occurs when one person expects something to be done and the other does not do it, says Louise Andrew, MD, JD, FACEP, associate director for the Durham, NC-based Center for Professional Well-Being. The best way to avoid this is to be explicit in what you expect, Andrews says.
"This is not easy for doctors, who don’t like to ask for things, although we certainly do like having it all done for us" she says. It’s also not easy for nurses, who often don’t expect their needs to be valued or met and have limited recourse when they are not, adds Andrew. "This is true even of ED nurses, although they are among the most assertive of all nurses," she says.
• Don’t delay a confrontation.
It may be tempting to postpone addressing a disruptive colleague in the hopes that the problem will resolve itself, but this is a mistake, says Sanson. Instead, take immediate action so that anger and resentment will not continue to build, she recommends.
"The resolution of the conflict should take precedence over considerations of staffing, finances, and other personal or professional obligations," Sanson underscores.
• When you confront behavior, provide an out.
According to Andrew, the best way to stop disruptive behavior is to name the behavior, while providing an out for the individual, Andrew says.
She gives the following example: "Bob, the nurses have complained that you are being curt with them. I know you understand that doesn’t help our efforts in the areas of teamwork or good patient care. Is there something going on right now that is stressing you more than usual? Can I do anything to help you be more available to our staff?"
• Staff should be given inservices.
Provide training for staff on effective communication, with the goal of nipping problems in the bud as soon as they begin, Andrew recommends. "If the ED manager has to intervene, it has gone on too long unchecked," she says.
• Have an "adopt-a-doc" program.
At Christiana Care Health Services in Newark, DE, the ED nurses decided to hold an "appreciation party" for the ED physicians at a local restaurant.
"The ED nurses not only paid for it individually, they came up with the idea themselves," says Linda Laskowski Jones, RN, MS, CS, CCRN, CEN, director of the trauma, emergency, and aeromedical services.
ED nurses "adopted" a physician to pay for the individual’s cost of attending the party until all were spoken for, she explains. Since the party did not cost as much as expected, there were extra funds left when all of the bills were paid, and this money will be used for future events, Jones says.
• Make it easy for nurses to report problems.
Almost half of the study’s respondents reported barriers to reporting physician’s disruptive behavior. Nurses legitimately fear retribution from physicians to whom they report, Andrews notes. "Some hospitals have a tradition of firing nurses who are whistle-blowers on physician behavior," she says.
Having an open door policy is key, Sanson says. Use voice mail or a concern form that can be submitted anonymously, as ways for staff to voice concerns about an incident, interaction, or pattern of behavior, she recommends. (See Regional Emergency Center Concern Management Record.) "It is important to remove any hint of potential retribution," she says.
Although forms can be submitted anonymously, it is preferable to be signed so there can be a better exchange of information, Sanson says. "A form is helpful when schedules do not overlap, or when waiting to make personal contact might prevent an action being taken or allow a situation to continue," she says.
Sources
For more information on management of conflicts, contact:
• Louise Andrew, MD, JD, FACEP, Associate Director, Center for Professional Well-Being, 21 W. Colony Place, Suite 150, Durham, NC 27705. Telephone: (919) 489-9167. Fax: (919) 419-0011. E-mail: [email protected].
• Linda Laskowski Jones, RN, MS, CS, CCRN, CEN, Director, Trauma, Emergency and Aeromedical Ser-vices, Christiana Care Health Services, 4755 Ogletown-Stanton Road, Newark, DE 19718. Telephone: (302) 733-1835. E-mail: [email protected].
• Tracy Sanson, MD, FACEP, Assistant Medical Director, Department of Emergency Medicine, Brandon Regional Medical Center, 119 Oakfield Drive, Brandon, FL 33511. Telephone: (813) 571-5150. Fax: (813) 948-8477. E-mail: [email protected].
If you were asked to list a reason why nurses choose to leave their workplace, benefits, salary, or work schedule probably would come to mind. However, a recent study reveals another reason that you might not initially suspect: conflict with physicians.
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