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Intimidating coworkers are endangering patient safety

Patient Safety Monitor Alert, March 17, 2004

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Patient safety is at risk because nurses and pharmacists work in intimidating environments where they are talked down to, ignored, and verbally abused. This makes them less likely to question a physician's order, according to a new survey by the Institute of Safe Medication Practices (ISMP).

The ISMP surveyed more than 2,000 hospital healthcare providers, including 1,565 nurses and 354 pharmacists in November 2003 to learn about their work environments.

"Sadly, [respondents] confirmed that intimidating behaviors continue to be far from isolated events in healthcare," the ISMP reports in its March 2004 newsletter, Nurse Advise-ERR (Vol. 2, No. 3).

Among the findings: 

•  88% encountered condescending language or tone of voice
  
• 79% encountered a provider's reluctance or refusal to answer questions or phone calls
  
• 48% encountered explicit forms of intimidation, such as verbal abuse and threatening body language
  
• 38% reported that at least three to five different people exhibited intimidating behavior, while 19% reported that more than five people exhibited intimidating behavior during the last year

Physicians were usually the intimidators. In fact, 69% of respondents stated that physicians and/or prescribers had often or at some time during the past year stated, "Just give what I ordered."

Such intimidating behavior made careproviders reluctant to question the physician's order. At least once during the past year, for example, 40% of respondents said that they would avoid interacting with an intimidating prescriber by either assuming that a questionable order was correct, or by asking another professional to speak with the prescriber.

Physicians and prescribers weren't the only "menacing" individuals, however. Caregivers also experienced intimidating behavior from other nurses and pharmacists.

Although pharmacists and nurses reported the same frequency of intimidating behavior, pharmacists (50%) were more likely to encounter verbal abuse than nurses (38%), and a reluctance or refusal to answer questions or return calls (83% of pharmacists versus 69% of nurses). 

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