5 steps nurses should take when dealing with difficult doctors
Use your communication skills to your advantage to help mitigate professional conflicts.
The ultimate goal in a health care setting is to provide safe and effective patient care—to remember your promise to “first, do no harm.” But when a doctor on your team acts like a jerk, that can have a negative impact on you and your work—whether you like it or not.
This is all too common, says disruptive behavior expert Alan Rosenstein, M.D., M.B.A., a practicing internist in San Francisco and a medical consultant in health care management. In his paper for The Joint Commission Journal on Quality and Patient Safety, he cites a survey in which 77% of respondents reported witnessing disruptive behavior in doctors: 88% of nurses and 52% of physicians themselves.
The consequences of being on the receiving end of bad behavior, Rosenstein says, “include potentially preventable adverse events, errors, compromises in safety and quality, and patient mortality.”
Help reduce inter-professional conflicts—and encourage mutual respect—with these tips.
1. Don’t fan the fire
Heated confrontations during a stressful moment aren’t smart.
“Just like family, you'll still have to deal with the physician on Friday if you blow up at each other on Thursday,” says Nick Angelis, C.R.N.A. and M.S.N., author of How to Succeed in Anesthesia School (And RN, PA, or Med School) and co-owner of Florida-based BEHAVE Wellness, which trains individuals and corporations about bully prevention.. So keep your temper in check, and wait until you’ve calmed down to bring it up.
Managing your own tone is key for productivity, says Linda L Lindeke, Ph.D., R.N., C.N.P, associate professor and pediatric nurse practitioner at the University of Minnesota. “Avoid disclaimers while being direct and calm, build bridges and negotiate to ‘yes,’” she says.
Additionally, try not to gossip about the situation to all of your co-workers. “This weakens your position and leads to the passive aggressive behaviors that form a toxic workplace,” Lindeke says.
2. Find out the policies
Understand what your workplace policies are, assuming there are some already in place, before taking any action—so that you can follow the guidelines to the exact letter.
If a workplace policy isn’t already established, try suggesting one to your superiors. It puts a framework into place that ensures that incidents don't go unreported and continue.
“Establish an incident reporting system and encourage people to report—you can’t act on hearsay,” Rosenstein says . “This needs to be confidential and free of repercussion, with facts reviewed by people with no bias or conflict of interest.”
Put nurses and doctors on joint committees to discuss working relationships, or get them together informally, Rosenstien says, and implement a “code white” policy where certain people mediate during a disruptive event.
3. “Can we just talk about this?”
Once you have cooled down and know the policy, start with a simple conversation.
A nurse can simply tell a doctor, “You’re a great physician, but the way you deal with me makes me—and others—feel badly. We’re here to really try and help you,” Rosenstein suggests. “Information conveyed at the right place and right time may sometimes be successful.”
The worst thing you can do is excusing this behavior by letting it go unacknowledged—that simply enables it, says Angelis. But he also says that running to your human resources representative at the first sign of confrontation isn’t the best move.
“A hospital wants peace and uninterrupted revenue flow more than justice and equity for all,” he says. “Privately telling the physician you didn't appreciate their words and mannerisms works better than a public challenge.”
4. Recognize their workplace pressures
“Remember that nurses are socialized to be non-confrontational and to achieve consensus,” says Lindeke. “Physicians are socialized to make decisions.”
Rosenstein says many physicians are by nature stoic and have experienced a hazing process in medical school that encourages autonomic, dictatorial behavior.
“Health care reform has added stress, anger and burnout to the mix, as physicians must adapt,” he says.
They’d rather practice medicine without endless paperwork and administrative concerns, he says. Understanding physician behaviors, taking the time to listen to their needs and concerns, providing appropriate training, counseling and support, and soliciting their input and involvement can go a long way, he writes in Hospital Practice.
You might include in your confrontation of the person some acknowledgement of their stresses:, "I understand we're all under pressure..." or you might start by asking a question rather than expressing how you felt. For example, “I’d like to understand why you snapped at me in the OR?”
5. Get the help you need
Continued disruptive behavior may call for individual counseling in conflict management, communication skills, customer satisfaction, or even substance abuse help. “If they’re not willing to change, call in a trained expert,” Rosenstein says, and the best first step would probably be your manager or HR representative.
If you’re stressed and frustrated, or losing the ability to concentrate and focus, and unable to provide appropriate information flow within the team, you need to take action.
“Seek out assertiveness training to learn how to speak up in a professional manner,” Rosenstein says, “or maybe you do have to leave.”
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