DEFINING DISRUPTIVE BEHAVIOR

Any action that causes one to feel less than safe is known as disruptive behavior. There are four types of disruptive behavior seen in the workplace. The most common type of disruptive behavior is verbal. Christmas (2007) defined verbal abuse as communication delivered via a behavior, tone, or words that were meant to make an individual feel attacked or humiliated. The words delivered are meant to demean, isolate, belittle, threaten, or accuse a person of an action that is not founded in truth or facts. Psychologic abuse involves aggressive behavior that overtaxes a person’s ability to cope. A bully is one who uses psychologically abusive behavior to control the victim. Bullying is a purposeful exertion of power or intimidation that is physically or emotionally threatening to the victim (Kolanko et al, 2006). In the workforce we are able to identify two types of bullying. Direct bullying includes overt acts of verbal or physical aggression. Indirect bullying involves the use of passive-aggressive behavior or social isolation to intimidate the target. Physical abuse inflicts harm intentionally on another individual. Sexual abuse is accomplished when a person is forced into physical contact that has the sole purpose of humiliating the victim. Disruptive behavior can cross lines of authority and job hierarchy. An example of crossing lines of authority is when a surgeon bullies a certified registered nurse anesthetist (CRNA) and the anesthesiologist gets involved and retaliation occurs (Figure 25-1). The cycle of disruptive behavior is born and will spread quickly throughout the department if not stopped (Figure 25-2). Defining disruptive behavior is the first step toward stopping the behavior in the workplace. The following examples provide insight into what a nurse may experience as a direct result of disruptive behavior and bullying:

• I changed my perception of the entire institution where it happened as a result of the incident.

• I considered the incident to be a major factor in deciding whether or not to leave the institution and work somewhere else entirely.

• My supervisors were unsupportive of me during or after the incident.

• I felt as though I had to give in to the attacker’s demands to avoid disciplinary action from my supervisors.

• I felt as though my professional decisions were being monitored and being called into question after the incident.

• I felt others made subtle “behind the back” negative comments about the incident after it occurred.

• I felt management made me give in and compromise to maintain my status as a satisfactory employee.

• I believe patient care was affected by the incident in a way that could have resulted, or actually did result, in an error or a compromise of patient safety.

Figure 25-1 Disruptive behavior crossing lines of authority between surgery and anesthesia.

(From Beverly Kirchner, RN, BSN, CNOR, CASC; Jeanie Zelanko, RN, BSN, MSN, PhD; Richard Gilder, RN, BSN, MS.)

Figure 25-2 Disruptive behavior crossing lines of authority between nursing and administration.

(From Beverly Kirchner, RN, BSN, CNOR, CASC; Jeanie Zelanko, RN, BSN, MSN, PhD; Richard Gilder, RN, BSN, MS.)

Bullying Origins

According to Namie and Namie (2003) 81% of the bullies in the workplace are managers. This is a frightening number in our workplace that can destroy a culture of safety. Every nurse must ask, “What can we do in our workplace to eliminate the bully?” First we have to understand the person and the motivation that causes an individual to define his or her worth by destroying someone else. Where do we first see a bully? The answer is easy; we were first introduced to the bully in school. We noticed the behavior on the playground and in the lunchroom more than in the classroom. Women are far more likely to be bullies than men. The reason is that girls are presumably more likely to get away with passive-aggressive behavior, social isolation of others, and gossip. Young boys tend tobe overt and aggressive in behavior when angry or wanting to control a situation. In contrast, young girls resort to note passing, gossip, and avoidance to isolate another girl who was targeted by the bully. Boys—being overt—get into trouble, whereas girls—passing notes and being passive-aggressive—are not disciplined as often and thus the behavior becomes acceptable.

Bullies in the Workplace

In our workplace we now see this person as an individual who puts self above anyone else to control another human being. The bully seeks to control the targeted victim through the use of humiliation and the withholding of information and resources. If the workplace bully is left unchecked, the results can be an environment that is hostile, and everyone will suffer. An ignored workplace bully can put the whole organization at risk for employee trauma and/or possible litigation. Bullies at work are malicious individuals that can be considered to be endangering the health of the bully’s intended victim. The bully will repeat the behavior of attacking an individual over and over again. The bully’s target will often eventually leave the organization.

The bully will seek another victim after the target has left the organization. Bullies cannot survive without victims, and victims want nothing to do with bullies. A bully has low self-esteem and uses the target to feel better about his or her behavior. Workplace bullies usually have a lifelong history of disrespecting the needs of others. Namie and Namie (2003) claim that bullies are inadequate, defective, and poorly developed people that destroy others’ self-esteem to feel good about themselves.

Targets are the bully’s victims. Targets are vulnerable people who often make self-effacing statements, are private, and use several forms of self-denial for protection. In other words, some targets feel after a while that they deserve the abuse. The target makes statements like “If only I had …” Targets perceive themselves as victims. Targets find it hard to work with bullies. The target is brought into the relationship involuntarily, whereas the bully controls when to attack, when to hold back, and whom to perform in front of for the best results. The bully’s goal is to control the target completely. Weapons that the bully uses may vary from gossip to sabotage. Targets do suffer emotional damage at the hands of a bully. Targets often have problems with sleep and become fatigued. The fatigued health care worker/victim then places the patient at risk, because fatigue has been identified as one of the leading causes of medical errors in health care. When targets are being intimidated by the bully, they will not speak up, thus leaving the most vulnerable person in the perioperative environment—the patient—at risk. Targets are not the only ones who suffer in this type of work environment. The other staff members will suffer if they witness the behavior. The more the behavior is repeated, the greater the damage the work environment will suffer.

CORE ISSUES OF DISRUPTIVE BEHAVIOR

Survey Preparation and Distribution

Every health care facility has to examine the work environment to identify the core issues. The first step toward identifying core issues is to prepare and distribute surveys to physicians and employees (Box 25-1). The survey needs to be designed to explore specific concerns regarding the work environment. Successful data collection depends on ensuring the respondents’ confidentiality. Several concerns that need to be addressed in the survey design include ensuring that the respondents cannot be identified by their description of specific events or handwriting. Using an outside company is one way of providing this guarantee. A facility may be able to work with the information technology department and devise a plan for respondents to answer and feel safe using internal resources. No matter how the plan is designed and implemented, a baseline must be obtained to determine the work environment’s core issues according to the members who work in the environment.

BOX 25-1 Survey Questions to Assess Effects of Bullying