This is an exciting time for nurses as more and more emphasis is placed on building positive workplaces.  Discussions, articles, and initiatives addressing workplace violence can be found in all sorts of healthcare circles.  There is no doubt in my mind that these efforts will positively impact quality and safety for patients as well as job satisfaction for nurses. 

When I do workshops for nurses on understanding and improving workplace dynamics, I hear some common expressions regarding

toxic behaviors:

I'm finally getting used to it.

If I say anything, I'll lose my job.

It comes with the territory.

I know if I report him, he’ll make my life miserable. 

These comments paint a sad picture about current workplace conditions and fears. They highlight the need for repairing broken trust as well the challenges organizations face in doing so.

Historically, reports of disruptive behaviors have been minimized, ignored completely or have even resulted in blaming the victim.  With this kind of precedence, it stands to reason that nurses and others may be reluctant to report or actively intervene when inappropriate behaviors manifest themselves.

Abuse has never been explicitly condoned, but it has been implicitly accepted.  What I mean is that no organization has ever stated  its approval  for doctors to be aggressive or nurses to be passive aggressive.  No hospital that I know of has a policy that states, “We have a partial tolerance for abuse’! 

As absurd as a policy like this may sound, it is often grounded in  reality. This is a crucial point, because tolerating abuse has evolved from subtle mixed messages and unhealthy power dynamics.  Basically, what seems to be embedded in many organizational cultures is an unspoken practice, “We are not going to say that abuse is ok, but we will look the other way sometimes and since we have more power, we can”’.  

In January, 2009, The Joint Commission's new requirement for addressing disruptive behavior goes into effect.  This new standard includes requirements for establishing a code of conduct and a process for managing inappropriate behaviors.  In addition, The Joint Commission goes on to provide a comprehensive list of suggested actions regarding educating, enforcing, and documenting related issues.

(See the July 9, 2008 Sentinel Event Alert, for more information: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm)

Organizations have a rich opportunity here.   As they develop policies and procedures to meet TJC's requirement or develop their own initiatives, they can look for ways to show ownership for old unhealthy dynamics and their commitment to new healthy ones.   One way to do this would be to offer an announcement from senior management that includes an acknowledgement and apology about the past and a request to move forward. This does not need to be a long and involved probe into old wounds.  Such a letter might look like this:

Dear ABC Hospital Staff,

As your CEO, I am writing to prepare ABC Hospital for its  policy of ZERO tolerance for abuse.   This policy goes into effect immediately and includes  a long-term plan for related training and enforcing.  This letter is the first of many important steps.

We are learning how pervasive disruptive behaviors are in healthcare workplaces, and our facility is no exception.  I realize that there may be individuals who have experienced disrespectful treatment, and I want to publically apologize for any inappropriate behaviors that have occurred in this workplace.

No one deserves to be treated disrespectfully. I am sorry for any such behavior experienced by staff  at this facility. I cannot erase the past, but I can acknowledge it and offer resources to help build a better future..

If you have been a target of, or have witnessed, disruptive behaviors here or in other healthcare facilities and would like to share your experience openly, please contact Human Resources.  If you would prefer anonymous support, please contact the Employee Assistance Program we have set up to help with this initiative. 

I urge you to join me in creating a culture where we can work safely and respectfully together and offer the highest in healthcare quality. 

Sincerely...

A powerful memo like this could go a long way toward building trust and, with it, help set  the stage for identifying, reporting, and stopping toxic behaviors.  Even the most skeptical of nurses might begin to believe that things can and will be different. Seeking input for creatively taking this step from nursing staff, human resources, medical and administrative leadership, and others will likely increase investment in change as well as demonstrate, accountability, credibility, and sincerity.

Perhaps this is not a measure that all organizations will or should take.  There may be liability issues or other concerns which leadership must consider before acting on this suggestion.   In any case, getting the idea on the table seems like a valuable opportunity for discussion!

Let me know what you think at bbbboynton@earthlink.net.

http://www.jointcommission.org/

Beth Boynton, RN, MS, is an organizational development consultant and author of Confident Voices:  The Nurses’ Guide to Improving Communication & Creating Positive Workplaces. (Special book offer:  SAVE  20% NOW  at Beth's EStore  Use coupon code:  D359FSBP)

She is an adjunct faculty member with New England College and publishes the free e-newsletter:  Confident Voices for Nurses.  She has published numerous articles, offers a variety of workshops,  and can be reached at bbbboynton@earthlink.net or 207-752-0826.  Or visit www.bethboynton.com