Almost half felt pressured to accept the order, dispense a product, or administer a medication despite their concerns.As a result, 7% of respondents reported that they had been involved in a medication error during the prior year in which intimidation clearly played a role.In 2008, Rosenstein and O’Daniel conducted a survey of more than 4,500 nurses, physicians, and other healthcare professionals from 102 hospitals to assess the significance of disrespectful behavior and its impact on patient safety.5 More than two-thirds (70%) of respondents reported a link between these behaviors and medical errors and poor quality patient care; more than 65% linked the behaviors to an adverse event; more than 50% reported that patient safety had been compromised; and more than 25% linked the behavior to patient mortality!

“The worst behavior problem is not the most egregious,” added one participant.

“It’s the everyday lack of respect and communication that most adversely affects patient care and staff morale.”6(p.6) In this study, too, respondents reported that disrespectful behavior had led to patient harm.

To cite one example, a nurse had called a patient’s physician several times to ask him to come into the intensive care unit (ICU) to see a patient whose condition was declining.

Incredibly, 4% of respondents even reported physical abuse.

Almost everyone who works in healthcare has a story to tell about disrespectful behavior.

Unfortunately, patients have paid a high price–even with their lives–for our inability to be respectful to each other, as there is a clear link to adverse patient outcomes and disrespectful behaviors.

Almost half of our 2003 survey respondents told us that their past experiences with disrespectful behavior had altered the way they handled order clarifications or questions about medication orders.9 At least once during the prior year, about 40% of respondents who had concerns about a medication order assumed it was correct or asked another professional to talk to the prescriber, rather than interact with a particularly intimidating prescriber.

Bullying, incivility, intimidation, and other forms of disrespectful behavior have run rampant in healthcare, allowed to exist while many remain silent or make excuses—“That’s just the way he/she is”—in an attempt to minimize the profound devastation that disrespectful behavior can cause.

The term “disrespectful behavior” encompasses a broad array of conduct, from aggressive outbursts to subtle patterns of disruptive behavior so embedded in our culture that they seem normal (see Table 1 on page 2 in PDF version).1,2 On a personal level, disrespectful behavior causes the recipient to experience fear, vulnerability, anger, anxiety, humiliation, confusion, loss of job satisfaction, professional burnout, uncertainty, isolation, self-doubt, depression, and a whole host of physical ailments such as insomnia, fatigue, nausea, and hypertension.1-8 The presence of disrespectful behaviors erodes professional communication and collaboration, which is essential to patient safety and quality, and creates an unhealthy or even hostile work environment.4 Prevalence and link to safety Ten years ago, ISMP conducted a national survey of nurses, pharmacists, physicians, and other health professionals regarding intimidation in the workplace.

Results showed that disruptive (disrespectful) behaviors were not isolated events, they were not limited to just a few difficult practitioners, they involved both lateral (peer-to-peer) and intradisciplinary staff (and not just physicians), and they involved both genders equally.9 Back then, 88% of respondents reported that, in the year prior to the survey, they had encountered condescending language or voice intonation; 87% encountered impatience with questions; and 79% encountered a reluctance or refusal to answer questions or phone calls.

Almost half of the respondents reported more explicit forms of intimidation, such as being subjected to strong verbal abuse (48%) or threatening body language (43%).