The journal Academic Medicine recently reported that 100% of the
physicians interviewed in their study had witnessed or been
personally affected by incivility. A Joint Commission survey in 2008
nurses found that 90% of nurses had witnessed workplace bullying —
and 50% had been bullied themselves.
Friction between staffers and staffers and surgeons costs us big —
in absenteeism, loss of productivity and turnover. Estimates are that
nurse-on-nurse and surgeon-on-nurse bullying costs healthcare
facilities upwards of $14,000 per employee per year — a staggering
$4 billion annually in the aggregate. Worse, bullying affects outcomes.
Incivility in health care has been linked to an alarming 71% of
medical errors and to increased mortality in 27% of cases, according
to a report in The Joint Commission Journal on Quality and
Patient Safety. The OR is a particularly high-stress, high-risk
environment, and the one place in health care where physician-on-
nurse bullying is more common than the nurse-to-nurse variety.
Why can't we be nicer to one another? There are many reasons. One
is that doctors and nurses learn very early on in their careers that
toughness is a virtue. The barriers to entry in our field are high, and
stress is endemic. To get into a practice or to work on a hospital floor,
you must endure long, grueling years of training. When things get
stressful and rushed, as they so often do in our field, senior staffers
take out their frustrations on lower-level employees. The mentality is,
"I survived it and now it's your turn." Too frequently the victims
become perpetrators and the cycle starts anew.
Incivility manifests differently depending on gender. Many men were
raised with a "boys will be boys" attitude — they roughhoused on the
playground in an environment of overt aggression. In women,
generally, bullying is subtler. Many of us learned very early on to bully
by excluding other girls. We see both forms of incivility manifesting in
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