End Workplace Abuse

By Donna Cardillo, RN, MA

Over the years, I’ve received quite a few questions through my Nurse.com Dear Donna advice column related to on-the-job abuse by physicians, coworkers, supervisors and patients. These incidents run the gamut from verbal abuse and name calling to prejudicial behavior and even hurled objects. Abuse of any type is a serious issue and should not be tolerated. Unfortunately, we have become so accustomed to it in nursing that it’s often ignored, avoided or excused in some way. Many nurses feel powerless to combat abuse, or they’re convinced no one really cares. So what can a nurse do about it? While every situation is different, here are general guidelines.

Most organizations have strict policies against harassment, abusive behavior and hostile work environments. Familiarize yourself with your employer’s policy and the reporting mechanism. Immediately report any cases of abuse to your supervisor verbally. Depending on the circumstances, a written report also may be in order. If the situation is not satisfactorily resolved through your supervisor, report it to your human resources department. Keep good personal records. Document any incident, isolated or ongoing, that occurs, including the date, witnesses, who said what, and what action you took. Here are some actual questions I’ve received, along with additional advice and comments.

What is the best way to handle a nurse colleague who is verbally abusive to staff?

I have recently switched shifts and will be working directly with an RN who is verbally abusive. His behavior has been tolerated by the staff for the past 15 years. My boss knows about it, as many people have complained and quit because of him. I’ve encountered difficult personalities before, but that has been on a temporary basis. I will be working with this person directly every day, and I don’t want to be put into a predicament that escalates into something big.

It’s unfortunate that your supervisor and coworkers choose to ignore or tolerate this situation. When we tolerate and overlook bad and inappropriate behavior, whether with a coworker, a physician or any other peer, we encourage and support the behavior on some level.

In the event of a negative encounter with this individual, you should immediately call others to the scene to witness his behavior. Perhaps you can persuade others to join forces to stop the abuse. There is strength in numbers.

How do I cope with the screaming physician director of the intensive care unit who tried to put his patient in ICU when we were understaffed and stated, “You are incompetent.” I’ve worked in intensive care for about 25 years, and this is my first such encounter.

The next time something like this happens, you might attempt to confront the physician in private and inform him you do not wish to be spoken to in that manner. Ask for an apology and advise him that if it happens again, you’ll be forced to report him to the medical director. You also might want to give him, your supervisor and the medical director a copy of one of several articles written over the years that address how abusive physicians are impacting nursing recruitment and retention. One such article, “Nursing Wounds,” by Josh Fischman, was published in U.S. News and World Report.

What do you think about a patient who is not elderly or confused throwing a used syringe at a nurse because he thought she was late in giving his care?

Patients who attempt to assault nurses are dangerous and should be dealt with immediately. The employer has a responsibility to make reasonable efforts to protect workers from this type of hostility. In addition to immediately reporting this type of situation to your supervisor both verbally and in writing, also report it to the patient’s doctor. Depending on the circumstances and mental status of that patient, pressing charges also may be in order. Violence against nurses is a serious and growing problem and should never be tolerated.

While most workplaces have rules regarding abuse, reporting the abuse and enforcing the rules aren’t widespread. Many of us have learned to tolerate abuse or turn away from it. Unfortunately, this only perpetuates such behavior. Just as tolerance of drunken driving has decreased, less tolerance of abuse in the workplace will have an impact.

Value yourself as a human being and as a professional and do not tolerate abusive behavior. Protect yourself by taking appropriate action to resolve your own challenges and improve the workplace for those who follow.

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