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Original Research: Disruptive Behavior and Clinical Outcomes: Perceptions of Nurses and Physicians: Nurses, physicians, and administrators say that clinicians’ disruptive behavior has negative effects on clinical outcomes.

Rosenstein, Alan H. MD, MBA; O’Daniel, Michelle MHA, MSG

AJN The American Journal of Nursing: January 2005 - Volume 105 - Issue 1 - p 54-64

Overview: Providing safe, error-free care is the number-one priority of all health care professionals. Excellent outcomes have been associated with procedural efficiency, the implementation of evidence-based standards, and the use of tools designed to reduce the likelihood of medical error (such as computerized medication orders and bar-coded patient identification). But the impact of work relationships on clinical outcomes isn’t as well documented.

The current survey was designed as a follow-up to a previous VHA West Coast survey that examined the prevalence and impact of physicians’ disruptive behavior on the job satisfaction and retention of nurses (see “Nurse–Physician Relationships: Impact on Nurse Satisfaction and Retention,” June 2002). Based on the findings of that survey and subsequent comments on it, the follow-up survey examined the disruptive behavior of both physicians and nurses, as well as both groups’ and administrators’ perceptions of its effects on providers and its impact on clinical outcomes.

Surveys were distributed to 50 VHA hospitals across the country, and results from more than 1,500 survey participants were evaluated. Nurses were reported to have behaved disruptively almost as frequently as physicians. Most respondents perceived disruptive behavior as having negative or worsening effects, in both nurses and physicians, on stress, frustration, concentration, communication, collaboration, information transfer, and workplace relationships. Even more disturbing was the respondents’ perceptions of negative or worsening effects of disruptive behavior on adverse events, medical errors, patient safety, patient mortality, the quality of care, and patient satisfaction. These findings suggest that the consequences of disruptive behavior go far beyond nurses’ job satisfaction and morale, affecting communication and collaboration among clinicians, which may well, in turn, have a negative impact on clinical outcomes. Strategies aimed at reducing the incidence and impact of disruptive behavior are recommended.

The researchers examined the disruptive behavior of both physicians and nurses and found that the consequences may go far beyond morale, affecting collaboration among clinicians, as well as clinical outcomes.

Alan H. Rosenstein is vice president and medical director and Michelle O’Daniel is director, member relations, of VHA West Coast. The authors report that each contributed equally to this work. Contact authors: and The authors of this article have no other significant ties, financial or otherwise, to any company that might have an interest in the publication of this educational activity.

The American Journal of Nursing has given permission to Nursing Management to allow the simultaneous publication of this article.

© 2005 Lippincott Williams & Wilkins, Inc.