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Triggers Contributing to Health Care Clinicians’ Disruptive Behaviors

Bae, Sung-Heui*; Dang, Deborah†‡; Karlowicz, Karen, A.§; Kim, Miyong, T.

doi: 10.1097/PTS.0000000000000288
Original Article: PDF Only

Objectives This study's objective was to explore the possible triggers of clinicians’ disruptive behavior and to consider whether the type of trigger resulting in disruptive behavior differed by type of clinician, clinician characteristics, professional role, and ethnic background.

Methods Using data collected from 1559 clinicians working at an urban academic medical center in the United States, we examined intrapersonal, interpersonal, and organizational triggers. In addition, we measured 3 subscales of disruptive behavior including incivility, psychological aggression, and violence. Multivariate regression and logit models were used to examine the relationship between triggers and disruptive behavior.

Results We found that higher levels of intrapersonal, interpersonal, and organizational triggers related to a greater frequency of disruptive behaviors after controlling for clinician characteristics. Among nurses, all 3 types of triggers were significantly related to disruptive behaviors with the same direction and magnitude of difference. However, in the physician/affiliate group, only intrapersonal and interpersonal triggers were statistically significant factors for disruptive behavior.

Conclusions In the present study, important triggers were found to contribute to clinicians’ disruptive behaviors. Strategies to prevent disruptive behaviors should be multipronged and reflect intrapersonal and interpersonal features for both clinician groups. For nurses, organizational triggers should be addressed through process and system improvements. Because disruptive behavior continues to be frequent among clinicians, efforts to implement evidence-based practices to prevent disruptive behaviors must continue, and future research should evaluate them.

From the *College of Nursing, Ewha Womans University, Seoul, South Korea; †The Johns Hopkins Hospital, Baltimore, Maryland; ‡School of Nursing, Johns Hopkins University, Baltimore, Maryland; §College of Health Sciences, School of Nursing, Old Dominion University, Norfolk, Virginia; and ∥School of Nursing, University of Texas at Austin, Austin, Texas.

Correspondence: Deborah Dang, RN, PhD, 600 N Wolfe St, Baltimore, MD, 21287 (e-mail:

This work received grant from Maryland Health Services Cost Review Commission Nurse Support Program I.

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