Disrespectful Behavior in Long-Term Care: New Survey From ISMP

Disrespectful behavior has flourished in health care for years. In fact, disrespectful behavior occurs more frequently in health care than in other industries, largely because of the demands and pace of the dynamic, complex, and often stressful work environment along with dysfunctional hierarchies that nurture a sense of status and autonomy.^1-3

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 (Table).^1-7

The adverse effects of disrespectful behavior are widespread. Disrespectful behavior can jeopardize an individual’s psychological safety, emotional health, and overall wellbeing.^1-11 It causes the recipient to experience fear, vulnerability, anger, anxiety, humiliation, confusion, loss of job satisfaction, professional burnout, uncertainty, isolation, self-doubt, depression, suicidal ideation, and physical ailments such as insomnia, fatigue, gastrointestinal discomfort, hypertension, palpitations, and chest pain.^1,3 Disrespectful behavior also damages the individual’s professional identity, potentially limiting career opportunities.¹

On an organizational level, disrespectful behavior can significantly impact expenses and often creates an unhealthy or even hostile work environment.¹ Lower staff morale, productivity, and attendance may lead to increases in employee attrition, exacerbating staffing shortages and leading to increased operating costs.^1-11 Disrespectful behavior also erodes professional communication, teamwork, and collaboration, which is essential to resident safety and quality; indeed there is a clear link between adverse resident/patient outcomes and disrespectful behaviors.^1,9,12-15 Further, if disrespectful behavior has led to an unhealthy team dynamic, individuals may be hesitant to raise resident safety issues.¹⁶

To cite one example, a nurse had called a physician several times to ask him to come into the facility to see a resident whose condition was declining. Each time, the physician became verbally abusive and refused to come into the facility. After multiple attempts, the nurse hesitated to call the physician again despite the resident’s continued deterioration. By the time she called again, the situation was emergent. The patient was rushed to a hospital and the operating room to stop internal hemorrhaging but died.¹⁵

Results from 2003¹⁷ and 2013¹⁸ Institute for Safe Medication Practices (ISMP) surveys on disrespectful behavior showed that disrespectful behavior was not an isolated event, was not limited to a few difficult practitioners, involved both lateral and managerial staff (not just physicians), and involved both genders equally. In 2003, 88% of respondents reported that 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. A decade later, little improvement was seen in the 2013 survey.

To measure progress with managing disrespectful behaviors, ISMP is again surveying readers. We encourage long-term care nurses, physicians, pharmacists, and other health care professionals to participate anonymously in the 15-minute survey by visiting https://www.ismp.org/ext/781. Responses must be submitted by November 19, 2021.

Judy Smetzer, BSN, RN, FISMP
Vice President
Institute for Safe Medication Practices
200 Lakeside Drive, Suite 200
Horsham, PA 19044
Phone 215-947-7797