Laura Sweet, deputy chief of enforcement for the Medical Board of California, has said that the licensing body has investigated several maternal or fetal deaths resulting from the failure of nurses to contact doctors about a worrisome reading on a fetal monitor “for fear of being chastised or ridiculed.”
“Hospitals can no longer afford to look the other way,” said California internist Alan Rosenstein, who has written extensively about the issue, beginning with an influential 2002 study that found that bad behavior by doctors drove nurses from the profession, contributing to the nursing shortage. Bad conduct, notes Rosenstein, former West Coast medical director of the VHA hospital network, can have expensive consequences in the form of lawsuits by employees alleging the existence of a hostile workplace and an exodus of experienced nurses who are expensive to recruit and difficult to replace.
Sometimes patients are the victims. Rosenstein cites one case of a physician who ridiculed a nurse after she called him at home, worried that a patient in the intensive care unit had developed aspiration pneumonia, a potentially lethal complication that occurs when a substance such as food or vomit is inhaled into the lungs. “He told the nurse to ‘get better training’ and refused to address the issue,” Rosenstein said. “The patient died.”
Changes in the way health care is delivered — along with escalating demands to see more patients, reduced nursing staffs and uncertainty as hospitals buy medical practices — may help foster bad behavior, said J. Kim Penberthy, co-director of U-Va.’s Effective Coping and Communication Skills Program. “So much of what we see is the frustration and difficulty of coping with change” by older doctors.
Care is now delivered in teams, making interdependence, not autonomy, paramount, said Fontaine, who has written about disruptive behavior and confronted it as an operating-room nurse. “Forty years ago, medicine was more hierarchical” and teamwork less important, she said.