Numerous health professionals are involved in complex health care work processes and cooperate with others in health care settings. Bullying, incivility, and workplace violence are pervasive problems within the nursing profession, resulting in a toxic work environment, a variety of related health issues, increased costs to health care organizations, and compromises in patient safety.1 Stress, as well as production and time pressure at work may further increase tense communication in a disruptive, uncivil, and threatening manner such as yelling, using abusive language, being admonished in front of coworkers and patients, and taking insults.2 Such disruptive behavior often underestimates contextual factors that trigger tense episodes at work. Disruptive behavior is defined as unpleasant actions or a lack of regard for a person or group that is treated less favorably than another group primarily. It can be due to their race, ethnicity, gender, disability, socioeconomic status, sexual orientation, gender identity, primary spoken language, and place of residence.1
Disruptive behavior has negative impacts on public health, especially for vulnerable, underfunded health care institutions. It has the potential to drastically increase the need for health care services, decrease their supply, and make them hazardous and unsafe to use. The additional burden placed on an already overburdened and stretched health care system may affect the balance between demand and availability of health care services in a way that is detrimental to the health outcomes of populations receiving those services.3
Moreover, disruptive behavior has been linked to negative outcomes, decreased patient safety, and even patient mortality with a disadvantageous impact on patients' quality outcomes and health care if confidence and competency decline as a result. In addition, disruptive behavior is at the root of the challenges encountered in developing team-based methods to enhance quality of care. As professional performance is affected, such problems may compromise clinical judgment.4
Therefore, the main responsibilities of health care professionals are to be aware of rules such as zero tolerance and follow them based on the standards of the organization. A zero tolerance policy requires accountability for violations in order to eliminate various kinds of disruptive behavior and create an attractive and supportive workplace environment.5 These guidelines prevent managers from deviating from the rules to use their own discretion.6 However, situational aspects that trigger tensions need to be addressed as well.
Nurse managers can also increase awareness of workplace incivility, including a zero tolerance policy for all employees, by discussing the issue at staff meetings. To promote a culture shift that does not tolerate bullying, incivility, or workplace violence, nurse managers should be easily approachable, and the staff should feel comfortable reporting behaviors without fear of retaliation.7
CONCLUSION
Disruptive behavior in health cultures is a major issue. Hence, any effective approach should begin with a systemic method to solve the issue rather than just using the usual admonishing and punishing tactics that have been previously applied in such situations. To foster a culture in which the problem of disruptive behavior at work is identified and addressed, organizations must also provide an opportunity for everyone to freely discuss issues. Health organizations, teams, and patients all benefit from zero tolerance for reducing disruptive behavior.
-Violeta Lopez, PhD
Professor
School of Nursing
Midwifery & Social Sciences
Central Queensland University
Rockhampton, Queensland, Australia
-Samereh Eghtedar, PhD
Assistant Professor
Department of Medical Surgical Nursing
School of Nursing and Midwifery
Urmia University of Medical Sciences
Urmia, Iran
-Nader Aghakhani, PhD
Associate Professor
Food and Beverages Safety Research Center
Clinical Research Institute
Urmia University of Medical Sciences
Urmia, Iran
REFERENCES