Nursing Educators and Dealing With Disruptive Behavior

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How Deal With Disruptive Behaviors In Nursing Education

Nursing Educators and Dealing With Disruptive Behavior

What Is Disruptive Behavior,Impact of Disruptive Behavior on Educational Environment,Nursing Orientation/Residency Programs In Educational Systems,Zero Tolerance for Behaviors Undermining a Culture of Safety,How Do Addressing Disruptive Behavior,Necessity of Dealing with Disruptive Behavior,Outcomes of Dealing With Disruptive Behaviors.

What Is Disruptive Behavior

    Disruptive behavior is any inappropriate behavior, confrontation, or conflict ranging from verbal abuse to physical or sexual harassment (Rosenstein, 2013). Disruptive behaviors include overt and covert actions that are displayed by any health care worker that threaten the performance of the health care team (Joint Commission, 2008) Disruptive behavior includes profane or dis courteous language, demeaning behavior, sexual comments or overtone, racial/ethnic jokes, outbursts of anger, throwing objects, criticism in front of patients or staff, comments that undermine a patient's trust, and comments that undermine a caregiver's self-confidence (Porto & Lauve , 2006 )

Impact of Disruptive Behavior on Educational Environment 

    Health care workers are often exposed and desensitized to behaviors that support a non-conducive and disrespectful work environment . Nurses, as well as other health care providers, must support, establish, and maintain working environments that are safe and conducive to the provision of quality health care. Disruptive behaviors not only threaten patient safety but also the ability for health care workers to perform their job competently. Hickson (2012) identified four significant implications to decrease the incidents of disruptive behaviors: orientation/residency programs, collaborative partnerships between academia and service, zero tolerance for behaviors that undermine a culture of safety, and addressing negative behaviors.

Nursing Orientation/Residency Programs In Educational Systems

    These orientation/residency programs are intended to provide positive mentorship and preceptorship to support and promote a culture of professionalism and collegiality. According to the Quality and Safety Education for Nurses (QSEN, 2014), competency nurses, physicians, and other health care professionals are expected to function effectively within inter-professional teams, foster open communication, employ mutual respect, and share decision making to achieve quality patient care. 

    Nurse residencies and internships further indicate a relationship between the quality and quantity of nurse's orientation and the satisfaction and retention of novice professionals (Scott, Keehner  Engelke , & Swanson, 2008). The Institute of Medicine (2010) suggested that the collaboration of state boards of nursing and accrediting bodies should support the completion of a nursing residency program upon license or advanced practice degree program, or the transition to new clinical practice areas. 

    Collaborative Partnerships Between Academia and Service. A collaborative vision and partnership between academia and the practice setting can successfully translate to increased professionalism, effective communication, optimal patient care, and substantive working relationships.

Zero Tolerance for Behaviors Undermining a Culture of Safety

    Based on the Sentinel Event Alert (Joint Commission, 2008), the Joint Commission began requiring health care facilities to implement zero-tolerance policies that defined intimidating and disruptive behaviors. Zero tolerance includes, but is not limited to, intimidating and/or disruptive behaviors, especially the most egregious instances of disruptive behavior such as assault and other criminal acts (Joint Commission, 2008). 

    It is essential to provide information and education to students, as well as to the staff of all disciplines, concerning the phenomenon of disruptive behavior: defining characteristics, understanding the effects toward individuals and an organization, identifying the system for reporting and monitoring, and the responsibility that all stakeholders hold in eliminating disruptive behavior and adhering to the organization's zero tolerance policy. 

    Education about zero tolerance can be offered by formal or informal means, such as coaching, mentoring, or precepting . An emphasis on individual accountability at all organizational levels, as well as organizational adoption of a culture of civility, would be required for policies to be effective (Clark, Olender , Cardoni , & Kenski , 2011).

How Do Addressing Disruptive Behavior

    Careful attention must be given to implementing effective strategies to empower newly registered nurses or experienced nurses to confront, defuse, and resist disruptive behaviors in their professional nursing practice Griffin (2004) has delineated cognitive behavioral techniques addressing negative behaviors, emphasizing educational awareness and cognitive rehearsal as specific interventions that new nurses can use to confront their hostile offender. 

    Strategies identified by the Center for American Nurses (2008) include nurses adopting and modeling professional ethical behavior, recognizing and addressing bullying and disruptive behaviors in the workplace, reflecting on one's own behavior and communicating respectfully, participating in collaborative inter-professional initiative to prevent abuse , and working to ensure the mission, vision, and values of their work places are reflective of the Code of Ethics for Nurses and standards set by the profession in order to eliminate disruptive behavior.

    The burden of responsibility for decreasing and/or eliminating disruptive behavior does not fall solely on an individual or a group, but the organization as a whole organizational leader should use their constitutive capacity of persuasive influence to foster healthy and non-disruptive work environments, which ultimately create the ethical practice desired by the stakeholders of the nursing profession. It is not enough for the leaders to use their influence to reinforce a non-disruptive environment but also to commit to a role-modeling change in the pre-existing culture. 

    If organizational leaders continue to overlook the urgency of the domino effect that disruptive behavior has within health care, they steadfastly default on their vow of providing a culture of safety and promoting the standards of professionalism (Hickson, 2012 ) .

Necessity of Dealing with Disruptive Behavior

    Eliminating disruptive behavior in the nursing profession is necessary in order to support an environment conducive to a healthy workplace. If it is to be achieved, nursing education and health care must develop educational and mentorship programs that foster a healthy work environment and change the culture of nursing to one of valuing self, peers, and nursing practice organizations (Lux, Hutcheson, & Peden , 2014) Lux et al. (2014) stressed that nurse educators must educate nursing students about how to confront disruptive behavior before entering their profession. New graduates must leave nursing programs equipped with well-developed professional communication skills.

    Della Sega (2011) identified a three-step process for decreasing the incidents of disruptive behavior in the workplace, which can be affected by nursing educators to support the transition of students to newly graduated nurses. The three steps are educating nurses who are the victims of disruptive behavior about disruptive behavior in order to improve their understanding of the phenomenon, teaching interactive strategies to help nurses relate and re-frame disruptive behaviors, and using role modeling to integrate appropriate behaviors.

Outcomes of Dealing With Disruptive Behaviors

    Disruptive behavior can have deleterious effects on a personal or organizational level, which can no longer be ignored. Accreditation of health care facilities now depends on an organization's ability to effectively address disruptive behaviors. Organizations that operation and purely force zero-tolerance policies demonstrate to their employees the promotion of a healthy work environment ( Hickson , 2013). 

    A strong commitment on the part of health care agencies to eliminate disruptive behaviors, along with cooperation from everyone in the organization, is imperative. Longo (2010) identified approaches for addressing disruptive behaviors which include the following: adopt a zero-tolerance stance, develop a code of conduct that defines acceptable and unacceptable behaviors, provide education regarding communication skills, provide coaching and mentoring, provide mediation services to resolve disputes between parties, and take disciplinary action. 

    Rosenstein (2009) echoed similar topics as a call to action for health care environments to address disruptive behavior: strong organizational leadership, awareness and accountability, communication and team collaboration training, identifying clinical champion/clinical champions, enforcing policies and procedures, and reporting an intervention process.

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