Does physician verbal abuse create a bad working environment -- or the reverse?

(Press-News.org) A recent study by the RN Work Project found that newly licensed registered nurses (NLRNs) who were verbally abused by nursing colleagues reported lower job satisfaction, unfavorable perceptions of their work environment, and greater intent to leave their current jobs. Now, a new study by the same research team finds that high levels of physician verbal abuse are closely associated with more negative work environments. The RN Work Project is a program of the Robert Wood Johnson Foundation.

The study found that nurses who experienced high (more than five times in the last three months) or moderate (one or more times in the last three months) levels of verbal abuse by physicians had less favorable perceptions of their work environments, lower intent to stay in their jobs, and lower commitment to their organizations. Those who experienced the most frequent abuse also perceived poor collegial relations between RNs and physicians, poor workgroup cohesion, and more work-family conflict. Higher levels of verbal abuse from physicians were also correlated with more verbal abuse among nurse colleagues.

The study was published online in Nursing Outlook. Investigators for the study were: Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo; Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University; Rana Obeidat, PhD, RN, Faculty of Nursing at Zarqua University in Jordan; and Wendy Budin, RN-BC, PhD, FAAN, adjunct professor at the College of Nursing, New York University. Kovner and Brewer direct the RN Work Project.

The researchers surveyed 1,328 NLRNs about how often they were verbally abused by physicians and the nature of the abuse. They found that RNs who were the most likely to experience verbal abuse by physicians were: younger; working in hospital settings; working day shifts; and working on units that were short-staffed.

"One of the most striking findings is that higher levels of verbal abuse by physicians are correlated with poorer perceptions of the work environment across the board," said Brewer. "It also seems that verbal abuse is contagious. One potential explanation is that negative behavior exhibited by one member of a group spills over to other members of the group and hurts the group dynamic. We also see that in a stressful environment, including one in which there is physician to RN abuse, there is more likely to be RN to RN abuse, as well."

Similar to the findings regarding abuse by other RNs, this study revealed that working in Magnet hospitals was associated with lower levels of verbal abuse by physicians.

"Physicians' verbal abuse of nurses is a long-standing problem and one we need to do much more to address," said Kovner. "It hurts morale, breeds further verbal abuse, and is associated with nurse intention to leave, particularly among younger nurses. All of these things ultimately reduce the quality of patient care. Health care organizations need to do much more to create positive, healthy work environments"

The researchers note that a variety of methods have been proposed to prevent verbal abuse but suggest that those methods must be part of a holistic approach to improving the work environment, as targeting only verbal abuse is not enough. They also assert that any policies put in place should be developed in cooperation with nursing leaders, key physicians, and administrators.

### The RN Work Project is a 10-year study of NLRNs that began in 2006. It is the only multi-state, longitudinal study of new nurses' turnover rates, intentions and attitudes—including intent, satisfaction, organizational commitment, and preferences about work. The study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas.

Read the study here: http://tinyurl.com/naltv9d

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