ObjectiveTo explore incidents of bullying and undermining among obstetrics and gynaecology (O&G) consultants in the UK, to add another dimension to previous research and assist in providing a more holistic understanding of the problem in medicine.DesignQuestionnaire survey.SettingRoyal College of Obstetricians and Gynaecologists (RCOG).ParticipantsO&G consultant members/fellows of the RCOG working in the UK.Main outcome measuresMeasures included a typology of 4 bullying and undermining consequences from major to coping.ResultsThere was a 28% (664) response rate of whom 44% (229) responded that they had been persistently bullied or undermined. Victims responded that bullying and undermining is carried out by those senior or at least close in the hierarchy. Of the 278 consultants who answered the question on ‘frequency of occurrence’, 50% stated that bullying and undermining occurs on half, or more, of all encounters with perpetrators and two-thirds reported that it had lasted more than 3 years. The reported impact on professional and personal life spans a wide spectrum from suicidal ideation, depression and sleep disturbance, and a loss of confidence. Over half reported problems that could compromise patient care. When victims were asked if the problem was being addressed, 73% of those that responded stated that it was not.ConclusionsSignificant numbers of consultants in O&G in the UK are victims of bullying and undermining behaviour that puts their own health and patient care at risk. New interventions to tackle the problem, rather than its consequences, are required urgently, together with greater commitment to supporting such interventions.
An urban shelter in Charleston, South Carolina developed and began a tuberculosis (TB) prevention and control plan that addressed the priorities recommended by the Centers for Disease Control and Prevention. After an increase in TB in the shelter in 1992, the local health department, the homeless clinic nurse practitioners, and Medical University of South Carolina College of Nursing faculty and students collaborated with the shelter staff to provide initial mass screenings for contact investigation. They also developed and implemented new policies and procedures for an ongoing TB prevention and control program. The new policies required that guests obtain screening for TB within 7 days of arrival at the shelter and every 6 months thereafter. Also, a public health nurse began providing directly observed therapy twice weekly at the shelter. Of the initial 22 persons who started TB preventive therapy in 1993, 17 (77%) completed therapy. The clinic nurse practitioners, nursing students, and public health nurses had important and defined roles in the mass-screening process, case identification and treatment, policy development and implementation, health education, and establishing methods of communication between the shelter, clinic, and health department. An ongoing health care community collaborative effort may successfully reduce tuberculosis disease in a homeless shelter population.
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