Creating a Culture of Mutual Respect

Abstract

The Joint Commission mandates that hospitals seeking accreditation have a process to define and address disruptive behavior. Leaders at Maimonides Medical Center, Brooklyn, New York, took the initiative to create a code of mutual respect that not only requires respectful behavior, but also encourages sensitivity and awareness to the causes of frustration that often lead to inappropriate behavior. Steps to implementing the code included selecting code advocates, setting up a system for mediating disputes, tracking and addressing operational system issues, providing training for personnel, developing a formal accountability process, and measuring the results.

Analyzing the concept of disruptive behavior in healthcare work: an integrative review*

“…Regarding attributes, it was found that the most disruptive behavior conduct characteristics were concentrated in the categories of Violence and Psychological Incivility, which was also found in other studies (33)(34) . In analyzing the experience of clinical nurses with disruptive behavior in the United States, researchers found the occurrence of this behavior among all contexts of practice and among a wide range of health professionals.…”

Lateral Violence in Nursing

“…6 A Joint Commission review found that in 70% of the cases classified as sentinel events, communication was a root cause for the incident, not a technical or system failure. 6 Lateral violence may contribute to poor communication if a nurse is too intimidated by a co-worker to speak up as a patient advocate. For example, in the emergency department, patients are sometimes labeled as "frequent fliers" or drug seeking.…”

“…6,12 Team-building sessions conducted by recognized leaders in the department should focus on building trust, clarifying roles, engaging staff in decision making, role-modeling positive interactions, and holding one another accountable for behavior that is inappropriate. 12 A crucial conversation is a conversation where the stakes are high for all members and opinions often vary.…”

“…12 A crucial conversation is a conversation where the stakes are high for all members and opinions often vary. 6 One example of a crucial conversation is a novice nurse asking to speak with the seasoned charge nurse after overhearing a conversation that included a complaint about the new nurse being needy. I was asked to participate in this meeting where the novice nurse expressed how she was made to feel and the charge nurse spoke about the volume and urgency of patient arrivals.…”

“…The participants cannot stay stuck in their position and need to agree to commit to developing a win-win for both in the long term. 6 A mediator can be chosen to be part of a crucial conversation for support of the victim but should remain neutral and maintain confidentiality. 6 The key to training ED nurses in crucial conversations is that they are most effectively taught by a recognized leader in the department rather than an outside vendor.…”