When Disruptive Behaviors are Normalized

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

This past weekend, I presented as part of a leadership program for the Association for Perioperative Registered Nurses. Feedback in the chat and polling reminded me of what a challenging time it is to be a leader. Much of the country is now headed into a second surge. We know so much more about caring for COVID-19 patients and have become more adept at managing surge staffing issues. Yet, the climate in the country has changed. Disruptive behaviors have become normalized in many parts of society, and these behaviors have seeped into healthcare environments. Nurse leaders are struggling with negativity among their staff and contending with angry patients and family members. Meeting the challenges of this next phase of COVID is likely to be much more complex.

In the October edition of Nursing Outlook, Dr. Cynda Rushton from John Hopkins writes about moral outrage. She defines it as anger, disgust, or frustration directed toward those we feel have violated ethical values or standards. When we observe events that cause us moral distress, our emotions can quickly shift to moral outrage. Many nurse leaders are experiencing this emotion from staff who feel like leaders in their organizations have failed to plan effectively for supplies, staffing, and safety of staff. Some nurses feel dispensable as they are furloughed and then recalled and redeployed to other clinical areas. Watching the public fight over mask-wearing (and their own family members) has led to moral distress in nurses as they wonder whether their community will have the capacity to meet COVID patients’ needs. Many feel outraged that they will again have their personal safety jeopardized.

The challenge with moral outrage, Rushton contends, is that it can move to moral contagion. Moral contagion fuels divisions, exacerbate differences, and creates a climate where disruptive behaviors become accepted and normalized. The problem with moral contagion is that collective negative emotions become so powerful that finding solutions to problems is more difficult and stress increases.

Today, nurse leaders find themselves walking a fine line between being supportive of a stressed nursing workforce yet confronting negativity and disruptive behaviors. Guidance about some key behaviors that have a known negative impact on team effectiveness was offered by the Duke patient safety team of researchers in a 2020 article. They identified the following six disruptive behaviors (already present in 97.8% of work settings in a large health system pre-COVID) that directly impact team effectiveness and patient safety:

Turn their backs before a conversation is over.
Hang up on the phone before a conversation is over.
Bully other people.
Try to humiliate others publicly.
Make comments about sexual, racial, religious, or ethnic slurs.
Show physical aggression (grabbing, throwing, hitting, pushing).

All six of these behaviors fall into the Circle of Influence of a team that needs to rebuild their culture. I would urge leaders concerned about disruptive behaviors to use this research to guide your efforts. Get some data from your team about how prevalent each one is in your environment. With that evidence in hand, you can more effectively plan your next steps.

References

Rehder, K.J., Adair, K.C., Hadley, A., McKittrick, K. Frankel, A. Leonard, M. Frankel, T.C. & Sexton, J.B. (2020). Associations between a new disruptive behavior scale and teamwork, patient safety, work-life balance, burnout, and depression. The Joint Commission Journal on Quality and Patient Safety. 46: 18-26.

Rushton, C.H. & Thompson, L. (2020). Moral outrage: Promise or peril. Nursing Outlook. 68: 536-538.

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Read Rose Sherman’s book available now – The Nurse Leader Coach: Become the Boss No One Wants to Leave