Sexual harassment, confrontation and conflict are pushing nurses out of an industry that is already suffering from one of the worst employment shortages in recent history.

Disruptive physician behavior, classified as any inappropriate behavior including verbal and physical abuse and sexual harassment, was found to influence nurses' morale, patient outcome and healthcare costs.

In a survey led by Alan H. Rosenstein, MD, MBA, vice president and medical director of VHA West Coast in Pleasanton, Calif., 92 percent of those polled found that healthcare workers had witnessed disruptive behavior. Some 1,200 nurses, physicians and healthcare executives responded to the 24-question survey. The survey was sent to employees within the VHA network, which comprises 26 percent of the nation's community hospitals.

Rosenstein says the response has been surprising.

"To date, I haven't had a negative physician response to the survey," he says. "The physicians have wanted to interject their concerns, one of which was to remember that nurses themselves can subject themselves to disruptive behavior. One example given was a physician who was called at 2 am when he was covering someone else's patient. The nurse was not prepared with any of the patient information and was rude on the phone.

The second point that physicians say is important is the need to differentiate disruptive behavior from the need to get things done, particularly in a crisis situation where there is a sense of urgency. The physician is preoccupied with getting the tools and making the decisions to get the best patient care. Of course he may be abrupt and less sensitive to other people's feelings at that time."

He says that nurses and physicians have also given positive feedback to the research.

"Nurses have been overwhelmingly supportive," he says. "They were very appreciative to get this type of information out to the public. The physicians were also supportive. A lot of the physicians who filled out the survey were physician executives and they are the ones who are dealing with this on a day-to-day basis. They want to get the work out to other physicians that this is a serious issue."

Rosenstein proposes three solutions: New hospital policies and enforcement; enabling communication between staff members; and dedicated education programs

"Hospitals need to have a code of behavior policy with zero tolerance to disruptive behavior, and they need to have the enforcement and backup so if there are significant cases, they can make the appropriate recommendations and follow through.

Secondly, it is important to have more vehicles to enable appropriate communication. Some of this may be informal, like whenever the doctor comes onto the floor, he should introduce himself to the lead nurse. Putting nurses and physicians on committees where they have opportunities for input is another example. In fact, one of the suggestions is to put physicians on nurse recruitment committees so they can see what the nurses are looking for in their workplace environment.

The last part is to put on dedicated education programs to inform about team collaboration, team building skills, conflict management, stress management, time management and phone etiquette. Part of the way we approach physicians is not only to raise their sensitivity to the issue, but also to promote the value of collaboration, communication and team building because that is what gets you your best patient outcome. That's our business."

The survey, which Rosenstein says took 9 months to conduct, was released in June.