Ethics and Professional Misconduct Essay Example

The Center for American Nurses position statement on lateral violence asserts that these behaviors are “toxic to the nursing profession”3(p1) and contribute to an organization’s inability to retain quality staff members. This is of particular concern at a time when there is a shortage of qualified nursing professionals. The Joint Commission revealed in a survey that 77% of respondents had witnessed disruptive behavior in physicians and 65% had seen similar behavior in nurses.

The Joint Commission survey reported that nurses are primarily bullied by physicians; however, nurse-to-nurse indicates that continuing education contact hours are available for this activity. Earn the contact hours by reading this article and taking the examination on pages 697–698 and then completing the answer sheet and learner evaluation on pages 699–700. The continuing education credits for this article expire April 30, 2012.

Additionally, the Joint Commission reported that a survey conducted by the American College of Physician Executives revealed that 38. 9% of respondents admitted that physicians who generate high amounts of revenue are treated leniently when they exhibit negative behavior. 5,6 This may contribute to the idea that lateral violence is an accepted part of the OR culture and must be tolerated.

Although correction of physician issues is organizationally driven, nurses must take the lead in addressing the lateral violence or bullying behaviors that occur in their own profession. Studies show that the primary reason lateral violence is widespread is that nurses do not recognize the issue as behavior that must be corrected; rather, they accept these behaviors as the “way things are. ”6-8 Expressions such

as “nurses eat their young” have long been a hallmark of the nursing profession, which is ironic in a profession that prides itself in being a community of caring and nurturing practitioners.

While this is not a new topic, having been referenced in the literature for the past 20 years, the frequency of lateral violence appears to be escalating. 9 The unsettling and intimidating behaviors that constitute lateral violence among nurses not only threaten the health and well-being of the nurse, but also of the patients entrusted to the nurse’s care. states that “no other area in the hospital has a higher probability of lateral violence than the OR. ”2(p6) Dr Griffin adds that compared to other areas at her facility, she is contacted most frequently by OR personnel for assistance with behaviors that she refers to as “inhumane.

In a study published in the AORN Journal in December 2003, Dunn10 concluded that sabotage is one of the more frequent forms of lateral violence in the perioperative setting. Expressions such as “nurses eat their young” have long been a hallmark of the nursing profession, which is ironic in a profession that prides itself in being a community of caring and nurturing practitioners.

Experts agree that the perioperative setting is an area in which nurses commonly become the victims of bullying and lateral violence. Whether perpetrated by physicians, administrators, or colleagues, bullying behaviors have been identified as a routine part of OR culture. This may be due to several factors including the inherent stress of performing surgery, high patient acuity, a shortage of experienced perioperative professionals, overtime and on-call demands, and a restricted

department traditionally isolated from the rest of the facility, which allows negative behaviors to be concealed.

Martha Griffin, RN, PhD, a nurse researcher, former perioperative nurse, and program coordinator for nursing professional development at Brigham and Women’s Hospital in Boston, Massachusetts, Nurses themselves have been keenly aware of the deleterious effects lateral violence has on both their personal and professional lives. Cases of “burnout,” frustration, and disenchantment with the profession have caused nurses to abandon a career that many in the past considered a calling. 1 Nurses who are victims of bullying will experience more job stress, will have less job satisfaction, will exhibit increased absenteeism, and may provide substandard patient care, according to recent studies. 6-8,12 The effects of lateral violence on nurses can manifest as both physical and psychological maladies.

Lack of collegiality and professional development opportunties are well-known contributing factors to an organization’s nurse vacancy rate. For example, a perioperative nurse who in the past has been berated and made to feel inadequate by a colleague may avoid new procedures and unfamiliar experiences, thus inhibiting his or her professional growth and development. Organizations experience increases in nursing turnover and an inability to retain qualified nursing personnel when lateral violence goes unchecked.

Bland-Jones and Gates15 determined that costs associated with nursing turnover range from $22,000 to $64,000 per nurse, which would strain any facility’s fiscal reserves. Fear of reprisal and lack of organizational support have led perioperative nursing professionals and other nursing specialists to accept lateral violence behaviors as unavoidable.

For example, how many fledgling perioperative nurses have been advised to develop a “thick skin” for survival during their

orientation, which thereby conveys the expectation that abusive behavior is acceptable? Such a mind- et becomes enabling, so that bad behaviors are excused with the assumption that “that’s the way things are” and that lateral violence must be tolerated, not changed.

The cycle of abuse continues and in turn promotes an atmosphere of nurse-to-nurse hostility. Victims unconsciously mimic the behaviors that they endure and pass them on to the next wave of new nurses. Although the personal implications created by lateral violence are quite apparent, nurses may not routinely make the connection to the negative effect bullying behaviors have on their ability to provide safe patient care.