can lose it when they are under a lot of stress.
And we have managed to create an environment where everybody's under
stress, so there's a lot of different causes for it, but
the fact of the matter is, it is poisonous to collaboration.
It is detrimental to patient safety, and we have to do something about it.
My own feeling is it starts at the top, that is,
the organization has to have a policy that says we do not tolerate
grossly disrespectful behavior, and that if you do this, there are consequences.
And unless that's in place then it's very difficult for
anybody in the front line to deal with it.
The nurse in the situation can't do anything if the institution
doesn't back her up and doesn't back up a policy.
So, we have to have a policy.
I think beyond that, we need to get at the root causes and
that means we need to do a lot to, if you will, rehabilitate these people.
Take people who have these problems and teach them to behave properly.
And that of course should start in medical school.
We should start with medical students being taught about
the importance of respect, and most of all, they have to have proper role models.
They have to have their teachers be people who model this.
So it's a big issue, it's a big order.
But it's something that's time has come to do something about it.
>> Now Lucian, if a nurse, he or she encounters particularly
disruptive behavior, do you have any recommendations for them?
What they can do on the spot, and immediately afterwards?
>> On the spot is very difficult because emotions are very high, and
the person who has just been humiliated or
treated badly is not in the position to do much to the person who's abusing them.
So probably the best thing in that situation is to just be quiet and
get the situation over with.
The important thing, however, is not to let it stop there.
That is, this kind of behavior
will continue unless something is done about it.
Now if you're in an institution that doesn't want to do anything about it,
then that's a problem.
But if your institution does indeed have policies and
practices, then it's important this kind of behavior be reported and
it go up to the appropriate level to be dealt with.
But I think the individual is very hard pressed to do much about it
if the leadership hasn't got effective policies.
Of course, if they had effective policies, perhaps it wouldn't happen.
So this is a chicken and egg kinda problem.
But I think it's very difficult for people on the front line.
An institution cannot survive if it tolerates this kind of behavior.
>> Lucian, I totally agree and thank you very much.
>> My pleasure.
>> Why should institutions actively address this problem?