Most physicians get along well with nurses, patients, and ancillary health care professionals, though there are a few exceptions in most health care organizations. Physician behavior problems, such as intimidating nurses, yelling, screaming, and throwing surgical instruments, are well-known, and most organizations have policies to address this issue. However, in many cases, these physicians are not held accountable for their behavior.

The health care organization's medical staff is responsible for assuring quality patient medical care, and disruptive physician behavior can affect this care by compromising nurse-physician communication and diminishing morale. Some say that it has even contributed to the nursing shortage.

Nurses should not tolerate disruptive physicians. Optimal patient care results from promoting a safe, cooperative, and professional health care environment. Following a facility's disruptive physician policy helps to prevent or eliminate behavior that disrupts hospital operations and assists staff to do their jobs and practice competently. It is also usually the same physician(s) who are guilty of this behavior. And since it is not usually just one incident that justifies disciplinary action, it is very important that documentation of this type of conduct occurs. Physicians themselves do not have a good track record in their own profession of recognizing the behavior in their peers and know even less about dealing with it. However, the disruptive behavior does not usually occur between physicians, but between a physician and another health care professional lower on the totem pole - like nurses. In addition, there are disagreements among physicians as to whether the problem is worsening or getting better. But most agree that problems with physicians tend to stem from the stress of dealing with difficult patients or the frustration of today's health care environment of regulatory requirements, financial constraints, and declining reimbursements.

Regardless of the reasons for disruptive behavior in any form, there must be a formal disciplinary process in place so that complaints can be investigated and proper steps taken to enforce standards. Since nurses work the closest with physicians in acute care hospitals, they are usually the ones that take the brunt of the behavior. However, historically, they are not well-versed in taking action by following the facility's policy to address the behavior. In addition, depending on the medical staff and the hospital's administration, attempts to follow the policy may be met with resistance. Indeed, in many instances such behavior is allowed to continue without documentation or disclosure, until the frustration level of nursing and ancillary staff reaches the boiling point, and the situation is out of hand. The problem needs to be addressed and not ignored, as it rarely gets fixed without intervention.

Nurses should follow their facility's policy to facilitate action in mitigating disruptive physician behavior. This process documents the occurrence and provides tracking. It also gives nurses some assurance that this issue is being properly addressed.

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