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Saturday, October 10, 2009

Reversing a Bullying Culture

A dire situation is looming in the U.S. healthcare system. It has been noted that respiratory therapy dissatisfaction and related intent to leave the work environment and being powerless to do anything about it are believed to be key factors contributing to a significant increase in RT dry humor and a significant increase in RT complainers.

Moreover, exposure to incivility, including workplace bullying, particularly by RT Bosses, and lack of turnover, is one of the primary factors influencing RT dissatisfaction, and can be a reason why some leave the the profession altogether, or yearn to do so.

Evidence suggests workplace bullying by RT Bosses and related disruptive behavior are commonplace, and on the rise. The combination of a busy healthcare setting, difficult patient situations, and the requirement for interdependent relationships can serve as a breeding ground for incivility and bullying behaviors.

In response to a survey by the Joint Commission, more than 75% of RTs reported having been a victim of bullying and/or disruptive behavior by RT bosses at work, and more than 90% stated that they witnessed the abusive behavior of others.

Despite the subsequent Joint Commission Sentinel Alert requiring healthcare facilities to design and implement a system wide approach to ensure employee awareness of disruptive and/or bullying behaviors, bullying continues and still is perceived to be steadily on the rise.

The implications for RT's work environments are noteworthy, since the health and availability of RTs are vital for the provision of a safe environment for our most vulnerable population -- the patients we serve.

At the core of incivility and bullying seems to be, according to most RTs surveyed, complaint due to stupid doctor orders, or doctors who simply have no clue what the purpose of a bronchodilator

"When we talk to our bosses about questionable therapies, they simply blow us off," wrote one of the surveyed RTs. "The comment we get most often is: 'we need these procedures so you can keep your jobs, so we hate to start cornering doctors and holding them accountable for their stupid orders."

Of the 75% of dissatisfied RTs, studies show 80% of them develop a keen sense of humor, as noted over at the Respiratory Therapy Cave and again over at Respiratory Therapy 101.

Dr. Ven T. Olin, president of the National Physician's Association of America noted that "all this extra humor in the hospitals has created an aura of lack of respect for physicians and RT Bosses by RTs, but thankfully no RT Bosses have the nerve to cross the physicians ordering stupid procedures for fear of losing procedure counts.

In a letter to this author, Mr. Olin noted, "if our RTs don't chart their procedures correctly, we expect RT Bosses to hound them until they become perfect. It's not something we want to do, but we have to do it."

So, instead of crossing the physicians, RT Bosses often cross the irritated RTs, and sometimes even become irate to the point of shouting. RT Bosses have been known to force RTs to be perfect, or suffer through humiliating notes that make them aware of all their flaws.

"Yes," Mr. Olin notes, "It happens at hospitals across the nation. It has been the beaming topic of RT blogs across the nation."

According to the joint commission, a committee is currently performing an extensive review in response to concerned RTs, and is currently looking for additional information about effective approaches to address these challenges.

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