More than 75% of participants in a recent Institute for Safe Medication Practices (ISMP) survey feel that the COVID-19 pandemic has contributed to an increase in disrespectful behaviors by healthcare professionals. Any behavior that causes staff or patients to be less willing to speak up or interact with that individual because they expect the encounter will be unpleasant or uncomfortable fits the definition of disrespectful. The adverse effects of disrespectful behaviors in healthcare can be clearly linked to unsafe practices, medical errors, and suboptimal patient outcomes.

ISMP has conducted national surveys of health professionals in 2003, 2013, and 2021 to measure the extent of and progress made to reduce these behaviors. The most recent survey was conducted during September and November 2021 and completed by more than 1,000 respondents, mainly nurses and pharmacists. Unfortunately, in 2021 participants reported that disrespectful behaviors continue to persist unchecked, are not limited to just a few offenders of a single gender, and occur in both individuals ranked higher, equal, and lower in terms of staff hierarchy than the target of their behaviors.

Highlights of findings from the 2021 survey have been published in the February 23, 2022, issue of the ISMP Medication Safety Alert!® Acute Care newsletter, including:

• Most survey respondents have personally experienced (79%), witnessed (60%), or otherwise have been aware of disrespectful behaviors (23%) during the past year.

• Types of disrespectful behavior most frequently encountered included condescending/demeaning comments and insults (64%), impatience with questions/interruptions (53%), and negative comments about colleagues/leaders (52%).

• Twenty-seven percent of respondents (more than a quarter) were aware of a medication error in the last year in which disrespectful behaviors played a role. That percentage has more than doubled between 2013 (11%) and 2021 (27%).

• Nearly half (47%) admitted to feeling pressured to accept a medication order, dispense a drug product, or administer a drug despite concerns about its safety. At least once during the year, more than one-third (35%) of respondents had concerns about a medication order but assumed it was correct rather than interact with a particular prescriber.

• Forty percent of respondents reported that three to five different individuals in their workplace had engaged in disrespectful behaviors during the year, and another 35% reported that more than five different offenders were involved.

• Least frequently reported behaviors that approximately one in 10 respondents still said were among the three most frequently encountered during the year included insults due to race/religion/gender appearance (8%), throwing objects (3%), and physical abuse/assault (2%).

• Three-quarters (75%) of respondents reported that their healthcare organization does NOT effectively deal with disrespectful behavior in the healthcare workplace. Nearly half (45%) said that their organization has not clearly defined the process for handling disagreements with the safety of an order.

• On a positive note, 65% of survey participants felt that their organization or manager would support them if they reported disrespectful behavior by another professional.

ISMP’s surveys show that these behaviors are clearly learned, tolerated, and reinforced in the healthcare culture. Many of the survey respondents’ comments in 2021 pointed out that the current stressful environment, poor staffing levels, excessive workloads, power imbalances, and constantly changing science and data associated with COVID-19 treatments were all factors contributing to the ongoing prevalence of disrespectful behaviors.

For a copy of the ISMP newsletter article that summarizes survey results, visit: https://www.ismp.org/resources/survey-suggests-disrespectful-behaviors-persist-healthcare-practitioners-speak-yet-again. Access may require free registration. A future issue of the newsletter will provide ISMP’s recommendations to help address this longstanding problem.