BE NICE TO THE NURSE | Verbal Aggression is cause of Nursing Errors

April 10, 2013

stressed nurse 300x199 BE NICE TO THE NURSE | Verbal Aggression is cause of Nursing Errors

I was recently at the hospital preparing injections for a patient when a belligerent family member interrupted me in the hallway.  He berated me about an overflowing trash can in one of the rooms and told me that I was a lazy nurse for not having emptied it.  His pushy, condescending and sarcastic demeanor elicited a fight or flight response but in the moment I had to squelch my instinct to react and decide which was most important—calming the visitor’s displaced aggression, dumping the garbage, or preparing my sick patient’s medications on time.  Unfortunately my brain stopped working altogether and my focus was drawn to the shaking in my hands.

Sadly this happens all the time in the hospital.  Nurses are constantly bombarded by aggressive patients, family members, doctors, and coworkers who interrupt the process of their work. Day in and day out, nurses are the recipients of unacceptable behavior and hostility while attempting to complete tasks that require their full attention.

A recent study published in the Journal of Applied Psychology [September 2012, When Customers Exhibit Verbal Aggression, Employees Pay Cognitive Costs by A. Rafaeli, et al*] explores what happens to a customer service employee’s cognitive functioning when they encounter rude behavior from customers.  Since nurses are the ultimate customer service employees, this research is appropriate for both waiters in restaurants and nurses in the hospital.

The study shows even minor verbal aggression can negatively affect an employee’s performance.  Under hostile circumstances, the employee experiences memory and perception problems.  He or she feels upset, contemplates what went wrong, and dwells on the encounter.  These brain functions distract an employee from the task at hand which ultimately leads to errors.

Some errors are more serious than others.  When a waitress makes an error at a restaurant, the result is frustration.  If a nurse makes a mistake at the hospital, a patient might be physically harmed or worse.  In 1999 the Institute of Medicine published “To Err is Human”  which concluded that between 48,000 to 98,000 patients die each year as a result of preventable medical errors.  In 2004 HealthGrades conducted a study  that showed an average of 195,000 patients died between the years of 2000 and 2002 because of potentially preventable in-hospital medical errors.  A report released in 2010 by the Office of the Inspector General at the U.S. Department of Health and Human Services found that in-patient medical errors contributed to the deaths of 180,000 patients every year.  A New England Journal of Medicine study published in 2010 showed approximately 18% of hospital patients are injured during the course of their stay and that many of those incidences are life-threatening, or even fatal.  A study published in 2011 showed that medical errors occur in one-third of hospital admissions which is 10 times more than previously estimated.

Hospitals have implemented countless strategies for reducing errors that are sound in theory but are not significantly reducing the number of mistakes which continue to occur.  Rafaeli et al offer a reason for this.  Protocols simply will not work when a nurse is frazzled by workplace hostility or verbal aggression.  Nurses become distracted and their cognition and perception are altered after an encounter with a rude patient, family member or doctor.

Because nurses make errors when they encounter aggression, there should be protocols that protect nurses from such behaviors.  Patient care liaisons should be on the front lines fielding patient complaints and buffering family member freak outs.  Doctors should be reprimanded when they belittle nurses and managers should be active in creating a healthy milieu for staff.  Patients and family members also need to be educated that their bad behavior can have serious consequences when directed at a nurse.  Aggressive behavior on their part opens the door to medication mistakes and other nursing errors.

So please, BE NICE TO THE NURSE.   In doing so, you might prevent a medical error and save a patient’s life.




*Rafaeli, A., Erez, A., Ravid, S., Derfler-Rozin, R., Treister, D.E., & Scheyer, R. (2012). When customers exhibit verbal aggression, employees pay cognitive costs. Journal of Applied Psychology, 97(5), 931-950.



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  1. Wow– I never knew that! It makes sense though. Some patients and their family members don’t have their priorities right!!

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