Disruptive behavior in healthcare has been identified as a threat to quality of care, nurse retention, and a culture of safety. A qualitative study elicited registered nurse experiences with disruptive clinician behavior in an acute care hospital. A conceptual framework was developed to provide a structure for organizing and describing this complex construct that includes 4 primary concepts: disruptive behaviors and its triggers, responses, and impacts.

This study investigated registered nurses' (RNs) and physicians' (MD) experiences with disruptive behavior, triggers, responses, and impacts on clinicians, patients, and the organization. Using the Disruptive Clinician Behavior Survey for Hospital Settings, it was found that RNs experienced a significantly higher frequency of disruptive behaviors and triggers than MDs; MDs (45% of 295) and RNs (37% of 689) reported that their peer's disruptive behavior affected them most negatively. The most frequently occurring trigger was pressure from high census, volume, and patient flow; 189 incidences of harm to patients as a result of disruptive behavior were reported. Findings provide organizational leaders with evidence to customize interventions to strengthen the culture of safety.

Background The Fuld Fellows Program provides selected pre-licensure nursing students with a foundation in the science of patient safety, quality improvement and leadership through coursework and a mentored experience working on a quality improvement project. We evaluated this program’s impact on Fellows’ patient safety competence and systems thinking. Methods Cohorts I-VI ( n = 116) completed pre-post program evaluation that included measurement of patient safety competence through the Health Professional Education in Patient Safety Survey (H-PEPSS) and systems thinking using the Systems Thinking Scale. Pre- and post-program H-PEPSS and Systems Thinking Scale scores were compared using the Wilcoxon Signed-Rank Test. The Fellows were compared to non-Fellows on patient safety competence and systems thinking using t-tests. Results Patient safety competence on all H-PEPSS scales improved from baseline to end of program: teamwork (2.6 to 3.1), communication (2.1 to 3.2), managing risk (2.2 to 3.3), human environment (2.8 to 3.7), recognize and respond to risk (2.7 to 3.6), and culture (2.9 to 3.8) ( p < 0.05). The Fellows, in comparison to the non-Fellows, reported a significantly higher ( p < 0.05) mean change score in five of the six H-PEPSS subscales. Fellows’ mean systems thinking score increased from 66 ± 7 at baseline to 70 ± 6 at program completion ( p < 0.05), this mean post completion score was significantly higher than the non-Fellows reported mean STS score of 62 ± 7. Conclusion The Fuld Fellows Program effectively facilitated patient safety and quality improvement and systems thinking learning among pre-licensure nursing students. This program can serve as a model for integrating quality and safety concepts into health professionals’ curricula.

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