Working late on a quiet shift, you glance in on a patient—only to spot a new nurse slyly pinching a pain patch. When you screw up your courage to report the incident the next day, you find it’s already been reported. The new nurse has named you as the culprit!
A stomach-churning scenario—but not the only one nurses have faced. Perhaps you, like many nurses, have found yourself in a situation where the head nurse acts charmingly in front of hospital administrators, but hides a potent mean streak, except, of course, with her handpicked favorites, who share her propensity for hidden nastiness. (These are the kind of people who laugh at you, not with you, and somehow are able to make you feel it’s your fault when they leave their duties undone.) When you complain about poor patient care resulting from the attitude of staff members, you’re isolated and bullied all the more. You become literally sick with worry and stress—depression looms, debilitating arthritis strikes, your blood pressure skyrockets.
Lying, bullying, manipulation, intimidation—situations such as the ones described above can destroy anyone’s love of nursing, not to mention zest for life. Research has shown that not only is hospital morale diminished, but patient lives can be lost because of the actions of a few disruptive people, who set everyone on edge with their unfair and even unethical behavior (Joint Commission Resources, 2006). After all, who wants to question a possibly incorrect prescription when there’s a good chance the doctor will angrily lash out because you’ve questioned his or her authority? And who wants to call a physician at home when there’s a good chance you’ll be made to feel like an idiot for doing so? And finally, who wants to take a chance reporting the behavior of a powerful supervisor who has even more powerful friends?
But there is good news! Help for these types of seemingly impossible-to-handle situations is on the way in the form of new regulations—and surprising insights from neuroscience.
The federal government has recently instituted mandates for firm, far-reaching policies involving “reportable events” related to disruptive behavior. The intent is full-fledged reform that prevents “good old boy”—and “good old girl”—reporting strategies that, in the past, have allowed the same disruptive people to circumvent limits time after time. Effective 1 January 2009, The Joint Commission requires that hospitals have “a code of conduct that defines acceptable, disruptive and inappropriate behaviors” and that “leaders create and implement a process for managing disruptive and inappropriate behaviors” (Rosenstein, 2008). To remain accredited, a facility must follow these processes and procedures and handle the behavior appropriately.
So how does neuroscience play a role in all of this? It’s simple—in a complex sort of way. Cutting-edge research using medical imaging has shown that personality disorders previously thought to arise from unresolved psychological conflicts and issues may instead result from hard-wired glitches in how the brain functions. Some people, for example, have a hair-trigger temper that causes them to instantly lash back when provoked, even when the provocation is imagined. See animated illustration showing abnormal and normal brain responses. (Flash player software must be installed to view animation.)
Other manifestations of these “subclinical” mood disorders can be more subtle, showing up in behavior that, though problematic, is generally not apparent enough to be diagnosed by a professional as a full-blown personality disorder. This last concept is key—no one except professionals should go around trying to diagnose personality disorders on the basis of nasty or unethical behavior! Even professionals may find it difficult to accurately diagnose a disorder because of subjective differences in opinion about what is “clinically significant.”
Cutting-edge research using medical imaging has shown that personality disorders previously thought to arise from unresolved psychological conflicts and issues may instead result from hard-wired glitches in how the brain functions.At the same time, no one should have to carry a load of guilt or frustration because of the unfair tactics of a few who, as research is showing, may have unusual, hardwired motivations for their disruptive behavior. This means that, even though you cannot justify putting a psychological label on an individual who is acting disruptively, you can be aware of what may be causing the disruptive behavior. By being aware of the behavior and its causes, you remove some of its power to hurt you.
What are typical behaviors of a disruptive person?
First and foremost is blame-shifting. Neuroscience has discovered that some individuals are neurologically incapable of accepting that there might be anything wrong with them or what they do. This may seem illogical, but that’s the way their neurological cookies crumble, so to speak. Given this illogical premise, a logical path can then be followed. If something can’t possibly be my fault, it must be someone else’s fault! In fact, it might be your fault. Thus, you find yourself blamed for something that you clearly aren’t responsible for! If you’re like many conscientious and caring nurses, who would never inappropriately pass blame, you can’t help but wonder if perhaps it really is your fault. And thus begins an insidious and frustrating cycle of self-doubt and escalating tension.
How can you stop this from happening? The best course of action is probably the most counter-intuitive for those who are passionate about their work. On this one issue, you must stop being passionate. Dispassion and calm are, in fact, the most important features you can display. Remember, the person who is falsely blaming you may well be doing so because of deep-rooted neurological underpinnings. When you excitedly deny what the person is saying, you actually feed the irrational circuits that led to the blame-shifting behavior in the first place. If, on the other hand, you remain calm and deal dispassionately and in politic manner with the situation, resorting to official reporting mechanisms only as a final resort, you are responding in the best possible fashion.
Being aware that some people are neurologically incapable of accepting blame can empower you. It can help you realize that blame-shifting isn’t really about you, no matter how much it seems to be. It’s about the person showing the disruptive behavior. After all, if you weren’t there, the disruptive person would need to find someone else to blame.
Another common disruptive behavior is gaslighting. This is a term taken from an old 1940s’ movie, “Gaslight,” which told the story of a wealthy heiress who was being driven mad by her ostensibly kind and loving husband. Unbeknownst to the heiress, the husband would climb to the attic and fiddle with the fuel supply to the gaslights that lit the home. As the lights flickered, the heiress expressed concern, but her husband denied seeing the fluctuation. By denying obvious reality, he so confused his wife that she began to doubt her sanity.
Gaslighting is done so convincingly that you find yourself doubting what you know to be true. How might you experience gaslighting? Perhaps a fellow nurse insists that she has been closely monitoring a critically ill patient. She is so convincing that you assume she is telling the truth, until the patient’s family advises you otherwise.
Another common and hard-to-fathom disruptive behavior is black-and-white thinking. A person exhibiting this trait sees people as all good or all bad, with no shades of gray. Initially, he or she may place a person on a pedestal and then, because of some perceived insult, reverse course and treat the same person badly, demoting him or her to a nobody in the blink of an eye.
For example, you may have a supervisor who, from the day of her arrival, has despised you. You’ve never done anything to hurt her and can’t understand why she treats you so abysmally. This same supervisor may simply adore another nurse, giving her preferential treatment at every turn and turning a blind eye to her many faults. You may wonder what you have done to deserve such treatment and guiltily assume it must be your fault but, as you now know, it may well not be. It may be that your supervisor has a neurological inability to deal with shades of gray.
Finally, there’s situational competence. Surprisingly, a person can be extraordinarily competent at a very difficult job—neurosurgery, for example—and yet, in another setting, be a very different person with many undesirable traits. This Jekyll and Hyde behavior can make life tough for managers who must deal with the disruption it causes in the workplace.
What causes blame shifting, gaslighting, black-and-white thinking and situational competence? Neuroscientists don’t know for sure, but they have evidence that it may arise from subtle dysfunction in the emotional system. What’s important for you to realize, however, is that disruptive behavior often arises from neurological issues that have nothing to do with you. The best you can do is react professionally and dispassionately.
To learn more about disruptive behavior and how neuroscience can provide information about appropriate ways to handle it, check out Dealing With Difficult People, the new continuing education course offered by the Honor Society of Nursing, Sigma Theta Tau International. RNL
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Barbara Oakley |
Barbara Oakley, PhD, PE, is associate professor of engineering in the School of Engineering and Computer Science at Oakland University in Rochester, Michigan, USA, where her research centers on the effects of electromagnetic fields on biological cells. Her tongue-in-cheek book, titled
Evil Genes: Why Rome Fell, Hitler Rose, Enron Failed, and My Sister Stole My Mother’s Boyfriend, has received critical acclaim for its sympathetic, scientifically based explanation of why people do nasty things. Oakley’s writing is based on worldwide experience and research. Her many adventures include working as a Russian translator on Soviet trawlers in the Bering Sea at the height of the Cold War; serving as a radio operator at the South Pole station in Antarctica, where she met her husband; and serving in the U.S. military, where she advanced from private to regular Army captain.
References:
Joint Commission Resources. (2006). Civility in the health care workplace: Strategies for eliminating disruptive behavior. Retrieved November 23, 2008, from http://www.ccforpatientsafety.org/31174/
Rosenstein, A.H., & O’Daniel, M. (2008). A survey of the impact of disruptive behaviors and communication defects on patient safety,” Joint Commission Journal on Quality and Patient Safety, 34(8), 464-471.
