Professional Experience Placement

This mixed-methods systematic review by Hutchinson and Jackson (2013) examined the literature on hostile clinician behaviours and patient care. The review was guided by two questions – (i) do hostile clinician behaviours negatively influence patient care? and (ii) if so how do these behaviours impact aspects of care delivery.  The behaviours included aggression, the threat to harm, physical violence, verbal abuse, bullying, horizontal violence and lateral hostility, intimidation and harassment as well as the more subtle forms of uncivil and disruptive behaviours such as refusing to cooperate, withholding information, being unavailable to give assistance, hampering another’s performance and making their work difficult.

The authors describe their search strategy including their inclusion criteria and the detail of the studies is tabulated.  Studies were predominantly undertaken in the USA, Australia and Canada and in hospital or large health centres. A meta-analysis of the quantitative data was not feasible due to the heterogeneity of the outcome measures and behaviours investigated. Content analysis was undertaken and four themes emerged. These were: physician-nurse relations and patient care; nurse-nurse bullying, intimidation and patient care; reduced nurse performance related to exposure to hostile clinical behaviours and nurses and physicians directly implicating patients in hostile clinician behaviours. The findings of the review indicated that claims of hostile clinician behaviours can impact negatively on patient care, however due to the lack of robust evidence it was difficult to establish the nature and extent of the relationship of this concept.

The authors indicated nurse-nurse and nurse-physician hostile behaviours have the most potential to impact on patient care and the more subtle behaviours previously mentioned have the most potential to impact on care of patients. Future research into this concept is warranted as there is a lack of robustly designed studies investigating this phenomenon.

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