Are You a Boiled Frog? How to Un-Normalize Deviant Behavior in Healthcare

“When I was signed up for this course I thought, ‘Oh great. Why do I need to take this? We don't have bullying in my workplace anyway.’ Boy was I wrong. I learned so much. Most important: bullying wears many faces.”

A participant in my online course, Eradicating Bullying & Incivility: Essentials Skills for Healthcare Leaders wrote the above comments on her evaluation. When I talked with her during our one-on-one coaching session, she shared that after 29 years, she had became numb to the eye rolling, condescending attitudes, nit picking, and even the overt criticisms, gossiping, and mocking. She just didn’t notice it.

She had normalized the deviance!

If you take a frog and you drop it into boiling water, the frog will jump. But if you put a frog into tepid water and slowly increase the temperature to boiling, the frog will just sit there until it boils to death because the frog doesn’t recognize its environment has now become toxic.

You know you’ve normalized disruptive behaviors in your organization when you hear things like…

“Well, that’s just the way she is. Don’t let anything she says bother you. Don’t take it personally.”

“If you have any questions, don’t go to him. He doesn’t like people very much.”

“You’re going to have to grow a thick skin if you’re going to want to survive here.”

We’ve accepted bad behaviors to the point where we fail to recognize them as abnormal. We’ve in a sense; become boiled frogs swimming in a pond of badness.

Exposing the Badness

• A 2012 study showed that novice nurses reported that 21% of them are exposed to bullying behavior daily.
• A recent Occupational Safety and Health Administration (OSHA) survey reported over 50% of registered nurses and nursing students were verbally abused (a category that included bullying) in a 12-month period.
• 2016 National Healthcare Retention & RN Staffing Report showed that 70% of nurses reported an association between disruptive behaviors and compromised quality of patient care.

Numerous studies show the prevalence and devastating impact disruptive behaviors have on retention, patient safety, and the financial health of the organization, yet in a recent study only 6% of top healthcare executives identified addressing disruptive behaviors as a top priority.

Are they guilty of the boiled frog phenomenon?

I once listened to a discussion about bullying and incivility during an advisory board meeting with healthcare leaders from the community. One chief nurse executive said, “Oh. We have no bullying in my organization.” Really? I knew for a fact that she did because some of her nurses were coming to me asking for help.

Healthcare organizations have an ethical responsibility to DO something about disruptive behaviors. Don’t just take my word for it; regulatory bodies are now recognizing the impact disruptive behaviors have on patient safety and are now holding healthcare organizations accountable.

In The Joint Commission’s (TJC) Quick Safety Issue #24 and their more recent 2018 Sentinel Event Alert, they recommended ongoing training and education for employees and prevention interventions to reduce incidents of disruptive behaviors.

In 2017, The American Nurses Credential Center (ANCC) added addressing disruptive behaviors to their Magnet? Recognition requirements.

We’re finally getting serious about disruptive behaviors in healthcare!!

How to un-normalize deviant behavior in healthcare:

Heighten awareness

I’ve been conducting workshops on addressing disruptive behaviors for almost 10 years. One of my favorite comments was from an executive leader who basically said… We had a wound we didn’t know we had. A nice band-aid covered the wound that we didn’t know was there. You came in, ripped off the bandaid and exposed the wound!

You have to heighten awareness of behaviors that undermine a culture of safety by talking about it in your organization and on the front line. Include curriculum regarding disruptive behaviors in orientation, in your nurse residency programs, preceptor programs, physician residency programs, leader orientation, leadership development, etc. Include this topic in everything ongoing – not just when employees are hired.

Take the Mother Test

If a coworker refused to take report from you because you “were an idiot”, if that patient was her mother, would she still refuse?

A study conducted by John’s Hopkins showed that 250,000 deaths occur per year due to medical error. Poor communication was cited in many of them.

Our ability to provide high quality, safe, and effective care relies on our ability to communicate with each other. Like a river, information flows through the nooks and crannies. But when communication breaks down, like a dam, it stops the flow of information.

If we made decisions as if all patients were members of our precious family, disruptive behaviors would almost disappear.

Well, every patient is someone’s mother, father, wife, husband, child, grandchild, etc.

Be a fly on the wall

Like the leader in my course, start paying attention to your coworkers by standing back and observing. Like a fly on a wall does right before pouncing on your picnic barbeque! You’ll be amazed at what you see and hear.

Pay attention for these types of statements:

You’ve got to pay your dues. 

It’s always been done this way.

I’m making her a stronger nurse. 

If she thinks I’m hard on her wait till she’s meets _______.

Just suck it up buttercup.

It’s sink or swim here so if you want to survive, you’d better learn how to swim.

Just ignore him like everyone else does.

Trust me. If you’ve been normalizing bad behaviors in the past, once you rip off the band aid and discover the wound, you’ll have no choice but to treat the wound.

Look in the mirror

If 73% of us report witnessing or experiencing disruptive behaviors, the disruptors can’t be everyone else. We each have to look in the mirror to determine how we each own a piece of our workplace culture.

Bullying and incivility are alive and well in healthcare, yet we’re hopping around (well, not for long) like boiled frogs, ignorant to our surroundings.

If you’re not doing anything about this in your organization, not only are you putting your patients and employees at risk, but you’re also in violation of regulatory requirements. Make a commitment starting today that you will no longer just accept bad behavior as the norm and that you’ll take action.

The way we treat each other is just as important as the care we provide!

Here are two resources Just For You:

• Scripts for Healthcare Leaders: Are you dealing with a Nurse Bully? Grab these scripts so you can Stop Disruptive Behavior in the Moment
• Healthy Workforce Meeting Guide: Are you looking for proven steps to create a Healthy Workforce Culture? In this guide I share how you can lead your meetings more effectively and strengthen your workforce culture. Click here to claim yours!

Be kind. Take care. Stay connected.