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Nigerian Nurses Say No To Disruptive Behavious From Anybody In The Health Care Setting: A Compilation By Nurse Udogwu Felix, RN, OHNcert Part 1
Date Posted: 21/Jun/2018
Case. # 1.
Delta Commissioner, Joseph Otumara, Slaps Female Nurse By AMOUR EGODIBIE AMOURAPR 01, 2012
The Delta State Commissioner for Health, Dr. Joseph Otumara, descended on a female nursing officer at the Central Hospital in Warri, Mrs. Akata Oghenero, and slapped her for taking a phone call. Nurses at the hospital have reacted to the commissioner’s unprofessional conduct by embarking on a strike action pending when a state-wide strike would commence. Similarly, the Forum for Justice and Human Rights Defence (FJHD) in Delta State, has threatened to drag the commissioner to court if he fails to tender an unreserved apology to the nurse or resign from office. This reporter reliably gathered that the physical assault on Mrs. Oghenero took place at the gynecologist ward of the hospital in front of other nurses and officials of the Ministry of Health who watched helplessly.
 
In her account, a senior nurse in the hospital who pleaded for anonymity stated, “On 29 March, 2012, while Mrs. Akata Oghenero, a Nursing Officer II at the Central Hospital, Warri was on duty in the Gynae ward of the said hospital, the Health commissioner, Dr. Joseph Otumara, and his entourage came into the said ward and, in the process, Mrs. Oghenero, in company of some student nurses who were present, immediately stood up to acknowledge his presence, while the commissioner and his entourage walked through to the maternity ward.  Shortly after a while Mrs. Oghenero received an emergency call on her mobile phone and she was on the phone all of a sudden she got a severe slap on her right check. Lo and behold she was shocked on turning her face to discover that the slap was from the Health commissioner Dr. Joseph Otumara."
 
The source said the helpless Mrs. Oghenero at that point “burst into an uncontrollable cry.”
 
As if that was not enough, it was gathered that the permanent secretary and the Hospitals Management Board, Asaba, swung into action by trying to track down the identity of the nurse and pacify their boss by issuing her a query or possibly firing her. Relaible sources close to the ministry who confided in this reporter disclosed that such incident was not the first time adding that Otumara is synonymous with such unholy act.
 
In a press statement in Asaba signed by the group’s national coordinator, Mr. Oghenejabor Ikimi, FJHD disclosed that it has received a protest letter from the Warri chapter of the National Association of Nigerian Nurses and Midwives. 
 
It is entitled “Letter of protest: Physical Assault on the person of Mrs. Akata Oghenero, a Nursing Officer II at the Central Hospital, Warri by Dr. Joseph Otumara, Hon Commissioner for Health, Delta State,” and was signed by Comrade Ojei J.O, the Central Hospital, Warri Unit chairman of the association
 
Case # 2
Doctor dresses patient’s wound, pours waste water on nurse Published June 15, 2018 Samson Folarin
A crisis is looming at the Ondo State Trauma and Surgical Centre, Ondo State, after a medical doctor, identified only as Dr Ajibola, allegedly assaulted a nurse, Olayinka Oladele. Oladele had allegedly sent the porter, identified as Jimi, on an errand when he was allegedly intercepted by Ajibola, who gave him another task. The nurse, on discovering that her assignment was abandoned, reportedly fought back by ordering the porter to leave the doctor’s task This was said to have started an argument between the medical practitioners.
 
In a fit of anger, the doctor allegedly kicked a bucket of water at the nurse before bathing her with waste water from the wound irrigation of a patient. Nurses at the hospital were said to have protested against the assault as they threatened to down tools.
Oladele, in a report she wrote on the incident to the Chief Medical Director of the centre, Dr Wole Ige, said some nurses at the medical facility were witnesses.
 
She said, “I was at my duty post on the said date with two other colleagues and two porters. Around 11.30pm, I sent one of the porters, Mr Jimi, to the pharmacy to get drugs for a patient. While the pharmacy technician was dispensing the drugs, the porter left him and went to the crash room without any notice.
 
“This was discovered when a medical student, who was in the crash room, came to call the second porter for help. In response to the call, I and nurse Egunranti rushed into the crash room. We met a new patient and the porter, Mr Jimi, irrigating a patient’s wound. The medical student was holding on to grey cannula and tourniquet; Dr Ajibola was on glove.
 
“I challenged the porter, Mr Jimi, for his failure to complete his previous task and for sneaking into the crash room without notifying me that there was a patient newly admitted into the crash room. I told him to return to the pharmacy where he was initially sent.
 
“The doctor in the crash room confronted me that I had no right to order the portal while he had assigned him to assist him in the crash room. I responded that the porter could go since I was on the ground to assist him with anything that he had to do.”
 
She said the doctor threatened that if the porter left the room, he would follow him, adding that she also maintained her stance. Oladele said Jimi bowed to her request, which angered the doctor who allegedly began insulting her in the presence of the patient. She noted that he asked the medical student to leave as the second porter, Victor Akinola, walked in.
 
“I replied to him that it was not Mr Jimi’s duty to irrigate the patient’s wound, though I met him securing an intravenous access under his watch on the previous patient during the same shift. This angered him and he kicked the trolley that had the bowl of water used for patient wound irrigation towards me; the water splashed on me. I reacted by asking him, ‘I guess what just happened was a mistake, right?’ Surprisingly, he carried the bowl of water already used for the patient’s wound irrigation and poured it on me from head to toe in the presence of the porter, Mr Victor Akinola, and the patient.
 
“I screamed and other workers from the unit rushed in to the crash room. A worker at the health information management section assisted me out. I went to take my bath and have a change of clothes and continued my duties,” she added.
 
It was gathered that the National Association of Nigerian Nurses and Midwives, Ondo State branch, had taken up the matter. The doctor, when contacted, did not pick his calls and had yet to respond to a text message sent to him on the incident.
 
However, the CMD of the Ondo State Trauma and Surgical Centre, Ige, said a panel had been set up to investigate the incident. He said, “To enforce discipline and make the case official, when she called me and said she had been assaulted, I asked her to put it into writing.  She alleged that the doctor poured water on her on Saturday around 11pm. At about 11am, I was in the theatre when about four head nurses came to me and changed into theatre gowns. They said they were angry that nothing was being done about what happened to the nurse. I asked if I was supposed to arrest or suspend the doctor without first hearing from him. We are supposed to give him 48 hours to respond. When I came out of the theatre that day, I discovered that the doctor had also reported the nurse.”
 
Ige said Ajibola, in his report, claimed that a patient had arrived in the accident and emergency unit and when he called nurses to join him in the treatment, he was ignored. According to the CMD, the doctor claimed that an orderly, however, joined him in the room. Ajibola reportedly said after about two hours of working with the orderly, Oladele walked in and ordered the man to leave, offering to assist instead.
 
The doctor was said to have disagreed, which led to an altercation between him and the nurse. “As of that Monday afternoon, that was the position. There was a public holiday on Tuesday. On Wednesday, we set up an investigative panel.  If you set up a panel, you need to inform the committee members. However, around 10am of that day, I saw the nurses having a meeting. I asked them what they wanted and they said we should have suspended the doctor, which is not possible. He has to respond,” he added.
 
Ige said the investigative panel was expected to turn in its report by Tuesday. The situation was reported to have caused disaffection among the health workers.
Ondo State Unit NANNM Responds To Case Of Assaulted Nurse At Ondo State Trauma And Surgical Center Date Posted: 14/Jun/2018 by Nursinworld Nigeria
Fellow comrades,
 
It is indeed a time to appreciate what all has felt and done. All our efforts in the closed approach has started to come to the ope Our style of leadership might seem slow to the members but our wisdom is for effective justice and extreme orderliness. At this juncture, the unit NANNM will only feed you with deliberations and achievements from the National leadership as the trending case has been taken over by the association and professional leadership now. Please remember that your welfare is a major concern to us. 
 
Lets learn how good to use the social media as we learn everyday.  Ondo state government is at the top gear to bringing justice to us. While we encourage our leaders with prayers for more wisdom.
 
AMERICAN NURSES ASSOCIATION. Don’t tolerate disruptive physician behavior April 2010 Vol. 5 No. 4 Author: Stephen Lazoritz, MD, CPE
96%! In a poll of nurses, physicians, and healthcare executives, 96% of nurse respondents said they have witnessed or experienced disruptive behavior by a physician. 96%!
 
Several other surveys show that nurses are the primary victims of disruptive behavior. And increasingly, those in health care are recognizing that disruptive behavior can undermine patient care and cause staff dissatisfaction and turnover.
 
In response to the problem, the Joint Commission released draft standards on behavioral expectations for hospital staffs, including the medical staff. These standards require hospital leaders to develop a code of conduct that defines desirable and disruptive behavior and to establish processes for managing disruptive behavior. Plus, the medical staff must manage disruptive behavior by physicians and others who are granted clinical privileges.
 
Defining disruptive behavior
The American Medical Association defines disruptive behavior as personal conduct, whether verbal or physical, that affects or potentially may affect patient care negatively. That’s a good starting point, but a policy or code of conduct needs to specify which behaviors are disruptive. These behaviors can be classified as four types:
1. intimidation and violence
2. inappropriate language or comments
3. sexual harassment
4. inappropriate responses to patient needs or staff requests.
 
Intimidation and violence includes throwing objects, threatening violence, pushing or hitting others, finger pointing, and invading another’s space. The most common display of intimidation is yelling. Most surveys of nurses show that 40% to 80% have had a physician yell at them.
 
Inappropriate language consists of racial, ethnic, or socioeconomic slurs; profanities or obscenities; sarcastic, cynical, or demeaning remarks; and comments that show a distain for another staff member. Jokes about sex and comments with sexual innuendo are considered sexual harassment. The fourth category; inappropriate responses to patient needs or staff requests;includes late replies to pages, inflexible responses when asked for assistance, and retaliatory notes in the medical record. Inappropriate responses also include disregarding policies, blaming others for adverse outcomes, and routinely making rounds at odd hours.
 
Establishing a code
Despite this broad spectrum of disruptive behaviors, most nurses summarize their experience with problem physician behavior with the word disrespect. All hospital employees have the right to be treated with respect. But merely feeling disrespected is not enough to trigger a meaningful intervention. The disrespectful behavior must be described in terms of institutional definitions of bad behavior.
 
That’s why every hospital medical staff should have a behavioral policy or code of conduct that contains a clear statement of the type of behavior expected from members and a detailed list of prohibited behaviors. Also, the policy must contain a clear description of the process for documenting and reporting disruptive behavior and for protecting those who make such reports from repercussions. Nurses need to be familiar with the policy. If the hospital medical staff doesn’t have such a policy, nursing leaders should intervene. (To see examples of medical staff codes of conduct and behavioral policies, visit http://lazoritz.com/). Establishing a code of conduct or reviewing and updating an established one provides an excellent opportunity to educate the nursing and medical staffs about expectations for professional interactions and the negative effect disruptive behavior has on patient care. Grand rounds, educational sessions, debriefings after an episode, and newsletter articles can reinforce these expectations.
 
Reporting bad behavior
If you have been directly affected by or have observed behavior that violates the medical staff’s policy or code of conduct, you may want to try talking calmly and privately to the physician and explaining the effect of the behavior. Whether you try this approach or not, you must document the incident and report it. You may be reluctant because you believe the behavior is an isolated act by a well-liked physician who usually acts professionally or because you’ve already talked to the physician privately and he has apologized. In fact, many incidents result from the stress of the moment, not from a chronic pattern of bad behavior. But your role is not to decide whether the behavior is acute or chronic. If it was disruptive, report it no matter what. The hospital and medical staff leaders will decide if it’s an isolated incident or part of a pattern.
 
You may also be reluctant to report disruptive physician behavior because you fear reprisals. This fear is understandable, but remember that intimidation allows disruptive physician behavior to persist. Hospital and medical staff policies must protect you. The method of documenting and reporting varies, depending on medical staff policy, but typically, you’ll write a factual description of the incident, including the time, the place, and a list of witnesses, including patient witnesses. Make sure your report is objective, and include any effect on patient care. Follow your nursing policy for incident reporting. Document any verbal exchanges verbatim, if possible. And make the report as soon as possible after the incident. After you document and report the incident, continue to act professionally. Remember, patient care always comes first. Even if the physician is rude and demanding, continue carrying out your duties in a professional manner. Likewise, your intervention should be conducted in a calm, professional way. Yelling back at a physician who is yelling creates an excuse for disruptive physician behavior.
 
Benefits for all
The intervention by the medical staff should benefit both nurses and physicians. If the physician has a history of abusive, disruptive behavior, obviously the medical staff needs to intervene promptly and effectively for the good of all. Luckily, this type of physician is in the minority. The majority of disruptive incidents involve competent, effective physicians who resort to this type of behavior during times of stress, you create an opportunity to make such physicians aware of their disruptive behavior and help them change.
 
CONTINUE TO PART 2
 
Selected references
American Medical Association. Physicians and disruptive behavior. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/”>www.ama-assn.org/ama1/pub/upload/mm/
21/disruptive_physician.doc. Accessed September 4, 2007.
Johnson CL, Martin SLD, Markle-Elder S. Stopping verbal abuse in the workplace: nurses should not tolerate this behavior and it should be reported when it occurs. Am J Nurs. 2007;107(4):32-34.
The Joint Commission. Proposed standard for disruptive behavior. Available at: <ahref=”http://www.jointcommission.org/NR/rdonlyres/”>www.jointcommission.org/NR/rdonlyres/
E7FF18DD-4667-42C0-A1F53E121A76BD78/
0/Disruptive_Behavior_hap_stds.pdf. Accessed May 1, 2007.
Rosenstein AH. Nurse-physician relationships: impact on nurse satisfaction and retention. Am J Nurs. 2006;102:26-34
Weber DO. Poll results: doctors disruptive behavior disturbs physician leaders. Physician Exec. 2004;30(5):6-14.
Stephen Lazoritz is Principal of the Lazoritz Group, Hospital Interaction Specialists; Clinical Professor in the Departments of Pediatrics and Psychiatry at Creighton University School of Medicine; and Adjunct Professor in the Department of Pediatrics at the University of Nebraska Medical Center in Omaha.

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