We are hearing more and more about disruptive behaviors in healthcare and how they impact the work environment, retention, AND patients. I’ve surveyed thousands of nurses over the years about the types of disruptive behaviors they’ve either experienced or witnessed in the workplace.  These behaviors range from eye rolling to actual physical violence.  Out of all of the behaviors listed (there are 15), the third most common behavior that nurses reported was being yelled at, openly criticized, or mocked in front of others.

Unfortunately, many times the “in front of others” are patients.

A few examples:

“No matter how hard I try, Jackie always finds fault with how I leave my patients at the end of my shift. What makes it worse is that she berates me in front of my patients during shift report. It’s so embarrassing!” 

While cleaning an incontinent patient in a semi-private room, two nurses are gossiping about their manager – how she never holds anyone accountable; that she must have gotten her leadership skills out of a “Cracker Jack box”, and that they think she won’t last long. The patient in the next bed is cognitively intact and hears every word.

“The charge nurse barged into my patient’s room while I was giving meds and yelled, ‘Elena called in again so now we’re going to be short staffed yet again. You’ll have to take another admission, and then storms out of my room leaving me to make an attempt at reassuring my patient and his wife.”

A nursing assistant threatens a nurse in the hallway in front of patient’s room by saying, “My boyfriend knows what shuttle you take and will be waiting for you to beat the sh** out of you!”

These nurses are guilty of violating healthcare’s sacred spaces.

According to Encylopedia.com, a sacred space is a space distinguished from all other spaces because of the rituals that are practiced within that defined space. Most commonly used for religious purposes, sacred spaces are usually identified by something physical, like a temple or symbol and something ritual based, like prayers. But non-secular sacred spaces exist too.

Sacred spaces in nature

You can’t watch a sunrise, sunset, storm rolling across the sky with lightning, walk through the woods, or look down from a mountaintop without feeling the magnitude of nature. Nature is the equalizer for all people and all things made by man. It is in nature we truly sense the presence of something more – of a higher power. Nature is our first sacred space – before religious temples and churches.

Sacred spaces in your home

Men have their “man caves” that are never to be violated by lavender scented candles, lace, or Kenny G soft jazz. Sometimes the sacred space for women is their bathtub in their bathroom because it’s the only private space they have! But many of us have a special place in our homes where we relax or read. Mine is a special chair in my living room or on my patio in the summer time.

Sacred spaces in a nail salon

My daughter found the most amazing place to get pedicures in Raleigh, North Carolina, where she lives. I live in Pittsburgh, PA so when we went there for the first time, we starting chatting as soon as we sat in the chairs. Immediately, we got the “shhhh” from the nail specialists, who then pointed to a sign that said, “To experience our calming and relaxing pedicures, we ask that you respect this space by turning off your phones and refraining from talking.” Best relaxing pedicure ever!!!

Sacred spaces are everywhere if you just look for them and without a doubt, they should exist in healthcare too.

Sacred spaces are everywhere if you just look for them and without a doubt, they should exist in healthcare… Click to Tweet

When nurses treat others badly in front of patients, it negatively impact two things:

  • Patient satisfaction

Put yourself in a patient’s shoes. How satisfied would you be if your nurse said nasty things about the nurse who just left after caring for you for 12 hours? Or if you heard the oncoming nurse nitpicking and yelling at the nurse giving him report? Knowing that hospitals are reimbursed in part due to their patient satisfaction scores, how does violating this sacred space impact the bottom line?

  • Performance

Studies show that when you witness disruptive behavior, it impacts your performance and concentration for the next 4 hours!! I don’t know about you, but our environments are becoming more and more complex, requiring our focused attention constantly. I have NO extra wiggle room for distraction and neither do you.

WHAT SPACES ARE SACRED?

  • In a patient’s room – this is the ultimate sacred space and the one that should be protected at all costs. Violating this space should be a never event.
  • In the hallways in front of patient rooms – patients and their family members hear EVERYTHING. What you say in the hallways filters directly into the patient’s rooms. Just like the nursing assistant who threatened the nurse in the hallway, it was a patient’s wife who reported it.
  • In the nurses’ station – patients and their family members hear EVERYTHING! For some reason, nurses think that there is an invisible force field surrounding the nurses’ station and that nobody can hear them. Wrong. Not only do patients hear you, but they actively try to listen to your conversations just in case you’re talking about them!

BEHAVIORS THAT VIOLATE SACRED SPACES

  • Yelling
  • Physical or verbal outbursts
  • Profanity
  • Criticism
  • Gossip
  • Name-calling
  • Threatening
  • Complaining

WAYS TO PROTECT AND HONOR YOUR SACRED SPACES

  1. Decide where your department/units sacred spaces are

Each department is a bit different bu, but generally speaking your sacred spaces should be any space where patients and their family members can hear you.

  1. Use pre-determined gestures to address violations

If you and your coworkers have made a habit out of violating your sacred spaces for decades, it’s not as simple as, “starting today, we will no longer tolerate bad behavior in front of patients…” You need a gesture to remind people. Personally, I’ve always used the “time out” symbol but others have used the “hand heart”, or tapping the heart as a way to remind someone that they need to stop and redirect. When you all decide what gesture you will use, then when someone violates the sacred space by gossiping, you can respectfully interrupt with the gesture and then say the words, “sacred space”.

  1. Post positive messages in your sacred spaces

Positive affirmations can be written on patient’s white boards, in your hallways, and at your nurses’ station. We know that when exposed to positive words, phrases, and images, they influence our behavior in a positive way. They influence patient’s attitudes and behaviors too!

  1. Adopt a ritual before entering patient rooms

We all do bedside report (or at least we are supposed to). Why not create a ritual that whomever enters the patient’s room, whether individually or together, that you pause, take a deep breath, and say softly, “sacred space” as a reminder that you are entering a special place?

Creating sacred spaces for your patients and their family members is not only the right thing to do for them, but it’s the right thing to do for us, too. We get so caught up in our work that sometimes we forget nursing is a service profession and that we are called to serve our public and each other. By honoring and defending this space where we intimately care for our patients, we are demonstrating the respect for the one sacred and precious life we each have.

Thanks so much for reading!

Take care. Be kind. Stay connected.