Running head: DISRUPTIVE BEHAVIORS AFFECT PATIENT SAFETY

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Disruptive Behaviors Affect Patient Safety

Nikki Thao
California State University, Stanislaus
December 15, 2014

DISRUPTIVE BEHAVIORS AFFECT PATIENT SAFETY

Disruptive Behaviors Affect Patient Safety

When working in any hospital setting or healthcare establishment, team trust, respect,
collaboration, and communication, are some of many pivotal factors that determine patient
outcome and safety (Mion, 2010). Healthcare providers, nurses, and hospital staff play an
important role as their direct care reflect on patient health. Although physicians and nurses differ
in their philosophical approach in managing patient care, an established professional relationship
among the two is crucial in ensuring better patient outcomes and working environments. When
this fails, undesirable events can occur, thus leading to poor patient safety and creating a hostile
environment for healthcare professionals (Mion, 2010). Disruptive behaviors in the hospital
environment should be addressed, as they can significantly have a negative impact on team
relationships, communication, and collaboration, which will undesirably affect patient care
outcomes.
Sentinel Event
According to the Joint Commission (2013), a sentinel event occurs when an unforeseen
incident results in an adverse outcome that leads to a patients inability to function, such as death
or a serious and/ or psychological injury. Sentinel events are grave occurrences that require
immediate attention and investigation. Unfortunately, sentinel events are inevitable and can
range in severity, depending on the individuals case. These events include medication errors,
infant deaths or injuries, retained foreign objects in the patient during a surgical procedure,
tubing and catheter misconnections, and etc. Nevertheless, this paper will focus on the main
issue of disruptive behaviors and the impeding effect that it has on patient satisfaction and
outcome. Disruptive behaviors are unfavorable actions that can be triggered due to stress or a
tensed working environment. When these unwanted circumstances escalate, disruptive responses
can have a negative effect on patient care. The Joint Commissions mission is to improve the

DISRUPTIVE BEHAVIORS AFFECT PATIENT SAFETY

safety and quality of health care for the public. Thus, in order to address the issue on disruptive
behavior, a devised plan must be performed to analyze the root cause and identify appropriate
countermeasures to decrease the chances of future incidents (TJC, 2013).
Story
Nurse Nina worked on the Labor and Delivery Unit. What was supposed to be a routine
delivery became an unsettling sequence of nerves and stress- the end result was maternal death
and fetal injury.
The day of the incident, Nurse Nina was taking care of one of Dr. Sours patients. Dr.
Sour was a 55 year old obstetrician and widely known physician (Rosenstein, 2011a). He was
also known for his demanding personality that would quickly turn into frustration and agitation.
During her morning shift, Nurse Nina received an order to hang Pitocin. While preparing the
patient for an induction, she became very concerned with the protocol for the use of Pitocin drip
and called Dr. Sour for clarification. Instead of confirming the order, the doctor yelled at the
nurse for questioning him on what he was doing and specified that he wanted to have the baby
delivered by 4:00PM. He then continued to insult Nurse Nina about her training and experience
by stating Let me know when you finish medical school (p. 191). Irritated and flustered by the
doctors remark, Nurse Nina continued the drip and began to notice signs of fetal distress.
Although knowing Dr. Sours temperament, she resentfully called the doctor again. Dr. Sour
responded by screaming at the nurse for having the nerve to call him again and articulated that he
was not to be bothered unless there was an immediate emergency. When Nurse Nina asked the
doctor to come and assess the patient, he, again, remarked on her lack of competency and
authority as a nurse. The doctor told the nurse that she should continue to push the Pitocin drip as
ordered and that he would come by when the patient was ready to deliver (Rosenstein, 2011a).
Frustrated and emotionally exhausted from being scolded, Nurse Nina followed the doctors

DISRUPTIVE BEHAVIORS AFFECT PATIENT SAFETY

orders. Concerned about the patients safety, one of the fellow nurses on the floor told Nurse
Nina to report to the charge nurse about the patient progress and the physicians inappropriate
behavior. Instead of agreeing, Nurse Nina lashed out at her colleague and stated I know what I
am doing; you dont need to help me. Im following the doctors orders. Mortified by Nurse
Nina comments, the nurse went on her way without reporting the issue to the charge nurse. The
fetus continued to show signs of distress and eventually the expectant mother was complaining
of nausea, followed by a low blood pressure. Additionally, Nurse Nina noticed that the patient
was bleeding excessively. An emergency c- section was performed; the team delivered a baby
boy with low Apgar scores and due to prolonged oxygen deprivation because of the Pitocin, the
baby was discovered to have sustained brain damage. The mother, however, died due to a
ruptured uterus, which was the cause of the hemorrhage. Had Nurse Nina advocated for her
patient and sought the advice of her unit supervisor, this mishap could have been avoided, and
both the mother and baby would have had a better chance.
Root Cause Analysis
There are a number of reasons why disruptive behaviors occur. In order to understand the
underlying cause of the behavior, a root cause analysis is used to examine all the possibilities and
reasons behind the inappropriate conduct. Disruptive behavior involves a violation of workplace norms that promote respectful, interpersonal interaction (Felblinger, 2009, p. 14). When
this incivility is left unattended, mishap and undesirable outcomes can arise, which can lead to
a sentinel event. With the intention of identifying the reason behind disruptive behaviors in the
healthcare setting, it is important to analyze the people, environment, equipment used, and
policies and procedures.
People
When quality care involves the health and safety of a patient, multiple healthcare

DISRUPTIVE BEHAVIORS AFFECT PATIENT SAFETY

professionals, such as physicians, nurses, and staff members are involved. More importantly,
nurses play a huge role in patient outcomes because they are the ones who directly interact and
stay with the patients during care. As nurses are the main caregivers of the patients, they are also
at the receiving end for dealing with physician demands or nurse- colleague outrage. Studies
have shown that in the healthcare setting, nurses, especially, experience or see some form of
disruptive behaviors (McNamara, 2012). One of the foremost signs that are seen in nurses, who
work in a hostile environment, is burnout or stress. As a result, patient quality care is affected.
In the case of Nurse Nina, she was overwhelmed and stressed by the continuous belittling that
she was receiving from Dr. Sour; therefore, she ignored the signs and symptoms of distress in
both the mother and fetus. According to the American Nurses Associations (2014) code of
conduct, a nurses commitment is patient safety and when a questionable practice is determined,
as the advocate for the patient, the nurse must be alert to and take appropriate action regarding
any instances of (p. 7) impaired practices that may jeopardize the patients health. When an
inappropriate practice or behavior is witnessed, it is the nurses responsibility to report the
misconduct to a person of higher authority. Both the Nurse Nina and her fellow colleague failed
to report to the nurse on duty. Not only did Nurse Nina feign ignorance, she failed to advocate
for the patient. Although it was understandable for Nurse Ninas stress, her behavior towards her
nursing colleague was not appropriate, which may have led to a hostile relationship between the
two nurses. She also continued the administration of the medication, which is against a nurses
moral values of doing no harm (ANA, 2014).
Physicians are one of the main team players that nurses go to when there is a question
regarding the plan of care for a patient. However, when a physician fails to provide the necessary
support of care and instead emphasizes their authority, this affects not only the physician- nurse
relationship, but also patient outcome. In the healthcare setting, certain traits are revealed when

DISRUPTIVE BEHAVIORS AFFECT PATIENT SAFETY

disruptive behaviors occur, for example, the abuser often feels the need to be above the rules
and regulations within the workplace (McNamara, 2012, p. 536). Some physicians are known to
be such abusers as they believe that medical hierarchy revolves around them as being at the top
of the tier in the healthcare organization (McNamara, 2012). Instead of acting as a team player,
these abusers develop a hostile behavior that affects the working ability of those around them.
Dr. Sour is a prime example, as he refused to see the patient in Nurse Ninas care and repeatedly
questioned and ridiculed the nurses competency and knowledge.
Medical staffs and personnel also play an important role in patient care because they are a
second set of eyes for the nurse. However, when staff members failed to support the nurse,
patient care outcomes can be decreased. In the case of Nurse Nina, the staff members failed to
notice the worsening signs and symptoms that the patient was exhibiting. While one of the nurses
noticed the poor progress of the patient, she failed to report to the charge nurse. Staff members
also avoided having to deal with the physician because they did not want to get on Dr. Sours bad
side. According to a survey done by Rosenstein (2011a), more than 90% of the respondents,
including physicians, nurses, and administrators from over 100 different acute hospitals, reported
to have witnessed some form of disruptive behavior. Often times, those who witness the behavior
choose to look the other way, in fear that they may instigate the offender and further contribute to
the misconduct (McNamara, 2012). It is also important to consider that the patient and family
members contribute greatly to the wellbeing of the patient. While exhibiting symptoms of
weakness and distress, the patient did not use her call light or, when she did, the nurse did not
take her seriously. Another important factor to consider was that the patients family was not at
her bedside.
Equipment Used
Equipment that is used in hospital settings contribute to the quality of care that patients

DISRUPTIVE BEHAVIORS AFFECT PATIENT SAFETY

receive. Often times, nurses rely on equipment as a support for their assessment of the patients
status. However, when hospital equipment is not used correctly, there are potential causes for
harm of the patient. For example, the patients vitals were not continuously monitored, which led
Nurse Nina to miss important clinical signs and symptoms that the patient may have been
experiencing.
Environment
Nurses function at their best when they are stress-free and treated with respect. However,
sometimes they face undesirable circumstances, such as physician disruptive behaviors, that not
only threatens patient outcome, but also creates a hostile working environment. When constant
verbal abuses are not resolved, this will eventually lead to unsafe medical practice (Felblinger,
2009). Whether it is a newly hired grad or a veteran nurse, they all have different ways to cope
and adjust to the working environment. Nurse Nina was feeling pressured and humiliated by the
doctors demand; this created an impaired relationship between Nurse Nina and Dr. Sour.
Furthermore, her inappropriate behavior towards her colleague may have resulted in a hostile
relationship between the two of them.
Policies and Procedures
In the case of Nurse Nina, multiple policies and procedures may have been overlooked,
which contributed to the patients death. For instance, Nurse Nina did not follow the six rights of
medications, which include the right medication, right patient, right time, right dosage, right
route, and right documentation (Principles of medication administration, 2011). There was a
lack of medication knowledge on her part as she did not notice the potential side effects when
administering Pitocin. Under provision 3.4 on Standards and Review Mechanisms of the
American Nurses Association Code of Ethics (2014), nurses are responsible for overseeing the
safety of the patient by reducing the chances of errors, and addressing potential environmental

DISRUPTIVE BEHAVIORS AFFECT PATIENT SAFETY

system factors and human factors that present increased risk to the patient (p. 7). This means
that the nurse is the last line of defense to catch any errors regarding physician orders, before
administering medications to the patients. With that in mind, the physician may have ordered the
wrong dosage of Pitocin and the nurse did not catch the mistake and administered the IV drip. A
nurses primary commitment is to ensure the safety of the patient and this involves the
consideration of the patients ideas for plan of care. Addressing the patients interests and wishes
requires that the nurse provide patient teaching and education, which will decrease conflicts, in
terms of health care decisions (ANA, 2014). However, there was a lack of patient-family
education and involvement during Nurse Ninas care for the patient.
Target Change, Stakeholders, Attitudes, Beliefs, Knowledge, & Behaviors
Reducing the likelihood of sentinel events through hospital interventions and
management of disruptive behaviors among healthcare professionals is the targeted change. In
patient care, stakeholders include patients, insurers, the Joint Commission, the community,
hospital owners and administrators, and healthcare professionals, as they are all affected. Patients
are the main stakeholders because they are the ones paying for their own health care. Insurers are
also identified because they manage the monetary aspect of patient care. The Joint Commission
is a stakeholder because they overlook hospital practices to ensure patient safety. The community
is affected because they are future clients who will utilize the health care system. Hospital
owners and administrators are included because they promote the reputation of the hospital. They
are at risk for financially treating conditions that result from adverse events, because most
insurance companies will no longer cover the expenses (Rosenstein, 2011b). Last but not least,
healthcare professionals, such as nurses and physicians, are stakeholders because they are the
primary caregivers of the patients.
In essence, disruptive behaviors among nurses and physicians have a direct impact on

DISRUPTIVE BEHAVIORS AFFECT PATIENT SAFETY

patient outcome. Evidence shows that there is a correlation between disruptive behaviors of
physicians and nurse morale, which reflects poorly on patient outcome (Rosenstein & ODaniel,
2008). In fact, the study showed that among individuals who experienced some form of
disruptive behavior, 94% reported frustration and aggravated stress. 99% of the participants
reported that disruptive behavior led to a compromised relationship between the nurse and
physician, thus poor communication and collaboration among the two professions increases the
risk for patient mortality (Rosenstein & ODaniel, 2008). While physicians are just as important,
nurses are the main target population because they are patient advocates and promote patient
wellbeing.
In the medical world, physician hierarchy continues to thrive as physicians practice their
authority and autonomy (Rosenstein, 2011a). Often times, physicians who display these
disruptive behaviors have a hard time accommodating to the expected principles, in terms of
behavior, staff responsibilities, and using best practice. In other words, physicians may express
lack of cooperation and compliance, which can lead to poor patient satisfaction and increase
nursing frustration (Rosenstein, 2011b). Nurses who face the wrath of a physician are more than
likely to comply with the change because this will increase their chances of a better and reducedstress environment.
The problem among the targeted population is that some individuals are unaware of the
unacceptable disruptive behaviors that they display or they make choices that evolve into lateral
violence (Embree & White, 2010). Nurses who have a lack of an authoritative position will
typically turn to lateral violence, which is directed towards those with very little power, such as a
colleague or newly hired RN. Similar to the physician hierarchy, nurse hierarchal abuse is
unavoidable because of the importance surrounding status and power. Unfortunately, this is
something that is deeply rooted in the societal culture. Often, oppressed nurses harbor internal

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feelings, such as anger and rage, which then evolves into behaviors, such as jealousy, blaming or
hatred. These disruptive behaviors are then unnecessarily directed at other nurses, therefore
negatively impacting nurse-to-nurse relationships and team collaboration (Embree & White,
2010). As a targeted population, the majority of disruptive nurses are women, who may have
certain personality traits, attitudes, express jealousy towards their colleagues, or have a lack of
respect towards each other (Lux, Hutcheson, & Peden, 2011).
Lewins Theory, Change of Action, & Implementation
Change is an important concept, as it provides a chance for future endeavors and greater
improvements. Kurt Lewins theory incorporates three stages of change: the unfreeze stage, the
change stage, and the refreeze stage (MindTools.com, 2013). Each stage contains specific
standards that must be applied in order for any successful change process to occur.
Unfreezing Stage
The unfreezing stage involves making important preparations to ensure that the affiliated
group knows that change is necessary (MindTools.com, 2013). This first stage is often more
difficult because many individuals are reluctant to change their behaviors. In order to effectively
implement the first step towards change, Nurse Managers should identify the main issue and
point out noticeable behaviors that affect the work environment. It is necessary that the
individuals involved understand that current behavioral conducts cannot continue, by showing
reports related to poor patient outcome, as a result of the adverse event. Nurse Managers can
implement change by gathering anonymous feedbacks, from both administrators and nurses from
different units, regarding inappropriate experiences that they had and how they responded
(Coursey et. al, 2013). The goal of this is to raise awareness of the need for change, as the
continued trend has a significantly negative impact on patient safety. During the unfreezing

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stage, nursing staff must be aware that old practices are not working and new implementation
must take place to improve a better working environment.
Changing Stage
Following the unfreeze stage; we have the changing stage, which can often take a lot time
to reach (MindTools.com, 2013). During the changing stage, people are beginning to resolve
their differences and accept the change that is implemented. In order for this to happen, people
must realize that change does not occur overnight. They must understand how the change will
greatly impact them and the benefits it will provide. This stage requires that people are open to
communication and managing their time to promote success (MindTools.com, 2013).
One recommendation for change in behavior is through education. Just how nurses teach
patients to manage their illnesses, Nurse Managers can educate about coping skills for nurses
who deal with disruptive behaviors. A supported study done on effective coping skills showed
that nurses who confronted the instigator was able to stop the violence (Coursey et. al, 2013).
They can also teach about how to confront disruptive behaviors, which studies have shown to
increase job satisfaction and obligations by nurses to improve patient care (Lux, Hutcheson, &
Peden, 2011). Among health care workers, only one in ten choose to confront the disruptive
behavior, which evidently shows that nurses are not equipped with the necessary skills to
confront or mange disruptive behaviors. Nurse education should include lessons regarding how
to handle lateral violence in the work environment and learn ways to change negative feelings
into positive ones (Lux, Hutheson, & Peden, 2011). For this to succeed, education must be
consistent, as part of the changing stage. Nurse Managers will ensure that there are opportunities
for staff members to bond with each other, which will help improve better working relationships.
Another important approach is to consider improving leadership skills and team collaboration
(Burgess & Curry, 2014). Open communication and team conflict management can enhance

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patient safety, as issues are resolved collaboratively. When nurses are able to communicate
effectively and with nonviolence, they are displaying positive leadership skills. Practicing team
collaboration not only improves team work, it sets the nurse up for change, by allowing the nurse
to alter the disruptive behavior in the working environment (Burgess & Curry, 2014).
Refreezing Stage
Last but least, the last stage of Lewins theory is the refreezing stage (MindTools.com).
As people become well-adjusted to the new changes, refreezing allows for the involved affiliated
group to reevaluate the effectiveness of the change and secure it. This means Nurse Managers are
making sure that the new ways are continuously being used all the time. To enforce this, ongoing
team training and support must be managed to ensure positive feedbacks. With the success of the
change, it is important to celebrate the achievement because the main reason it was implemented
was to increase better nurse- to-nurse, as well as, nurse- to-physician relationships towards
reducing sentinel events related to disruptive behaviors (MindTools.com, 2013). While some
people are inclined to adapting to new changes in the workplace, there are individuals who will
continue to be reluctant; for example, a physician who refuses to listen to the opinion of a nurse.
However, it is inevitable because developing change is being able to recognize that there will
also be oppositions. One way to overcome these hurdles is to continue to inform and support
everyone, with hopes that everyone will eventually embrace the new change.
Budget
A budget must be created in order to implement a successful action plan. In order to
combat sentinel events related to disruptive behaviors, the hospital will provide funds for
educational classes regarding effective coping and leadership skills, how to identify disruptive
behaviors, team collaboration workshop, and an active simulation to confront disruptive
behaviors. To implement the changes, data must be collect over a span of two months. The

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hospital will pay for four different instructors to educate on the different topics. Educational
classrooms or workshops will need to be available on four different days to educate the
individuals participating. Two class sessions will focus on learning effective coping and
leadership skills and an introduction to disruptive behaviors. One session will focus on team
collaboration and will give the staff the chance to bond and work together. The last session will
be an active simulation, where individuals will be able to act out disruptive behaviors and learn
how to confront them. Written materials will need to be purchased, so that participants can take
notes. Technical equipment will also be needed for the instructors to have visuals to enhance
their presentation. Light snacks and coffee will be purchased for each session. Last but not least,
an evidence- based, zero tolerance policy will be written to address disruptive behavior. This will
allow individuals to report any disruptive behavior in the hospital setting. The grand total to
implement these changes is $17,970.
Conclusion
Sentinel events, such as disruptive behaviors, are tragic occurrences that affect a large
number of patients in the acute care setting. Healthcare providers, nurses, and hospital staff must
be aware that the main goal is to ensure better patient outcome and safety. When a sentinel event
occurs, it is important that a root cause analysis is conducted to figure out the causes of poor
patient care and implement successful changes. Disruptive behaviors can be avoidable if nurses
and hospital staffs learn to work together to reduce unfavorable dilemmas that lead to a sentinel
event. Not only will team trust, respect, collaboration, and communication enhance better patient
care, they will help to improve a better working environment for everyone.

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References
American Nurses Association. (2014). Codes of ethics for nurses with interpretive statements.
American Nurses Association. Retrieved from http://www.nursingworld.org/codeofethics.
Burgess, C. & Curry, M. P. (2014). Transforming the health care environment collaborative.
AORN Journal, 99(4), 529-539. Retrieved from http://dx.doi.ord/10.1016/j.aorn.2014.012
Coursey, J. H., Rodriguez, R. E., Dieckmann, L. S., & Austin, P. N. (2013). Successful
implementation of policies addressing lateral violence. AORN Journal, 97(1), 101-109.
Retrieved from http://dx.doi.org/10.1016/j.aom.2012.09.010
Embree J., & White, A. (2010). Concept analysis: nurse-to-nurse lateral violence. Nursing
Forum, 45(3), 166-173. doi:10.1111/j.1744-6198.2010.00185.x
Felblinger, D. M. (2009). Bulling, incivility, and disruptive behaviors in the healthcare setting:
identification, impact, and intervention. Frontiers of Health Services Management, 25(4),
13-23.
Lux, K. M., Hutcheson, J. B., & Peden, A. R. (2011). Successful Management of Disruptive
Behavior: A Descriptive Study. Issues In Mental Health Nursing, 33(4), 236-243.
doi:10.3109/01612840.2011.647255
MindTools.com. (2013). Lewins change management model: Understanding the three stages of
change. Retrieved from http://mindtools.com/pages/article/newPPM_94.htm.
McNamara, S. A. (2012). Incivility in nursing: unsafe nurse, unsafe patients. AORN Journal,
95(4). 535- 540. doi: 10.1016/j.aorn.2012.01.020
Mion, L. (2010). Nurses behavior in the clinical setting: The good, the bad and the really ugly.
Geriatric Nursing, 31(5), 375-378. doi:10.1016/j.gerinurse.2010.08.005
Principles of medication administration. (2011). New Hampshire: BDS Medication
Administration Curriculum Section IV. Retrieved from http://www.dhhs.nh.gov/dcbcs/

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bds/nurses/documents/sectionIV.pdf
The Joint Commission. (2013). Sentinel event policy and procedures. Retrieved from
http://www.jointcommission.org/Sentinel_Event_Policy_and_Procedures/
Rosenstein, A. H. (2011a). Managing disruptive behaviors in the health care setting: Focus on
obstetrics services. American Journal of Obstetrics and Gynecology, 204(3), 187-192.
Rosenstein, A. H. (2011b). The quality and economic impact of disruptive behaviors on clinical
outcomes of patient care. American Journal of Medical Quality, 26(5), 372-379. doi:
10.1177/1062860611400592
Rosenstein, A. H. & ODaniel, M. (2008). A survey of the impact of disruptive behaviors and
communication defects on patient safety. The Joint Commission Journal on Quality and
Patient Safety, 34(8), 464-471.

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14

People
Lack of Pt Advocate

Continues to
give Pitocin

Policies & Procedures

Refuses to see
the Pt

NURSE

Lack of
knowledge
on meds

Physician
Expectations

Directs stress
at colleague.

Lack of communication
to nurse on duty

MED
ADMINSTRATION

Orders wrong
dosage
PHYSCIANO
RDERS

PHYSCIAN
Ignores fetal
distress

6 rights of med
administration not
followed

Lack of Pt/ family

education/
involvement

Questions nurses knowledge

& assessment skill

Patient Death
Fetal Injury
Staff failed to notice
worsening s/s of Pt
Nurse failed to
report to charge
STAFF

Staff members avoid

having to deal with
physician

People

Pt doesnt use
the call light
Pt family not @
bedside

Pts vitals not assessed

continuous with
monitor

Nurse feels
pressured &
humiliated by
doctor demands

Doctor is
temperamental,
creates a hostile
environment

PATIENT

Equipment

Environment

DISRUPTIVE BEHAVIORS AFFECT PATIENT SAFETY

14

Budget
Year:

2014

Organization:

Hospital

Submitted by:

Nikki Thao
Total Budget:

$17,970

Budget Planning
Lin
e
1

Item
Gather data on patient outcome

Description/Justification
Data will be collected for two months,
regarding disruptive behaviors that lead to poor
patient outcome.

Qty.
1

Unit Cost/Rate
$2000

Total
$2,000

Perform anonymous
questionnaires.

Instructors

Ten boxes ($2) will be placed throughout the

hospital to allow nurses to put in/write their
feedbacks, regarding any disruptive behaviors
they have noticed or experienced.
Nurse Managers or qualified personnel will be
needed to educate on effective coping &
leadership skills, team collaboration, & how to
manage disruptive behaviors.

10

$2

$20

$650

$2,600

Written materials

Supplies, including paper and pens that will be

given out to participants to help them to
review/ take home.

$750

$750

Educational Classrooms/
Workshops

Instructors will need individual rooms to

educate on the different topics available. Will
also include tables and chairs. Two sessions
will focus on learning coping & leadership
skills & what disruptive behavior is and how to
identify it. One session will focus on team
collaboration and allow for staff to bonded/
work together. Last session will be an active
simulation by acting out disruptive behaviors
and how to confront the behavior.

$900

$3,600

DISRUPTIVE BEHAVIORS AFFECT PATIENT SAFETY

6
Technical Equipment
Computer and PowerPoints to run educational
lecture. Microphone and speaker for instructor.
7
8

Coffee, paper cups, light snacks

Policy and Procedure

Used for breaks during the course.

Evidence- based, zero tolerance policy will be
written to combat disruptive behaviors.
Guidelines will allow individuals to report any
disruptive behaviors.

$500

14
$500

1000
1

$8
$500

$8,000
$500

Grand Total

$17,97
0