Intimidation Still a Problem in Hospital Workplace, ISMP Survey Shows

Recently released survey results from the Institute for Safe Medication Practices (ISMP) show that bullying, intimidation, and other types of disrespectful behavior remain a problem in the healthcare workplace, and continue to erode professional communication, which is essential to patient safety and quality.

Ten years ago, ISMP conducted a national survey regarding intimidation that indicated disrespectful behaviors were not isolated events. Between July and August 2013, ISMP conducted a similar survey to determine how things have changed in the last decade. The 2013 survey included 4,884 respondents—more than double the number of 2003 participants. Most were nurses (68%) or pharmacists (14%), but more than 200 physicians and almost 100 quality/risk management staff also participated in the survey. Seventy percent had more than 10 years of experience. Following are some highlights of the findings.

Most Frequent Disrespectful Behavior Reported

  • Negative comments about colleagues (reported by 73% at least once, by 20% often)
  • Reluctance or refusal to answer questions or return calls (77% at least once, 13% often)
  • Condescending language or demeaning comments (68% at least once, 15% often)
  • Impatience with questions or hanging up the phone (69% at least once, 10% often)
  • Reluctance to follow safety practices or work collaboratively (66% at least once, 13% often)

Although physical abuse (7%), throwing objects (18%), insults due to race, religion, or appearance (24%), and shaming or humiliation (46%) were not encountered frequently by most respondents, nearly a quarter reported those behaviors were among the top three encountered during the past year.

Who Is Involved/Affected?

In both 2003 and 2013, respondents reported that physicians and other prescribers engaged in disrespectful behavior most often; more than half of 2013 respondents said physicians/prescribers had often (6%) or at some time during the year (51%) yelled, cursed, or issued verbal threats. However, they also made it clear that it is not just physicians—in many cases, encounters were nearly as frequent with other healthcare professionals.

Repeated occurrences of disrespectful behavior did not arise from a single individual—36% reported that 3 to 5 individuals were involved in incidents. The survey also showed that gender of the individual affected has little impact; only minor differences were reported in the frequency with which men and women encountered disrespectful behaviors.

Impact on Safety

Almost half of the 2013 respondents said their past experiences with intimidation altered the way they handle questions about medication orders. At least once during the year, 33% of respondents had concerns but assumed an order was correct rather than interact with an intimidating prescriber. More than one-third asked another professional to talk to a disrespectful prescriber about an order. Eleven percent reported a medication error that occurred primarily due to intimidation. It also appears that 2013 respondents were less satisfied than 2003 respondents with organizational efforts to address the problem. While 70% of respondents in 2003 reported that their organization would support them if they reported disrespectful behavior, just 52% of the 2013 respondents felt this way.

The results of ISMP’s surveys expose healthcare’s continued tolerance of disrespectful behavior in the workplace; little progress has been made in the last decade to eradicate intimidation and bullying. The Institute plans to issue recommendations on how healthcare professionals and organizations can address disrespectful behavior in a future issue of the ISMP Medication Safety Alert! newsletter.

For a copy of an article that analyzes the 2013 survey findings in more depth, visit: For a summary of results from ISMP’s 2003 survey, visit: