Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/lateral violence.

T he Joint Commission (2008) stated, “Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments” (p. 1). With the new Medicare reimbursement mechanisms for hospitals, these issues of cost, safety, and patient satisfaction become even more crucial to address. Yet various kinds of disruptive behaviors – incivility, bullying, horizontal/lateral violence – still are tolerated in many health care settings (Rosenstein & O’Daniel, 2005; Wilson, Diedrich, Phelps, & Choi, 2011). The majority of clinicians enter their chosen discipline with a strong interest in caring for patients. Nurses’ idealism and professionalism can be undermined by the allowed presence of individuals who create an unhealthy or even hostile work environment. In this article, the ethical issues and ethical justifications for zero tolerance for these disruptive behaviors are described. After types of disruptive behaviors are defined and the prevalence discussed, the focus will shift to the ethical issues and justifications for change for the individual nurse and for the health care organization. Four suggested practical change strategies are provided. Examples of disruptive behaviors are throwing objects, banging down the telephone receiver, intentionally damaging equipment, and exposing patients or staff to contaminated fluids or equipment. In Figure 1 the types of disruptive behaviors are defined and other key behaviors are outlined. The overlap of behaviors in the literature makes it difficult to separate the individual’s actions into different types, as overlap will be noticed (Read & Laschinger, 2013). However, bullying is beyond the ambivalent disrespect of incivility because it is intentional, intense mistreatment that targets particular individuals or groups (e.g., nurses’ aides, novice nurses). Some authors consider these two disruptive behaviors as forms of horizontal/lateral violence (Purpora, Blegen, & Stotts, 2012). Prevalence of Problem