More than half the doctors in our staff survey reported anger at their work environment, and four in 10 nurses reported the same. This is a major departure from the previous few years, when 80 percent of physicians and 89 percent of nurses were only moderately or extremely concerned with this topic.
Anger is common in the health care workforce. Physicians in our survey reported high levels of conflict and frustration, in some cases completely exhausting the concept of “workplace well-being.” It’s in this context that we developed a report on the state of anger in our health care community in the United States, tracking physicians and nurses across allopathic and osteopathic medicine. The reports found that the same issues that fuel physicians’ and nurses’ anger were also giving rise to high levels of injury and waste among health care institutions: substandard care, understaffing, patient abuse, discrimination and animosity from patients.
Surveyed physicians and nurses perceived dissatisfaction in the quality of patient care because of poor overall work cultures, lack of communication and the difficulty of scheduling patients. Adverse physical and emotional effects led to higher levels of absenteeism among physicians and higher preventable hospital admissions. This in turn led to increased cost overruns. At the same time, hospitals were facing increased competition from home health and at-home care. It’s easy to understand why. When U.S. hospitals experience high levels of patient demand, patients’ emotions can spill over into health care issues, with long waits, inappropriate procedures and miscommunication. More appointments mean more visits to the ER and in many cases a higher risk of developing a condition.
Anger may serve as an amplifier of disruptive behavior. Since it is essentially the emotion of agitation, “angry people” are easy targets for bullies, and hospital leaders might encourage conflict by rewarding the recent behavior. This can result in sloppy care, injury and overuse of medical procedures. Patient anger can make it easy for hospital administrators to blame physicians and nurses for problems they themselves created by becoming hypercompetitive and overworked.
Anger can also result in the assault of patients and cause physical harm to other staff, such as rupturing an EKG or triggering an intentional medical error. Often, management disengages with obstetricians and gynecologists by forgoing additional prenatal care and cutting off midwives, though midwives are in fact just as qualified.
Physicians and nurses hold hospital leaders accountable for how they treat their patients and must be especially vigilant of health care organizations that withhold resources from primary care physicians and experience financial pressures resulting from patient volume increases. We are optimistic that resolving the issues will reduce anger, but only if we recognize it is a problem and take the necessary steps to confront it.
Most importantly, doctors and nurses must have a voice in managing the conditions that inspire their anger. They must be assured they are making informed decisions and being managed with sensitivity by their co-workers. If leaders don’t see the need to address health care issues, they and their patients will simply wait for it to spill over. Their attempts to take appropriate action will ultimately fail.
Dana Ullrich is the associate executive director for policy and federal advocacy at the American Medical Association.