Negative behaviours in health care: Prevalence and strategies

J Nurs Manag. 2019 Jan;27(1):154-160. doi: 10.1111/jonm.12660. Epub 2018 Aug 31.


Aim: To evaluate the effectiveness of a professionalism taskforce and the prevalence of negative behaviours across interdisciplinary groups at a south-eastern US academic medical centre.

Background: Negative behaviours within health care organisations may undermine patient safety. These behaviours are associated with decreased productivity, increased turnover, and poor patient and staff outcomes.

Methods: A pre-post study design using an adapted instrument, the Negative Behaviors in HealthCare (NBHC) survey, assessed perceptions of negative behaviours by physicians, clinical, and managerial staff both before and after a professionalism taskforce was convened in 2012 to identify and promulgate key strategies to improve behaviours.

Results: The 1,980 respondents completed the pre-survey in January 2012 and 1,423 completed the post-survey in 2014. Significant reductions in use of lateral aggression (LA) and vertical aggression (VA) (χ2 = 5.65, p < 0.017), observation of LA and VA (χ2 = 4.90, p < 0.027), and experience with contributing factors associated with negative behaviours (χ2 = 9.03, p < 0.003) were identified.

Conclusions: Findings suggest that a professionalism taskforce guiding key strategies to elevate professionalism significantly affected beliefs about lateral and vertical aggression.

Implications for nursing management: Decreasing negative behaviours in health care will require additional strategies and consistent implementation. Additional research addressing fear, retaliation, and job stress, and linking these behaviours to patient safety outcomes, is required.

Keywords: bullying; disruptive behaviour; horizontal aggression; professionalism.

MeSH terms

  • Academic Medical Centers / organization & administration
  • Academic Medical Centers / statistics & numerical data
  • Adult
  • Aged
  • Bullying / psychology
  • Female
  • Health Personnel / psychology*
  • Health Personnel / standards
  • Health Personnel / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Problem Behavior / psychology*
  • Professionalism / education
  • Professionalism / standards*
  • Professionalism / trends
  • Psychometrics / instrumentation
  • Psychometrics / methods
  • Southeastern United States
  • Statistics, Nonparametric
  • Surveys and Questionnaires
  • Workplace / psychology
  • Workplace / standards