Workplace Violence and Disruptive Behavior

Formerly Position Statement Number 1.10

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Workplace violence and disruptive behavior (a form of workplace violence) are ongoing problems in modern American society, and the healthcare field is not immune to these difficulties. Workplace violence is an inclusive term that encompasses extreme examples such as disgruntled workers or students entering their environment with weapons intending to harm or murder peers and superiors. Other examples of workplace violence are poor behaviors in the form of exclusion/shunning, sabotage, spreading rumors, etc. While Certified Registered Nurse Anesthetists (CRNAs) are not particularly vulnerable to being victims of these behaviors, they are faced with challenges specific to the nature of their workplace that create opportunities for poor behaviors to be directed at them. Examples of these challenges are working in high stress environments or in close quarters, or interacting with other healthcare providers who have similar yet different educational backgrounds which may lead to jealousy, bitterness, uncooperativeness, or other negative mindsets. These sorts of mindsets often result in conflict. Some resources are currently offered within healthcare facilities to deal with these problems. For example, employee assistance may be available in the form of conflict arbitration and counseling at the departmental level and through Human Resource departments.   

Disruptive behavior may be described as bullying1, workplace bullying2-5, horizontal violence6-7, or lateral violence. Inappropriate shouting, belittling comments, sarcasm, needless public contradiction, physical threats, and passive activities such as refusing to perform assigned tasks and displaying uncooperative attitudes during routine activities8 are some examples of "dysfunctional personal interactions"8-9 which compose disruptive behaviors or workplace bullying. Some behaviors that typify the disruptive behaviors concepts include, but are not limited to, the following: verbal abuse (e.g., teasing, badgering, insulting4); sexual harassment; racial or ethnic slurs; intentional failure to respond to phone calls or pages; or a lack of respect for others.

When disruptive behaviors occur, communication and team dynamics are negatively influenced. This disruption may also place patient safety at risk. Literature has shown that disruptive behaviors produce elevated stress levels, affect concentration, and impede the transfer of pertinent patient care-related information.10  All these may have a significant impact on patient care.

Staff education and training are critical components to prevent or appropriately deal with disruptive behaviors and workplace violence. The Occupational and Safety Health Administration (OSHA) has guidelines to help facilitate compliance with facility policies and prevent such incidents. OSHA guidelines recommend an organization-wide assessment, facility or provider risk identification, management commitment, employee involvement through staff and supervisor training, and well-documented written records.11

Employers have a responsibility to ensure a safe working environment free from violent or disruptive behaviors.  The American Association of Nurse Anesthetists (AANA) supports development of comprehensive facility-level policies for the prevention of violent or disruptive behavior, and encourages CRNAs to play an instrumental role in the development of such policies to assure a safe perioperative experience for all. An open dialogue aimed at identifying and preventing these types of behaviors is optimal, before any tragedy occurs.



  1. Beyea SC. Intimidation in health care settings and patient safety. AORN J. 2004; 80: 115-117.
  2. Simons S. Workplace bullying experienced by Massachusetts registered nurses and the relationship to intention to leave the organization. ANS Adv Nurs Sci. 2008; 31: E48-59.
  3. Moayed FA, Daraiseh N, Shell R, Salem S. Workplace bullying: A systematic review of risk factors and outcomes. Theoretical Issues in Ergonomics Science. 2006; 7: 311-327.
  4. Hauge LJ, Skogstad A, Einarsen S. Relationships between stressful work environments and bullying: Results of a large representative study. Work and Stress. 2007; 21: 220-42.
  5. Martin WF. Is your hospital safe? Disruptive behavior and workplace bullying. Hospital Topics: Research and Perspectives on Healthcare. 2008; 86: 21-28.
  6. Bigony L, Lipke TG, Lundberg A, McGraw CA, Pagac GL, Rogers A. Lateral violence in the perioperative setting. AORN J. 2009; 89: 688-96; quiz 697-700.
  7. Sheridan-Leos, N. Understanding lateral violence in nursing. Clinical Journal of Oncology Nursing. 2008; 12: 399-403.
  8. The Joint Commission. Behaviors that undermine a culture of safety. Sentinel Event Alert. 2008: 1-3. Available at: Accessed May 18, 2010.
  9. Saxton R, Hines T, Enriquez M. The negative impact of nurse-physician disruptive behavior on patient safety: a review of the literature. J Patient Saf. 2009; 5: 180-183.
  10. Rosenstein AH, O'Daniel M. Impact and implications of disruptive behavior in the perioperative arena. J Am Coll Surg. 2006; 203: 96-105.
  11. United States Department of Labor, Occupational Safety and Health Administration. Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers. Available at: Accessed September 16, 2009.

Adopted by AANA Board of Directors August 2000 and June 2010.