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Bullying in Healthcare: Part 1

By Becky Lamberth, MJ, MS, CRA, FAHRA

The earned from the Quick CreditTM test accompanying this article may be applied to the CRA (HR) domain.

According to the Workplace rapidly changing environment, the con- Executive Summary Bullying Institute (WBI), approxi- cept of “doing more with less resources,” •• Bullying is a repetitive and abusive mately 35% of American workers have the hierarchal structure and the learning behavior in which the victim suffers experienced some form of workplace setting.3 As one physician stated, “the from abuse, humiliation, or intimida- bullying firsthand. This represents culture that perpetuates bullying goes tion to such an extent that it interferes roughly 53.5 million Americans. An back as far as medical school, when as with performance. additional 15% of workers have been , future doctors are trained in a •• Victims of bullying have three possible witness to acts of bullying.1 pecking order not unlike the military.”4 legal solutions: , hostile In 2013, millions of viewers watched within the medical field environment, and intentional/ footage on outlets of former tend to attract individuals who have a negligent infliction of emotional dis- Rutgers coach, Mike Rice, as he screamed, very high self-confidence level but then tress. However, the elements necessary pushed, kicked, and threw items at his expose them to an environment charac- to fulfill the legal definitions are subjec- players during basketball practice. These terized by great uncertainty.5 tive and difficult at best to satisfy. actions are unquestionably character- The word bully has Dutch origins •• Hospitals are hesitant to terminate any istic of a bully. Rice describes his own dating as far back as the 1530s, in which employee, which would result in open behavior as passionate, emotional, and the term meant “lovers” or “friends.” It staff positions that are difficult to fill. intense, but does not consider himself to wasn’t until much later that the term Replacing staff with specific skills, be abusive or a bully.2 This was not an bully morphed into a more callous including physicians, is daunting and isolated event for Rice but his behavior meaning. By 1909, the mistreatment of costly. This makes a significant factor in retaining staff was never formally addressed or chal- nursing staff was already being docu- members who demonstrate poor lenged because he was able to achieve mented and by the 1980s British jour- behavior. desired results from the . It wasn’t nalist, Andrea Adams, popularized the until there was public outcry that he was term “.”2 The concept •• Part 1 will focus on terminology and concerns related to bullying. Part 2 will terminated from the . was finally introduced and accepted in discuss the legal protection afforded Although workplace bullying occurs the American workplace in the 1990s. the bully and possible organizational in many varying professions, from Bullying abuse can be verbal, emotional, solutions. Part 3 will address managers blue-collar to academia, it is most or even physical, but typically takes the who have been accused of bullying by prevalent in the medical .3 form of emotional-verbal abuse.6 Com- disgruntled employees and what to do The reasons for such high levels of bul- mon examples of bullying include threat- about it. lying in medicine are not fully known ening or abusive language, demeaning or understood, but are thought to stem comments, repeated criticism, humili- from the high stress work atmosphere, a ation, refusing to assist, intimidation,

12 January/February 2015  radiology malevolent emails, and throwing items.6 It is estimated that workplace bullying Translated into workplace actions, bul- lying can take the form of unreason- an roughly 10% of their profits. able work demands, blaming the victim for errors, insults, deliberately denying access to critical , denying opportunities for or promotion, but are impatient and easily frustrated clinical depression, high blood pres- stealing credit for work successes or dis- when something does not go according sure, cardiovascular disease, impaired counting accomplishments.7 Although to plan.7 Fifty-eight percent of the time, immune systems, increased staff turn- physicians are often considered to be the victims are females who are highly over, increased , decreased the primary culprit of bullying, the fact competent and well accomplished.11 , and symptoms consistent is that healthcare bullies can be any one Victims are typically chosen because they with post-traumatic stress disorder.7 of the many professionals who work in pose some sort of threat to the bully, such Studies suggest that workplace bullying the organization including physicians, as being well liked by peers or are con- costs an estimated $200 nurses, radiology technologists, pharma- sidered a resource to the department or billion annually resulting from a 40% cists, ancillary staff personnel, adminis- organization.11 Victims refuse to be sub- decline in productivity, increased sick trators, or other non-physician staff servient and often demonstrate ethical days, increased medical claims by the members. The Society and of and honest work behaviors. Victims are victims, potential legal costs, and staff Radiographers (SCoR), a in non-confrontational and could poten- .7 the United Kingdom, conducted a survey tially be a whistle blower exposing uneth- Stanford University professor, Bob of its members in 2013 in which 1,463 ical or fraudulent actions.1 In situations Sutton, suggests that up to 82% of vic- members responded. Forty percent of where females are the bullies, 80% of the tims resign, transfer, or are terminated.7 the respondents indicated that they had time their victims are other females.7 Replacing employees costs two to three been subjected to bullying or harassment Bullying can also occur among work times their annual .7 This is a in the past two years and 21% identified peers of the same status. This type of concern especially with the potential cri- bullying as a serious issue.8 bullying is referred to as horizontal hos- sis in the US with the looming Because this behavior is often a mis- tility.12 Behaviors consistent with hori- of healthcare providers. A 2013 survey use of power, studies indicate that pri- zontal hostility (among others) can range indicated that the current average age of mary culprits are typically department from infighting, , demeaning a registered nurse was 50 years and that managers, , or organization remarks, and passive-aggressive behav- by the year 2020 over half of those nurses executives.7 A survey commissioned ior.12 The phrase “eating their young” will reach traditional age.14 In by the WBI with Zogby International regarding the behavior of more senior 2007, a study indicated that one quarter in 2007 found that in 72% of the cases, nurses with newly hired nurses has been of physicians were age 60 or older.14 Of the perpetrators are supervisors (the used for decades and is now being rec- those bedside physicians, approximately survey included online interviews of ognized as a form of bullying. In a study 209,000 were primary care. It is esti- 7,740 between 8/10/07 through conducted in the United Kingdom, it mated that an additional 52,000 primary 8/13/07. The margin of error was +/– 1.1 was determined that 86% of nurses face care physicians will be needed by 2025; percentage points). 9,10 Of those perpe- bullying during a 12 month period and and by 2030 the US will need an extra 3.5 trations, executive members supported at some point in their 97% of all million healthcare providers to maintain the behavior 43% of the time.1 Leaders nurses will be exposed to verbal abuse.2 the existing provider to patient ratio.14 do nothing 43.6% of the time when bul- For the patient, bullying in the health- lying occurs, offenders are punished in care workplace compromises job perfor- only 6.2% of the cases, and in 18.4% of Effects of Bullying mance of the provider and contributes to the cases, the victim felt that employer Regardless of the bully’s identity (and increased adverse events and near misses, intervention actually made the situation ), or the reasons behind bully- increased medical and medication errors, worse.9 Employees reported that bully- ing, there are severe consequences result- decreased patient satisfaction, decreased ing stopped 40% of the time because the ing from the behavior. It is estimated that safety and quality care, and a decrease in victim quit, 24% of the time because the workplace bullying costs an organization positive patient outcomes. This negative victim was terminated, and 13% of the roughly 10% of their profits.13 Approxi- impact on patients is often blamed on a time because the victim transferred.1 mately 40% of victims never report being decrease or lack of communication and Characteristically, 62% of bullies are bullied and for those that do report, 62% collaboration between patient provid- male.11 They crave power and control. of them are ignored.7 For the victim, this ers.6 The phenomenon has become so They are competitive and appear driven, can lead to increased stress and burnout, concerning, that regulatory agencies such

radiology management  January/February 2015 13  Workplace Bullying in Healthcare: Part 1

Bullying is four times more prevalent than harassment and when it is so egregious that it creates a .18 Federal laws there are some key differences that distinguish the two. that address harassment include Title VII of the , the Age Discrimination in Act of 1967 (ADEA), and the American with as The Joint Commission issued a senti- Legal Remedies for Victims Act of 1990 (ADA).19 Con- nel event alert in 2008 and implemented gress enacted Title VII of the Civil Rights two additional leadership standards in There is slow movement as some health- Act of 1964, (42 U.S.C. § 2000e et seq.) to January 2009 to address the inappropri- care leaders begin to recognize the sever- ensure equality of employment opportu- ate behavior:15 ity of bullying and are taking action. nities and to prohibit discrimination.19 There are no specific laws related to It makes it unlawful for any employer EP 4: The institution has a code of con- bullying; however, when severe enough, with 15 or more employees to discrimi- duct that defines acceptable, disruptive behavior with bullying implications has nate in regards to recruiting, hiring, pro- and inappropriate behaviors. been the subject of litigation. A Cali- motion, transfer, work environment, job EP 5: Leaders must create and imple- fornia cardiovascular surgeon, Dr. John training, discipline, discharge, , ment a process for managing disrup- Young, had a of disrup- benefits, or other terms, conditions, or 16 tive and inappropriate behaviors. tive and intimidating behavior. Young’s privileges of employment.19 Title VII cre- behavior escalated and became so erratic, ated the Equal Employment Opportunity Suggestions by The Joint Commission violent, and threatening, employees at Commission (EEOC) to implement the for organizations to address disruptive Tri-City Medical Center felt frightened. law but enforcement is vested with the behavior include:6 In Tri-City Healthcare Dist. v. Young, the federal court system. The EEOC defines plaintiff petitioned for protective orders discrimination as unwelcome conduct •• Adopt a zero tolerance position. against Dr. Young on behalf of four of its (toward members of protected groups) •• Provide training for all leaders of the employees. Staff stated that Dr. Young’s that is based on race, color, , sex, organization including physicians and communication was derogatory, intimi- national origin, age (40 or older), disabil- non-physicians. dating, and bully-like. The court issued ity, pregnancy, or genetic information.18 •• Develop appropriate policies and orders prohibiting contact with the The definition also includes conduct procedures that address disruptive employees and his behaviors ultimately that violates people’s dignity or creates behavior. led to termination of his medical staff an intimidating, hostile, or offensive •• Develop a reporting system. privileges. Under current federal law, environment.17 An employer is liable for •• Determine how and when to begin victims of what could be deemed bul- harassment by supervisors, employees, disciplinary actions. lying have sought redress utilizing three and non-employees if they fail to take •• Document attempts to address the main theories: harassment, hostile work corrective actions. behavior. environment, and intentional/negligent Bullying is four times more prevalent •• Hold all team members account- infliction of emotional distress. At best, than harassment and there are some key able for modeling desirable behav- success is mixed demonstrating the need differences that distinguish the two.19 ior regardless of seniority or clinical for a clearer, dedicated legal remedy for Unlike harassment, bullying is not spe- discipline. victims. cifically defined in the law, nor does federal employment or state employ- Other organizations that have taken a Harassment ment laws specifically protect the vic- stand on addressing this negative and dis- Federal laws that offer employee protec- tims of bullying. Since 2003, 26 states ruptive behavior include the American tion related to inappropriate behavior have introduced anti-bullying healthy Medical Association (AMA), the Center specifically address harassment. The legal workplace bills (HWB) but there is still for American Nurses (the CENTER), definition of harassment is the act of no state that has enacted laws to pro- and the American Association of Critical systematic and/or continued unwanted tect the victim.1 The proposed legisla- Care Nurses (AACN).7 The AMA recog- and annoying actions of one party or a tion would provide a mechanism for nizes any behavior that would potentially group, including threats and demands.17 victims to file legal claims for damages, affect patient care as disruptive behavior Harassment and bullying are not actually create legal incentives for employers to and both the CENTER and the AACN the same thing; however, approximately prevent and respond to bullying behav- note that collaboration among provid- 20% of bullying is considered harass- iors, and protect employees that have ers is paramount in sustaining a healthy ment.18 Harassment becomes unlawful made a complaint. Current recourse for work environment.6 when it is based on discrimination or bullying victims is simply to leave the

14 January/February 2015  radiology management organization. Additionally, bullies tar- conduct resulting in emotional distress.21 get anyone, not just those who are in a Many states have a high standard for Conclusion protected group (harassment based on claims of IIED and the requirements are The reasons behind bullying and the discrimination). When bullying does difficult to satisfy.22 The four elements continued tolerance of the disruptive not qualify as “harassment” or “discrimi- necessary to prevail are22: behavior are multi-faceted. First, char- nation,” proscribed by current employ- acteristically, bullies tend to be high ment law, there is no law that prohibits 1. The defendant intended to inflict achievers. They get results for the organi- workplace bullying. emotional distress or should know zation. This keeps the organization from that emotional distress was the likely acknowledging (or possibly even recog- Hostile Work Environment result of the conduct; nizing) the problem. Second, as statistics A hostile work environment is created 2. The conduct of the defendant was indicate, many bullies are in leadership by conduct that is so severe and perva- extreme and outrageous; roles. The staff members who are in place sive that it interferes with one’s ability to 3. The actions of the defendant were the to be the employee’s (manag- perform the job. What circumstances can cause of the plaintiff’s distress; and ers and administrators) are in fact at the rise to the level of creating a hostile work 4. The resulting emotional distress to the root of the problem. Finally, many bul- environment under the law can be diffi- plaintiff was severe. lies are key players in the organization. cult to define. Courts must analyze facts Physicians are the foundation of referral related to each case to determine the legal The element most difficult to prove patterns for a hospital. Without them, standards that apply which may not be is the presence of extreme or outrageous a hospital suffers financially. Nursing relevant in every situation. To be unlaw- behavior because the term “outrageous” and other crucial ancillary staff are in ful, it must be considered hostile, offen- lacks a specific definition making related demand. As the population continues sive, or intimidating to the reasonable lawsuits largely unsuccessful.22 to age, there will be an increase in the person.19 Courts have dismissed claims Two cases specifically demonstrate patient load (and demand for medical made by plaintiffs stating that to prevail the difficulty in satisfying the elements services) with less people to backfill open in a retaliatory hostile work environment of IIED. In Holloman v. Keadle, a female positions. Hospitals are hesitant to ter- assertion, “a plaintiff must show that the worked for a male physician in his minate any employee, which would result employer subjected the employee to for two years before voluntarily resign- in open staff positions that are difficult ‘discriminatory intimidation, ridicule, ing her position.23 In her 1996 lawsuit, to fill. Replacing staff with specific skills and insult’ that is ‘sufficiently severe Holloman stated that the physician, can cost an organization up to 21% of or pervasive to alter the conditions of Dr. Keadle, repeatedly cursed at her, belit- that employee’s annual and senior the victim’s employment and create an tled her, called her derogatory names (in leaders have a disproportionately high abusive working environment.’”20 Such front of other staff and patients), and turnover cost up to 213%.25 The cost for a situation occurred in a large hospital made vague threats (indicating he had a physician recruitment is just as daunting system in Dallas, Texas in which employ- gun and connections to the mob). The for an organization, requiring up to 350 ees made several complaints of a hostile situation became so stressful the plain- and an average of $40,000.26 This work environment against a cardiologist. tiff alleged that she suffered from stom- makes recruitment cost a significant fac- One employee accused the physician of ach problems, sleep loss, anxiety attacks, tor in retaining staff members who dem- physically intimidating her during a and a loss to her self-esteem. Similarly, in onstrate poor behavior. procedure while others stated that he Snyder v. Turk, a nurse filed suit against Victims of bullying have three pos- used racial slurs, demeaning comments, a surgeon after he demonstrated bully- sible legal solutions: harassment, hos- threatened job loss, and demonstrated ing behavior.24 During a surgical case, tile work environment, and intentional/ behavior consistent with sexual harass- the surgeon yelled at the nurse multiple negligent infliction of emotional distress. ment. According to the physician, the times and stated that she was incompe- However, the elements necessary to ful- staff was poorly trained and not accus- tent. The surgeon became increasingly fill the legal definitions are subjective and tomed to working such long, hard hours frustrated when she handed him the difficult at best to satisfy. This has created resulting in staff frustration, not a hostile incorrect instrument at which point, he a situation that is tolerant of unaccept- work environment pulled her down to the surgical open- able behavior. Regardless of the reasons, ing and stated, “Can’t you see where I’m the lack of specific workplace bullying Intentional Infliction of working? I’m working in a hole.” In both legislation, continued tolerance of such Emotional Distress cases, the courts ruled in favor of the conduct, and work safeguards that pro- Intentional infliction of emotional dis- defendants agreeing that the plaintiffs tect the bully but penalize the victim cre- tress (IIED), also referred to as the tort did not establish the necessary elements ates an environment that proliferates the of outrage, is a tort claim for intentional of the case. behavior in healthcare organizations.

radiology management  January/February 2015 15  Workplace Bullying in Healthcare: Part 1

Available at: http://www.workplacebully- 2014. Available at: http://definitions. References ing.org/multi/pdf/N-N-2009A.pdf. uslegal.com/i/intentional-infliction-of- 1Namie N, Namie R. Being Bullied? Start Here. Accessed December 29, 2014. emotional-distress/. Accessed December Workplace Bullying Institute. 2013 Available 11Workplace Bullying Institute. “Results of 29, 2014. at: http://www.workplacebullying.org/ the 2010 WBI U.S. Workplace Bullying 22Cavico FJ. The tort of intentional infliction of individuals/problem/being-bullied. Sur vey.” 2010. Available at: http:// emotional distress in the private employ- Accessed December 29, 2014. www.workplacebullying.org/ ment sector. Hofstra Labor & Emp Law J. 2Mahler J. “The Coach Who Exploded.” The wbiresearch/2010-wbi-national-survey/. 2003;21(1):110–180. Available at http:// New York Times. November 6, 2013. Avail- Accessed December 29, 2014. law.hofstra.edu/pdf/labor_vol21no1_ able at: http://www.nytimes. 12Wilson BL, et al. Bullies at work: the impact cavico.pdf. Accessed December 29, 2014. com/2013/11/10/magazine/the-coach- of horizontal hostility in the hospital set- 23Hollomon v. Keadle. 326 Ark. 168, 931 who-exploded.html. Accessed December ting and intent to leave. J Nursing Admin. S.W.2d 413, 1996 Ark. LEXIS 480, 12 I.E.R. 29, 2014. 2001;453:453–458. Cas. (BNA) 194, 132 Lab. Cas. (CCH) 3Yildirim D. Bullying among nurses and its 13Fowler J. “Financial Impacts of Workplace P58,170 (Ark. 1996). effects. Int Nurs Rev. 2009 Dec;56(4): Bullying.” Investopedia. July 8, 2012. Avail- 24Snyder v. Turk. 90 Ohio App. 3d 18, 627 504–511. able at: http://www.investopedia.com/ N.E.2d 1053, 1993 Ohio App. LEXIS 4063 4Yamada D. “Nurse writes about bullying by financial-edge/0712/financial-impacts-of- (Ohio Ct. App., Montgomery County doctors, and other doctors respond.” workplace-bullying.aspx. Accessed 1993). Minding the Workplace. May 9, 2011. December 29, 2014. 25Boushey H, Glynn SJ. “There Are Significant Available at: http://newworkplace.word- 14Harrington L, Heidkamp M. “The Aging Costs to Replacing Employees.” press.com/2011/05/09/nurse-writes- : Challenges for the Health Care Center for American . November about-bullying-by-doctors-and-other- Industry Workforce.” The NTAR Leader- 16, 2012. Available at: http://www. doctors-respond/. Accessed December 29, ship. March 2013. Available at: http://www. americanprogress.org/wp-content/ 2014. dol.gov/odep/pdf/NTAR-AgingWorkforce uploads/2012/11/CostofTurnover.pdf. 5McDonald J, Orlick T. “Excellence in Surgery: HealthCare.pdf. Accessed December 29, Accessed December 29, 2014. Psychological Considerations.” Zone of 2014. 26Greenwood B. The Average Recruitment Excellence. 2005. Available at: http://www. 15The Joint Commission. “Behaviors that Cost. Hearst , LLC. 2014. zoneofexcellence.ca/free/surgery.html. undermine a culture of safety.” Issue 40, Available at: http://work.chron.com/ Accessed December 29, 2014. July 9, 2008. Available at: http://www. average-recruitment-cost-3664.html. 6Longo J. Combating disruptive behaviors: jointcommission.org/assets/1/18/SEA_40. Accessed December 29, 2014. strategies to promote a healthy work envi- pdf. Accessed December 29, 2014. ronment. OJIN: The Online Journal of 16Tri-City Healthcare Dist. v. Young. 2013 Cal. Becky Lamberth, MJ, MS, RT(R)(MR), CRA, FAHRA Issues in Nursing 2010;15(1);5. App. Unpub. LEXIS 2368, 2013 WL is the current director of radiology for Methodist 7Williams R. “The Silent Epidemic: Workplace 1277893 (Cal. App. 4th Dist. Mar. 29, Dallas Medical Center in Dallas, Texas and an adjunct Bullying.” Psychology Today: Wired for Suc- 2013). professor for Midwestern State University. She is an active member of AHRA, a published author, and a cess. May 3, 2011. Available at: http://www. 17“Harassment.” Search Legal Terms and Def- noted speaker. Becky can be contacted at psychologytoday.com/blog/wired- initions. Law.com Available at: http:// [email protected] success/201105/the-silent-epidemic- dictionary.law.com/Default. workplace-bullying. Accessed December aspx?typed=harassment&type=1. 29, 2014. Accessed December 29, 2014. 8The Society and College of Radiographers. 18Workplace Bullying Institute. How is this dif- (2014). Society of Radiographers: Stamp ferent from harassment? Frequently Asked out Bullying. Available at: https://www.sor. Questions. 2011. Available at: http://www. org/trade-union-support/campaigns/ workplacebullying.org/faq/#3. Accessed stamp-out-bullying. Accessed December December 29, 2014. 29, 2014. 19U.S. Equal Employment Opportunity Com- 9Workplace Bullying Institute and Zogby mission. “Title VII of the Civil Rights Act of International. “U.S. Workplace Bullying 1964.” Pub. L. 88-352. Available at: http:/// Survey.” September 2007. Available at: www.eeoc.gov/laws/statutes/titlevii.cfm. http://workplacebullying.org/multi/pdf/ Accessed December 29, 2014. WBIsurvey2007.pdf. Accessed December 20Ramseur v. Perez. 2013 U.S. Dist. LEXIS 29, 2014. 119626, 119 Fair Empl. Prac. Cas. (BNA) 10Namie G, Namie R. “U.S. Workplace Bully- 1688, 2013 WL 4483511. D.D.C. Aug. 23, ing: Some Basic Considerations and Con- 2013. sultation Interventions.” Workplace 21USLegal, Inc. “Intentional Infliction of Emo- Bullying Institute. September 2009. tional Distress Law & Legal Definitions.”

16 January/February 2015  radiology management Continuing Workplace Bullying in Healthcare: Part 1

Home-Study Test

1.0 Category A credit • Expiration date 2-28-2017

Carefully read the following multiple choice questions and take the post-test at AHRA’s Online Institute The credit earned from the Quick CreditTM test (www.ahraonline.org/onlineinstitute) accompanying this article may be applied to the CRA human resources (HR) domain.

Questions

Instructions: Choose the answer that is most correct.

1. According to the Workplace Bullying Institute, what is the 4. the concept “Workplace Bullying” was finally introduced approximate percentage of American workers and accepted in the American workplace in the: experiencing some form of workplace bullying firsthand? a. 1990s a. 17% b. 1980s b. 35% c. 1970s c. 50% d. 1960s d. 62% 5. Bullying abuse can be verbal, emotional, or physical, but 2. What percentage of workers have witnessed acts of typically takes the form of: bullying? a. Verbal abuse a. 15% b. Physical abuse b. 30% c. Emotional-physical abuse c. 42% d. Emotional-verbal abuse d. 53% 6. A survey by the Workplace Bullying Institute in 2007 found 3. Workplace bullying is most prevalent in: that perpetrators are supervisors in: a. Blue collar jobs a. 43% of the cases b. Academia setting b. 13% of the cases c. Medical profession c. 72% of the cases d. All areas experience equal amounts d. 62% of the cases

radiology management  January/February 2015 17 7. in situations where females are the bullies, 80% of the time 14. Compared with harassment, bullying is: their victims are other females. a. Four times more prevalent a. True b. Ten times more prevalent b. False c. Twelve times more prevalent d. Twenty times more prevalent 8. Bullying which occurs among work peers of the same status is referred to as: 15. Since 2003, the number of states having introduced anti- a. Parallel aggression bullying Healthy Workplace Bills is: b. Horizontal hostility a. 6 c. Straight-line resentment b. 13 d. Leveled opposition c. 26 d. 44 9. studies suggest that, annually, workplace bullying costs organizations an estimated: 16. To be unlawful, a work environment must be considered a. $100 million hostile, offensive, or intimidating to the reasonable person. b. $200 million a. True c. $100 billion b. False d. $200 billion 17. The number of elements necessary to satisfy a claim of 10. How many additional leadership standards were Intentional Infliction of Emotional Distress set by many implemented by The Joint Commission in January 2009 to states is: address inappropriate behavior? a. 2 a. 2 b. 4 b. 4 c. 6 c. 8 d. 8 d. 10 18. The element of Infliction of Emotional Distress most 11. Suggestion by The Joint Commission for organizations to difficult to prove is: address disruptive behavior include: a. The defendant intended to inflict emotional distress a. Adopt a zero tolerance position b. The resulting emotional distress to the plaintiff was b. Determine how and when to begin disciplinary actions severe c. Document attempts to address the behavior c. The presence of extreme or outrageous behavior d. All of the above d. The defendant’s actions were the cause of the plaintiff’s distress 12. Which of the following is one of three main theories that has been utilized by victims seeking redress of what could 19. The reasons behind bullying and the continued tolerance be deemed bullying under current federal law? of the disruptive behavior are: a. a. Bullies tend to be high achievers b. Pestering b. Bullies are in leadership roles c. Harassment c. Many bullies are key players in the organization d. Aggravation d. All of the above

13. Approximately what percent of bullying is considered 20. Victims of bullying have how many possible legal harassment? solutions? a. 10% a. 3 b. 20% b. 4 c. 40% c. 6 d. 50% d. 9

18 January/February 2015  radiology management