1. Mason, Diana J. PhD, RN, FAAN, AJN Editor-in-Chief

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As a young girl, I enjoyed thinking about what was important for me to change in the new year-whether to be kinder to my siblings, cut down on sweets, or do better in school. I gave up making New Year's resolutions a long time ago, though-not just because I couldn't keep them (I probably couldn't) but because after a couple of months, I could-n't remember what I'd resolved.


Perhaps the ritual would be more meaningful-and longer lasting-if nurses joined together and came up with professional resolutions for the coming year, commitments to practices that are important to us and our patients. Here are two for your consideration.


End disruptive and intimidating behavior by any team member.

In June 2002 AJN published a study by Alan Rosenstein, MD, MBA, suggesting that disruptive or abusive behavior among physicians can adversely affect nurses' job satisfaction, as well as nurse retention. Since that time, the American College of Physician Executives published the results of a survey on physician behavior in the September-October 2004 issue of the Physician Executive. More than 95% of the physician executives who responded said they had encountered "these disturbing, disruptive, and potentially dangerous behaviors on a regular basis."


This month, AJN publishes a second study by Rosenstein-with Michelle O'Daniel, MHA, MSG-that has two important findings. First, nurses can be as abusive as physicians. This should not surprise any nurse working in an environment that tolerates abuse and poor communication. How can we ask physicians to clean up their act if our own house is dirty? Second, and perhaps more troubling, is that the failure of nurses and physicians to communicate civilly can put our patients at risk for medical error and poor care.


The effect of intimidation on patient outcomes was also highlighted in a survey published in the March 11, 2004, ISMP Medication Safety Alert of the Institute for Safe Medication Practices. The survey of physicians, nurses, pharmacists, and others revealed that nurses and pharmacists were reluctant to question a physician's medication order, particularly if they had had a confrontation with the physician. Often nurses or pharmacists would assume that an order was correct. And 7% reported that they had made a medication error because they'd been intimidated.

FIGURE. Make the com... - Click to enlarge in new windowFIGURE. Make the commitment to improve where and how you work.

It's time for nurses, physicians, pharmacists, and administrators to resolve to end intimidation and disruptive or abusive behavior by any employee. Rosenstein discusses some options for doing so, and the Institute for Safe Medication Practices has published a guide for changing institutional cultures that tolerate such behavior (


Advocate breastfeeding.

Two decades ago, a friend told me that nurses had actually thwarted her attempts to breast-feed her newborn, bottle feeding the baby at night in spite of her request to be awakened if the baby was hungry. None of the nursery or postpartum nurses would help teach her how to breastfeed. A "lactation specialist" was assigned the task, and she reported that she had great difficulty getting the nurses to support the breastfeeding mothers. At the same time, New York City's public hospitals were dispensing free infant formula packages supplied by the formula companies to all mothers, but they didn't provide all mothers with information on or support for breastfeeding.


There are now no doubts that breast milk is superior to formula. Although many perinatal services now use "mother-baby" models of care that embrace breastfeeding, there are opportunities for nurses outside these services to support breastfeeding. In this issue of AJN, Jeannette Crenshaw, MSN, RN, shows how nurses can support breast-feeding.


These are two resolutions that I care about. Although I hope that you will care, too, the point is to make the commitment together to improve where and how we work and how we promote wellness. May 2005 be a good year for all of us.