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Eye on Ethics

The Challenge of Disruptive Social Workers
By Frederic G. Reamer, PhD
September 2017

Recently I came across a USA Today article about "disruptive physicians." According to the authors, Jayne O'Donnell and Laura Ungar, "Whether it's angry outbursts, lewd remarks, or passive aggressiveness, bad conduct by those in the medical community is called 'disruptive behavior.' It's considered such a risk to patient safety that hospitals must have a system for addressing it in order to meet accreditation standards." The article describes multiple instances, many of them chilling, when physicians engaged in very bad behavior and caused considerable workplace turmoil. A surgeon disparaged a nurse, telling the nurse that his son is "a retard." A doctor stitched up an OB/GYN patient without giving her sufficient anesthesia and then joked about it. A surgeon did not wash his hands before an operation, and when a nurse quietly offered him gloves instead of confronting him, the surgeon dropped the gloves in the trash.

Based on their review of empirical research on the subject, the authors report that approximately 5% of physicians exhibit disruptive behavior. They cite a major study of doctors and nurses at 100 hospitals; more than three-fourths (77%) of respondents reported having witnessed physicians engaging in disruptive behavior.

Disruptive Social Workers
Every profession has its share of disruptive practitioners. Social work is not immune; over the years I have encountered some in our very own profession, albeit relatively rarely. I suspect that many victims and witnesses of disruptive behavior keep quiet in order to avoid retaliation, stirring up bad blood, or other untoward consequences. But some victims and witnesses go public; some disruptive social workers find themselves named as respondents in licensing board complaints and defendants in malpractice lawsuits. These may be extreme cases, but they reflect a significant problem that has received scant attention.

Disruptive behavior in social work takes various forms. Some practitioners suffer from some form of impairment, struggling perhaps with their own mental health challenges, addiction issues, financial difficulties, and other personal troubles. Others are burned out and have short fuses in the workplace. Still others have difficulty monitoring their own behavior or struggle with impulse control. The following are several real-life examples:

• A social work administrator at a residential center for treatment of addictions often berated staffers who, in his judgment, made mistakes. He criticized and chastised them in public, including during staff meetings. Within a six-month period, several senior staffers resigned because of the social worker's challenging behavior. Two of them met privately with the agency's board president to share their concerns. Shortly thereafter, the board fired the social worker, citing his abusive behavior.

• A social worker who served as clinical director at a school for teens with behavior challenges had a reputation among staffers and students as a bully. The social worker often screamed at students who engaged in inappropriate behavior. One student was so distraught following one of the screaming episodes that she overdosed on prescription medication. The student was hospitalized and told her parents about the social worker's abusive behavior. The parents filed a licensing board complaint against the social worker.

• A social work supervisor in a foster care agency often gossiped about staffers during casual conversations with his "favorite" colleagues. Over time, word spread about the social worker's unprofessional gossip. Many staffers grew wary of him and untrusting; agency morale plummeted and staff turnover increased. The social worker's disruptive conduct had a devastating impact on the agency's stability.

Whatever the causes of social workers' disruptive behavior, the profession must take steps to prevent it. First, undergraduate and graduate social work education programs should do their best to identify red flags among students and respond immediately and constructively. Educators should make a good-faith effort to help these students reflect on their disruptive behavior and take steps to prevent it. For some this may mean taking a leave of absence and engaging in therapy. In extreme cases, students may be terminated from their educational programs, particularly when their behavior poses a threat to clients, faculty members, or other students, and violates widely accepted ethical standards in the profession.

Also, students should be acquainted with the concepts of disruptive behavior and practitioner impairment. Both classroom and field education should focus explicitly on warning signs, prevention strategies, and meaningful responses.

The same holds for workplace settings. Supervisors and administrators should do their best to nip disruptive behavior in the bud and help disruptive staffers address their behavior promptly and earnestly. When necessary, supervisors and administrators may need to engage in what sociologist William Sonnenstuhl, PhD, refers to as "constructive confrontation." This involves the following steps:

• when feasible, discussing performance and behavior problems with the colleague and encouraging him or her to seek help;

• following up with the colleague and monitoring his or her progress; and

• if necessary, taking formal steps to address the colleague's impairment (e.g., bringing it to the attention of appropriate supervisors, administrators, or licensing boards).

Furthermore, social worker supervisors and administrators should create workplace protocols that encourage staffers to identify instances of disruptive behavior so the organizations can address it meaningfully. This may require creation of anonymous reporting mechanisms for those situations where employees are fearful of having their names attached to their complaints. One risk of anonymous reporting, however, is the possibility of gratuitous complaints that are retaliatory or mean spirited.

Also, employers should include the topics of disruptive behavior and impairment in their staff development training. This entails teaching staffers about warning signs and symptoms, ways to respond constructively, and prevention strategies. Many agencies acquaint employees with practical ways to prevent and respond to burnout, which can be a prelude to disruptive behavior. In recent years, many agencies have sponsored wellness initiatives to help employees cope with job-related stress.

Sadly, some impaired practitioners are reluctant to seek help or fail to acknowledge their personal challenges. Some assume they can manage their difficulties on their own or avoid therapeutic efforts because they think this will endanger their jobs and careers. Others are concerned about costs.

Fortunately, the social work profession has acknowledged the potential of problematic behavior among practitioners. Recognizing that disruptive behavior among professionals is unethical and often a reflection of some form of impairment, social workers should be mindful of relevant NASW Code of Ethics standards.

"Social workers should not use derogatory language in their written or verbal communications to or about clients. Social workers should use accurate and respectful language in all communications to and about clients" (standard 1.12).

"Social workers should treat colleagues with respect and should represent accurately and fairly the qualifications, views, and obligations of colleagues" (standard 2.01[a]).

"Social workers who have direct knowledge of a social work colleague's impairment that is due to personal problems, psychosocial distress, substance abuse, or mental health difficulties and that interferes with practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action" (standard 2.09[a]).

"Social workers should take adequate measures to discourage, prevent, expose, and correct the unethical conduct of colleagues" (standard 2.11[a]).

Having these important words in our profession's principal code of ethics is essential. By themselves, however, they will not prevent or eradicate disruptive behavior in the social work ranks. For that to happen, conscientious and principled practitioners must have the courage to acknowledge and respond to disruptive behavior when it occurs, take reasonable steps to prevent recurrence, and design curricula and training programs whose goal is to prevent disruptive behavior in the first place.

— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work at Rhode Island College. He is the author of many books and articles, and his research has addressed mental health, health care, criminal justice, and professional ethics.