Incivility in the OR: How hospitals, nurse managers and front-line nurses should respond

Incivility and bullying in the operating room is a common but dangerous problem. According to an article in the January edition of AORN Journal, 88 percent of nurses have witnessed physician incivility and 48 percent of physicians have noticed nurse incivility.

Not only does bullying and incivility affect workers' health, well-being and job satisfaction, it can also negatively affect patients. "The constellation of uncivil actions and unintentional nonactions can result in life-threatening mistakes, preventable complications and even the death of a patient," the authors wrote.

The piece in AORN Journal, written by Cynthia Clark, PhD, RN, and Diane Kenski, BSN, RN, outlined an instance of incivility involving a surgeon not participating in a time-out directed by a new OR nurse and belittling the nurse in front of others.

Dr. Clark and Ms. Kenski then give examples of how the hospital, the nurse manager and the affected nurse should respond to that situation.

Hospital response

"Incivility in the OR is typically not an isolated problem," they wrote. "Administrative and managerial buy-in is required to change the culture of the facility into one of safety, civility and effective communication."

The authors recommended the following steps for hospitals:

  • Align organizational statements with principles of civility and respect
  • Evaluate professional behavior standards in yearly personnel reviews
  • Implement elements of a just culture, such as investigating the motivation or purpose behind uncivil behavior
  • Reward civility
  • Use programs like TeamSTEPPS or other tools to improve communication and civility

Nurse manager response

"Nurse managers play a significant role in sharing information about incivility and its harmful effects and can take the lead in establishing civility charters, co-creating norms of desired behavior, implementing policies and rewarding civility," according to the authors. Nurse managers "set the tone for the types of professional interactions that are expected in the workplace."

Additionally, the nurse manager can show support to the affected nurse, reinforce the importance of nurses advocating for patient safety and also follow up with the surgeon to reinforce the need for respectful communication.

Affected nurse's response

"Addressing an uncivil encounter when it happens may be the most successful tactic for stopping the behavior, especially when patient safety is threatened," the authors wrote. "Nurses need to assert themselves when they have concerns."

The authors suggest nurses practice predetermined phrases that they can use to respond to uncivil encounters.

"Nurses must be well equipped to recognize and address incivility at myriad levels throughout an organization. This requires multilevel organizational collaboration to foster and sustain civility and promote effective communication to protect patient safety," the authors concluded.

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