Most of the time we see stories in the media about children being bullied at school by their peers, but what about bullying that occurs amongst healthcare professionals? More specifically the bullying we see in the operating room. Working in the OR for the last 9.5 years I have heard stories about or witnessed bullying, physical assaults, and lateral and sexual harassment. Bullying is unacceptable and should not be tolerated in an environment where lives are at stake. Bullying in the operating room will be my focus; the effect it has on patients and the OR environment, its prevalence, and prevention.
Workplace Bullying is repeated, health-harming mistreatment of one or more persons, by one or more perpetrators. It is abusive conduct that is: Threatening, humiliating, or intimidating, or; Work interference — sabotage — which prevents work from getting done; or Verbal abuse (Workplace Bullying Institute, 2014) (1). In the Sentinel Event Alert released by The Joint Commission in 2008, states that “intimidating and disruptive behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities.”(2) Working in a high-stress environment some do not always know how to cope with the stress that we deal with daily and will take it out on others and the bullying begins. Bullying has no place in the operating room. Some harmful actions may be more overt, such as making demeaning comments or using intimidation to undermine a coworker. Other forms of incivility and bullying can be more covert, such as failing to intervene or withholding vital information when actions are clearly indicated and needed for work to be done in a safe manner. We must stop and remember why we are there in the first place: The patients. We must make sure we are providing an environment that is appropriate to care for our patients to the best of our ability. We entered the field because to some extent we wanted to care for patients, but I believe in order to have the patience, respect, and ability to care for patients it all starts with how we treat those we work with every day. Bullying not only affects the person being bullied, it affects the whole department; communication suffers, and reduces performance and morale.
Bullying in the OR environment is becoming more and more prevalent. The Association of periOperative Registered Nurses released a study in 2013 in the AORN Journal, where the average number of bullying acts that participants experienced more often than ever (ie, intensity) was 9.7. Respondents experienced an average of 2.1 acts weekly or daily (ie, frequency). Approximately one‐third (34%) of participants would be characterized as targets of workplace bullying (ie, experiencing at least two bullying acts weekly or daily). Among individuals who met the definition of being a target, the most frequently experienced acts occurring weekly or daily were having rumors or gossip spread (50%), being ordered to work below competency level (46.3%), being humiliated (45.4%), having information withheld (43.6%), and being excluded (41.8%). Of the respondents, 59% reported witnessing coworkers being bullied. Only 6% of participants indicated they never experienced a bullying act (3). With such a high percentage of people witnessing coworkers being bullied, we can see that the prevalence of bullying in the OR is an issue. I personally have witnessed and experienced bullying while in the OR mostly from surgeons and senior surgical techs. Senior nurses and surgical techs can become extremely territorial and in turn, will bully new employees and even students. We quickly forget how it was to be thrown into this environment fresh out of school and I have witnessed techs purposely sabotaging new hires for absolutely no reason except for the fact that they were new.
Preventing and not tolerating bullying of any kind should be the goal of every operating room department. With so many negative effects that bullying brings with it and that it could potentially lead to a patient safety issue, policies regarding bullying should be in place. “Any behavior which impairs the health care team’s ability to function well creates risk,” says Gerald Hickson, M.D., associate dean for Clinical Affairs and director of the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center (2). Bullying should be zero tolerance, with non-retaliation policies set for those who report bullying, accountability, consequences for physicians, and a clear outline of disciplinary actions. Education on bullying would be appropriate for employees. A few years into my career there was a huge issue with senior scrubs bullying new employees who were fresh out of school. At the time we had management that only cared about cases getting done and nothing else. Fast forward a few more years and a new OR director was hired, and fresh new students were hired, but there was still the same group of senior techs who insisted on continuing to bully new employees. Complaints started to be reported and the new OR director was fantastic when it came to dealing with the bullying and not letting these techs bully management like they had in the past. The reports were not “swept under the rug” and were handled appropriately. There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care. Organizations that fail to address unprofessional behavior through formal systems are indirectly promoting it. Intimidating and disruptive behavior stems from both individual and systemic factors (2). After a few reported bullying incidents and disciplinary actions followed, a small group of senior scrubs were let go. I don’t think the amount of experience or skills should excuse such poor behavior. (4) I think the same actions should be taken when the bullying comes from surgeons. Behavior should be reported, and disciplinary actions should be enforced. I know in the last few years we have had surgeons who act out and get reported for their verbal abuse and a pulse survey is given to those who work in the department depending on the responses to the survey, it will determine the disciplinary actions set forth for the physician. They are being held more accountable for their actions.
According to The Joint Commissions Sentinel Event Alert, “Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators, and managers to seek new positions in more professional environments. Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.” (2) Bullying in the operating room should have a zero-tolerance policy. I feel with the newer generation being a little more sensitive, more reports of bullying will be noted. When our actions can cause a waterfall effect and potentially harm the patient, then things like bullying can not be tolerated.
- Workplace Bullying Institute, 2014. Retrieved October 6, 2019, from https://www.workplacebullying.org/individuals/problem/definition/
- The Joint Commission: Sentinel Event Alert. Issue 40, July 9, 2008. Behaviors that undermine a culture of safety. Retrieved from https://www.jointcommission.org/assets/1/18/SEA_40.PDF
- Workplace Bullying in the OR: Results of a Descriptive Study AORN Journal Volume 98, Issue 5 Pages 479-493) (November 2013)
- Esther Chipps PhD, RN Stephanie Stelmaschuk BSN, RN Nancy M.Albert PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM Linda Bernhard PhD, RN Christopher Holloman PhD. Retrieved from http://aornjournal.onlinelibrary.wiley.com.proxy.readcube.com/doi/full/10.1016/j.aorn.2013.08.015?token=B7KBNpdIxcBtXmrHteqGy/LwMAbcPr7kKzA2co5TCsKy1gNsK5QvafE+1fhi3xDg1ZJU1T0UnIZkdS0ek4sQuw==
- Professional Issues Panel on Incivility, Bullying, and Workplace Violence. 2015 American Nurses Association. Retrieved from file:///C:/Users/lande/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/PosStat-Endorsed-ANA-Incivility-Bullying-Violence%20(1).pdf