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Nancy Brent, RN[/caption] In today's world, we are much more aware of instances of bullying, harassment, intimidation and threats, and there's no doubt that good interpersonal skills in all healthcare settings can mitigate those issues and aid surgical patient outcomes. Whether lateral and horizontal violence, incivility, nurse-to-nurse or physician-to-nurse bullying, such conduct is unacceptable in all areas of nursing and nursing practice, including perioperative practice. Perioperative nursing involves many roles, including circulating nurses, nurses who provide direct patient care and monitoring in the postanesthesia area, and RN first assistants. In addition to the perioperative nursing staff, other staff also are present, including the surgeon and his team, and the nurse anesthetist or the anesthesiologist.
Patient outcomes
Because the very nature of perioperative nursing is complex and demanding, misconduct resulting from poor interpersonal relationships and poor communication skills can result in adverse outcomes for the surgical patient. Continuity of care is essential and poor communication or poor interpersonal relationships can clearly add to such adverse outcomes. In 2015, The Association of periOperative Registered Nurses, published its position statement on a healthy perioperative practice environment, in order to encourage safe patient care practices, promote optimal patient outcomes and foster a desirable workplace. The position statement lists collaborative practice, a communication-rich culture, adequate staffing systems, and expert, credible and visible nursing leadership, among other factors, as contributing to a "healthy perioperative practice environment."
Unhealthy workspaces and the law
When the perioperative work setting is unhealthy, another risk that emerges is the risk that federal and/or state laws that protect nurse employees may be violated. In one such case (Graham v. Memorial Health University Medical Ctr.,S.D. Ga., 2013), alleged destructive conduct on the part of several OR nurses toward another OR staff member resulted in a lawsuit filed in federal court. The allegations of the nurse plaintiff included, among other allegations, retaliatory discharge, racial discrimination and the presence of a hostile work environment created by her nursing staff colleagues. It is important to note the nursing staff colleagues were individually named as defendants along with the medical center where they worked. Responding to the defendants' motion for summary judgement, the court reviewed the facts in the case. The plaintiff, who is white, alleged she was continually harassed by two African-American nurses on the OR staff. Their conduct included "yelling and screaming at the plaintiff, requesting assistance and then refusing it from [plaintiff], unwarranted warnings and threats, intensive and unnecessary oversight of [plaintiff's] work and overloading [plaintiff] with work." The nurse plaintiff also alleged that African-American nursing staff were not subject to similar harassment. The plaintiff's attempts to remedy the unhealthy work environment fell on deaf ears, despite complaints to the harassers directly, to her nurse manager and to the human resources department. After these attempts, the plaintiff's work schedule of covering cross-over shifts was changed to a lower paying day-shift schedule without advising her of this change. Shortly thereafter, the plaintiff was terminated because of what were described as violations of two OR policies. The lawsuit was subsequently filed. Although the court dismissed many of the claims made by the plaintiff after carefully analyzing the applicable law, it allowed the claims of disparate treatment and retaliatory discharge against the medical center and two others to proceed to trial. The two people who remained as defendants included the plaintiff's nurse manager and the perioperative services director. The final result of this particular case is yet to be determined. Even so, it illustrates the distressing manner in which the plaintiff allegedly was treated by her peers, her nurse manager and the administration, whether or not their conduct violated federal law. Guidance from the case is fairly clear. Behaving in a manner that is not consistent with a healthy workplace can result in discord, disorganization and a disrespect for fellow nursing staff. It also can result in the utilization of the judicial process, which is costly, emotionally draining and may not always result in justice for the alleged victim of an unhealthy workplace. It's better to avoid such discord, disorganization and disrespect for fellow nursing staff. This involves being respectful and honest in your interpersonal relationships with fellow workers. Disagreements, a dislike of another colleague, or having a bad day that is taken out on a fellow nurse does occur. However, attempting to resolve such situations amicably, and in a humane way, is essential. A healthy work environment and better patient care outcomes are sure to ensue.
