Managing a surgery center staffed with catty, chatty women is like swimming with the sharks. The key to not getting eaten alive by the bickering and the backbiting that, trust me, fills the halls and walls of most every facility (not just yours!) is to prevent gossip and jealousy from becoming disruptive forces.

Combustible dynamics
Look around your facility. What do you see? Women. And lots of them. Of all ages, personalities and backgrounds (not to mention hair styles, shapes and sizes - all of which gets noticed and discussed). And they can't stay out of each other's business. What else do you see? Men. Many dressed as surgeons and anesthesiologists. Add the stress of outpatient surgery and you've got all the makings for an incendiary setting.

Let's take as an example that new RN you added to your stable staff. She brings her own ideas on how to do things from previous work experiences, and established employees may resent her excitement over having a new opportunity in an outpatient setting.

Veteran staffers reach a certain comfort level with the status quo and might resist changes that upset the unwritten perks they enjoy - first choice for holidays off, priority during scheduling, prime lunch break times. A comfortable routine is in place, with each staff member knowing her role in the admissions process, OR setup, PACU functioning and discharge procedures. Veteran employees also look out for each other. If one is late, the others will cover for her without notifying management.

A new nurse might not play by the unwritten rules. She defers to management for decisions regarding breaks; she clocks in on time and resents the staff that come in late, take longer breaks and only want to eat when their friends eat. A new hire also doesn't get caught up in the local gossip of the facility and might be the favorite of the docs because of her fresh attitude.

This clashing of interests can spiral into serious conflict. Senior nurses may view the new hire as a threat; the new hire may see two standards in the workplace, and warring cliques may form.

Peacekeeper on patrol
A manager must excel in several roles to defuse tension between employees. She must be a mediator and peacemaker, a liaison to communicate the needs of different staff groups, a role model to serve as an example of the professionalism she expects and a hiring agent responsible for bringing in new workers who mesh with the expectations of the facility.

The role of a manager is magnified when reacting to staff drama. You can literally be the water needed to squelch the fire or the gas that fans the flames. When faced with a complaint about a troublesome employee or a disagreement between co-workers, don't pick sides. A perceived intervention for one side of the issue will only exacerbate the problem, leading to a loss of credibility in the eyes of your staff. Remaining impartial will keep whatever power you have to solve the problem intact.

Don't confuse impartiality with a refusal to get involved when issues need addressing. Letting problematic behavior slide while overall morale declines is a formula for losing complete control of your staff. It will also lead to a feeling within your facility that certain employees are treated differently than others. If you let a veteran nurse get away with being late but punish a new hire to set an example, you're actually becoming a bigger part of the problem by serving as a divisive role model.

One of the key factors leading to staff behavior problems is a manager's inability to make her expectations clear. Start early and err on the side of being repetitive. Use the job interview not only to evaluate a candidate's potential, but also as an opportunity to convey the requirements for successful employment at your facility. Weave this message into each staff meeting; expectations will be constantly reinforced to not only the new hires who first heard your message during the interview process, but also to the experienced staff members who often need reminders of your facility's core policies.

Trust only yourself
You have to be able to act on what you've observed, not on hearsay, to discipline employees. In other words, know who's involved before acting. Is someone on your staff a rabble-rouser? Is the problem that's been brought to your attention a set-up? Have a few disgruntled employees conspired to get rid of a disliked co-worker?

It's often very difficult to discover the root of the problem because troublemakers like to stir the pot, but rarely act alone. Troublesome employees also behave differently in front of the manager, making proper identification of the problem difficult. You'd also be surprised how often the culprit turns out to be the person you least expected. Outspoken employees who are quick to challenge you during staff meetings are of course the usual suspects; but don't ignore the soft-spoken nurse who brought in a cake for your last birthday.

Once you've identified the problem and employees involved, talk to each person in private. Explain in clear terms that her behavior will not be tolerated, and follow through on this promise by using the disciplinary protocol in your employee handbook. But be warned - your actions will invariably make someone on your staff upset. Employees often want tangible evidence of disciplinary action taking place; some won't be satisfied without an open apology from the offending staff member, a suspension or even a firing.

Don't be intimidated by this development. Discipline should always be a private matter between you and individual staff members. I often ask blood thirsty employees how they'd feel if their dirty laundry were aired for all to see, and I also remind my staff that they might not be aware of all the steps being taken to discipline an employee.

Right isn't always popular
An unhappy staff is a difficult situation for all involved and is totally disruptive to the smooth operations of a surgery center. Whatever actions you take to discipline staff, realize that you'll never make everyone happy. I've lost employees over disagreements in the past, and you should be prepared for the same. Don't be bullied by disgruntled employees. As long as you do what's right for your center and inform your medical director and key physician-owners as to how you're handling disciplinary situations, no one can question your credibility and reputation.

Your only concern as a manager is filling your facility with people who are willing to put aside personality differences to focus all their energy and attention on the patients. Nurses are professionals. They don't have to like each other, but they do have to work well together.

How have you handled staff discord in your facility? E-mail associate editor Daniel Cook at "[email protected]") with stories of staff turmoil and your solutions to the problems.