Building a Culture of Collegiality

Most nurses are great people and exemplary co-workers, but the few disruptive personalities that do exist can wreak havoc on an OR's otherwise ideal environment, said Kathleen Bartholomew, RC, RN, MN, during her presentation on creating healthy nursing relationships. "We put up with a few bad apples because we can't get rid of them," she said, comparing a particularly toxic nurse she once worked with to "a gangrenous limb that the nurse manager wouldn't cut off in order for the rest of the staff to live."

The former manager of a 57-bed surgical unit in Seattle and current national speaker on nursing-related workplace issues can't understand how nurses working in a profession based on caring can be hostile toward each other. But whatever the root causes of horizontal hostility, it's a serious issue that can't be ignored. Despite a 2009 Joint Commission mandate that healthcare organizations establish a code of conduct designed to handle boorish behavior among healthcare employees, the nursing profession hasn't really done enough to rectify the problem, said Ms. Bartholomew. Why not? In part because this sort of behavior is often considered "normal," she explained, and while it certainly doesn't go unnoticed, it isn't often discussed.

Ms. Bartholomew recalled an exchange she once had with a nurse who administered morphine rather than Dilaudid to a patient. When asked how and why this mistake occurred, the nurse replied, "I shouldn't have let the other nurses get to me." Earlier, she overheard her peers saying she "didn't have what it takes" to be a good nurse after she had shown up a few minutes late for the previous night's shift. Sadly, such snide behavior and cutting comments are commonplace, admitted Ms. Bartholomew.

Damaging behavior thrives in ORs filled with silence and secrecy, said Ms. Bartholomew. She suggested implementing a staff action plan to discourage horizontal hostility and encourage your nurses to recognize and put a stop to it when it does take place. Be aware of the signs and symptoms of horizontal hostility; never be a silent witness to bullying or hostile behavior; adopt a zero-tolerance philosophy; compliment each other often; provide opportunities for socialization; conduct assertiveness training and learn to employ confrontation skills using the DESC (Describe, Explain, State, Consequences) model when incidents of hostile behavior occur.

Implementing and sticking to a plan of action is a critical first step toward stopping horizontal hostility, noted Ms. Bartholomew. "The best thing we can do to protect our patients," she said, "is to protect each other."

— Mark McGraw