ANGRY MOB Defuse staff tensions before they blow into full-fledged conflict.

If you've worked in surgery long enough, you're well aware of what it feels like when pressures mount and frustrated staff members are at each other's throats. Here are 4 ways to defuse tensions as the tick-tick-tick of a staffing time bomb grows louder.

Work within your policies
When I went through a nasty divorce, it affected my job performance and my superiors had to hold me accountable. The experience taught me a lesson about being fair, within the constraints of running a business. Everyone ultimately has to be accountable to the greater goods of patient care and overall employee/patient/physician satisfaction.

When dealing with employee performance issues, strive to be firm in principles while flexible in actions. When one of my employees was habitually late, I observed her tardiness for a while (maybe she was having a bad week), but it quickly became clear her constant lateness caused dissatisfaction among the other nurses. When the situation didn't improve with counseling, I got creative by scheduling her to begin her day at 7:30 a.m. — a half-hour before her shift started. I knew she'd be on with the 8 a.m. nurses.

Stand your ground
It's not easy to maintain the balance between being understood and making sure you're not being taken advantage of. As a single mother, I have a family-first attitude that carries over to how I treat my staff. One staff member, though, would start priming everyone the day before she was going to call out or leave early. The scenarios ranged from starting to feel sick to "hoping" she didn't have to take her grandmother to the doctor the next day.

The first few times, I let the call-out happen, or let her leave early to take care of things. But it was unfair to other staff members (and don't think they didn't notice the day-before complaints), and I was in danger of being taken advantage of as a manager.

So I met with the employee and said, "Look, I get it. Some situations are unavoidable. But that's not what's happening here. I'm willing to be flexible, but I can't do that if you're not approaching the situation responsibly." We developed a game plan: She'd provide proper notice if a doctor's appointment couldn't be scheduled outside business hours. Then she'd return and complete her assignments — no matter how long that meant she had to stay. If she didn't, I wouldn't let her just duck out early. Simple.

The result? I started getting notified about her leaving early up front and was able to plan accordingly. Now she rarely calls out or requests to leave early, and there's harmony between her and her peers.

WARNING SIGNS
Natives Getting Restless?

Just a few of the reasons staff become strained. Recognize any of these in your facility?

• disorganized work environment
• high staff turnover
• unpleasant management
• high-stress environment
• unsupportive management
• inflexible management
• perception that their ideas aren't important
• inaction over targeting/ harassment of a staff member
• unruly staff members or physicians (bullying)
• lack of team players
• gossips, pot-stirrers and those prone to melodramatics
• personal stressors

— Lisa Waters, RN

Set a fine example
Every day, I work on the front line, mainly as a circulating nurse. I take advantage of this time to not only listen to physicians and staff behind closed OR doors, but also to subject myself to the same challenges. Both provide invaluable insights into physician and employee satisfaction, and operational efficiency.

This also has the added benefit of breaking down hierarchy. I was a fairly new manager once, at a facility in which bickering and fractured teamwork were common due to nurses who didn't mop — "It's not my job" — and OR techs who didn't move equipment — "That's not what I was hired to do."

My solution? I started scrubbing in and doing whatever needed to be done. Mopping, circulating, turning over rooms, pulling supplies between cases. Don't get the idea I was taking it all on myself. Instead, I pulled in the rest of the staff. "Hey, do you mind helping me with this trash?" It didn't matter who they were — physicians, nurses, anesthesia providers or surgical techs. It quickly became clear that, if I could step outside the confines of my managerial title, they could too. The end result: The staff started working as a team, room turnover times decreased from an average of 45 minutes to under 10 minutes, and everyone was happier.

Stay vigilant
A small investment of time and the availability of a willing ear are sometimes all it takes to keep discord from building throughout the facility. If someone seems stressed, I'll just say, "Hey, stop by my office when you have a chance." Then I'll approach them as a friend: "I noticed you were distracted or seemed really on edge today. Anything going on I can help with?" Even people who aren't "talkers" like having the option to discuss whatever's bothering them. If the tension is coming from the staff as a whole — I find this happens particularly in the run-up to the holidays — I'll schedule something extra for fun, such as a bake-off.