Kathleen Bartholomew, RN, MN

Speaker Profile

• Managed the 57-bed surgical unit at Swedish Medical Center in Seattle, Wash.
• Before nursing, she worked in marketing, business and teaching.
• Her books include "Charting the Course: Launching Patient-Centric Healthcare" (with John J. Nance, JD), "Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other" and "Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication."

Even when on-the-job temper tantrums and other bad behaviors aren't part of the equation, there is a big divide between surgeons and OR nurses. This conflict of culture can affect your facility's staff retention and morale, but more importantly, it can put your patients' safety and outcomes at risk. Are your surgeons and nurses working together, or are they miles apart? Kathleen Bartholomew, RN, MN, came to nursing from the sociology field, which gave her a unique perspective on the power dynamics of the OR. In her special OR Excellence morning workshop, "Doctor-Nurse Relationships: How to Make Them Great," the former nurse manager and national speaker on nursing-related workplace issues will show you how to bridge the gap.

• The danger of inequality. As long as doctors and nurses are not equal and not collegial in the OR, patients will not be safe. Think about airline pilots and co-pilots. Until about 38 years ago, co-pilots were not allowed to speak up if something was wrong. What changed the culture of the cockpit was an accident that left 538 body bags on the runway. Medical errors kill an estimated 1,200 patients a day, but we hide those body bags. It's our ethical obligation to keep patients safe. That's why nurses have to be able to speak up and share their wisdom.
• Residual rewards. Better relations between doctors and nurses also carry staffing benefits. They lead to better retention and better morale. There's nothing more rewarding than working in a smoothly running OR. Then you really value your contribution to the team.
• The root of the problem. Nurses have always faced inequality in society. Due to class issues and gender issues, they've always been seen as playing a subservient role. Physicians and nurses are assimilated into this mindset and keep it in place, even if they're not aware they're doing it. Both parties play this game, and it is accepted and adequate. For example, we nurses ask questions and make statements in a way that will preserve the doctor's ego. If you're calling the doctor at home about a patient emergency, what do you mean, "I'm sorry to bother you, doctor?"

• Untapped resources. Meeting with a class of nurses, I asked them, "Can you name 2 or 3 things that nurses have, but physicians don't, that are critical to successful surgical outcomes?" They couldn't. I asked a group of physicians the same question. They also didn't know. I can tell you what they are. As a nurse:

I have the trendline. I may be with the patient for 12 hours, while you are working on him for a comparatively short time. I can anticipate emerging situations and opportunities for rescue.

I know your work patterns. I know what you usually use, when you use it, and can remind you when you've missed a step.

I see different doctors doing the same surgeries, as well as their results. Sometimes they do things differently than you. Sometimes their outcomes are better than yours. I can tell you how they've achieved those outcomes.

• Leading by example. I didn't become a nurse until I was almost 40 years old. I walked into the profession at age 39, after a divorce, and I immediately noticed the subtle power difference between doctors and nurses. I said, "Why are you treating your nurses like this?" I didn't play that game. I simply wasn't going to be intimidated. Within 6 months after I'd graduated from nursing school, I was promoted to charge nurse on my floor, because I could hold my own with the doctors.
• Bridging the gap. If you work at a surgical facility, you agree to adhere to its mission, vision and values. At any facility, these always include respect, in both directions. The most successful improvement in doctor-nurse relations I've seen in the past 3 years was the practice of orthopedic surgeons from Montana who asked their nurses to grade them, on a scale of 1 to 5, in their approachability, professionalism and patient complaints. That's leadership and respect.