Staffing: Keep Bullying Out of the OR

I was working as a brand-new circulator when the surgeon on the case started making snide comments about one of the OR nurses — a sarcastic jab here, a dig there. Soon the scrub tech joined in, and before long there was a textbook example of bullying taking place during a procedure in full view of residents, fellows and medical students. The nurse these comments were directed toward didn't catch most of what was said — partly because English was her second language and partly because the cowards were talking behind her back. But did that make it any better?

Here was a good nurse who was working extremely hard for a surgeon who belittled her in front of her peers. I wasn't going to be a bystander to the abuse, so I walked up to the surgeon and said, "Hey, that nurse who you're talking about is working hard for you. If you're going to talk about her, you need to do it to her face."

I knew I had to speak up. As surgical leaders, you need to provide our staff the tools, training and confidence to do the same.

Bullying is defined as "repeated and deliberate physical, verbal or written conduct intended to intimidate, degrade or humiliate any individual or group in the workplace." As a facility leader, it's your responsibility to recognize the signs that bullying is occurring in the OR. Here are just a few of the common signs:

• supervisors singling out one team member with unfair or unequal assignments
• gossiping
• backstabbing
• withholding informing that's critical to doing the job
• refusal to help
• direct or indirect threats
• exclusion
• jokes or slurs based on appearance, ethnicity, sexuality, etc.
• demeaning non-verbal behaviors (eye-rolling, for example)

Preventing bullying at your facility boils down to culture. You have to believe — and your staff has to believe — in a code of civility and professionalism, and you must establish a zero-tolerance policy for those who fail to meet those standards. There are entire textbooks dedicated to creating this type of culture, so there's no way to discuss everything we need to in a single article, but here are a few tips to start with:

• Ask for feedback. Involve frontline staff in creating an anti-bullying and workplace civility policy. They are too often victims of bullying and have powerful insights on how to prevent it.
• Include bullying as a topic for your regular educational training and in-service sessions. Have staff role-play bullying scenarios and provide them lessons on how to handle difficult conversations to teach them how to establish and maintain a culture of workplace civility.

Ultimately, your best weapon against bullying is a staff that isn't afraid to speak up when they need to. Granted, this is no small feat. Ensure every member of your team — no matter their role or position — feels empowered to say something if they experience or witness bullying behavior. If you consistently encourage your team to speak up against anything they see as a detriment to patient care and have their backs when they do, you'll be amazed at how empowered they will become — and how little tolerance they'll have for bullying in any of its many forms.

There are various ways in which your staff can report bullying up the chain of command. They should first report incidents to their immediate supervisor. If staff feel reporting to management isn't addressing the issue, they should contact human resources (in larger facilities or health systems that have a department). As a last resort, they can contact the state board of nursing to report their concerns.

Reporting up the chain of command is crucial in holding your workplace accountable, but their concerns should be addressed long before they reach upper management. Listen to your staff about bullying behavior and act immediately to ensure they feel comfortable and safe while at work. Their well-being — and the safety of your patients — depends on it. OSM