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Let's Not Eat Our Young
Chris Rosenthal
Publish Date: March 17, 2008   |  Tags:   Staffing

When I first learned to scrub many years ago, I was constantly missing a sponge after the surgeon closed. My preceptor was always the one who managed to come up with the missing item. As it turns out, she'd hide a sponge at the beginning of each case and would of course "find" it while I frantically searched. I was new blood, and she made sure my first experiences in the OR were difficult.

I'm sure you know of similar "welcoming" behavior. It's known as lateral violence. Whether the violence is emotional or physical, it's still a real problem in today's ORs. The behavior can be obvious or devious. Either way, it makes the recipient feel uneducated, unprepared or worse. Your staff may not like each other every minute of every day. That's not an employment requirement. If they don't appreciate each other, expect them to act as if they do.

Play right
Have you heard these zingers directed to new staff members? "How long are you going to stay in this department?" or "I'll get the catheter. It'll take too long for you to get it." Those comments are not conducive to teaching or improving the performance of new clinical team members. They may seem minor, but in reality — no matter how small they seem — digs are blocks to team building and staff retention. When word of established nurses discouraging new hires reached my desk, I decided that skits performed during weekly staff meetings would help the staff see how harmful words and actions looked and sounded.

Our department coaches for patient and staff satisfaction organized the first skits. Even though they were loosely based on behavior witnessed in our ORs, we made sure to stress that the short acts weren't representative of real people. In other words, we changed the names to protect the guilty. Skits used to prove a point shouldn't embarrass individuals. Besides, those who have misbehaved will recognize their behavior in the fictitious scripts.

Our actors first present the inappropriate behavior, followed by a replay of the scene using correct staff conduct. We then discuss the scenario as a group, critiquing not the acting of our volunteer cast but the ways we can take the lessons of the skit into the real-life performance of our staff.

Nurses who knew they'd be acting used to script the skits before the staff meetings. Lately, though, I've been asking for two to four volunteers at the start of our meetings and assigning a lateral violence topic for them to tackle. They huddle for a few minutes to organize a basic script and largely improvise the action.

We have fun with the process. The players endure their share of laughs and good-natured ribbing, but the lessons learned are far from funny. Often a nurse will approach me after a meeting to ensure me that she doesn't act like the villain in the scene. I emphasize that the skit is not about individuals, but instead portrays behavior that some of us can identify with and hopefully learn from.

Good staff behaving badly
Like yours, I know my staff is full of talented, hard-working individuals who know the right way to act. But bad behavior does exist, and it can be the result of many underlying factors. The skits offer peer-generated solutions for improving staff behavior. Since we've started acting out our issues, the group's teamwork has improved and complaints of lateral violence have decreased.