Surgeons and nurses both pick on nurses when they bully, but they attack in very different ways. Surgeons tend to be aggressive, all fists and fury, neck veins bulging and expletives — and sometimes instruments — flying. Nurses tend to be passive-aggressive, cunning, vengeful and deceitful assassins, delicately slipping their stiletto between the ribs of an unsuspecting colleague. Regardless of whether the bullying is in your face or behind your back, the result is the same: a dysfunctional workplace, a dangerous setting for your patients and nurses hurting deep down inside.

Beja Mlinarich, RN, BSN, CAPA, nurse manager at Outpatient Surgery Medical Center of Plano in Plano, Texas, has seen a lot of hissing-mad surgeons and malicious nurses in her 30-plus years of nursing. We were talking about OR bullying, the topic of this month's cover story ("Staring Down OR Bullies" begins on page 38), when she shared her observation that surgeons are just plain aggressive and that nurses are passive aggressive. Better duck, I thought — double-barreled trouble in the OR.

"I have seen way too many patients put in danger because nurses delayed reporting a patient's condition and needs to a physician who predictably responded with unreasonable, arrogant disbelief that something was not proceeding according to plan," says Ms. Mlinarich.

It was a couple years ago when Ms. Mlinarich paged a surgeon to notify him that he'd apparently "neglected" to complete the immediate post-operative progress note and discharge summary. "I asked him if he could please come to fast-track recovery and do that because the patient was ready for discharge," she says.

When the surgeon arrived, he was seeing red and went into a five-minute tirade at the nurses' station, taking great offense to the word neglected, she says. "How dare you insinuate that I neglected my responsibility?" she recalls the surgeon saying.

"This went on and on and on," says Ms. Mlinarich. "That's the kind of behavior that makes people around you not do their best work. You think too much about how people will react to what you say. Maybe you're not as forthcoming about a piece of equipment that's not operating properly. All of those things compromise patient care."

At an AORN session on OR bullying two years ago, an OR nurse who was the shop steward of her hospital's union drew great applause when she told of how her union forced two verbally abusive surgeons to attend anger management courses.

"Every member of the healthcare team has an ethical obligation to unite and move those [abusive] people into improved emotional health," says Ms. Mlinarich, "and to create a culture that puts the patient first."