Self-reflection, ownership and respectful communication are examples of “soft” skills that are extremely hard to develop and practice. Yet, the surgeon or nurse manager who can teach the right way of doing something without humiliating a team member will show everyone that respect is guaranteed, skills and knowledge are required to work in the OR, and passive aggressive behavior will not be rewarded with alignment.
Not long ago in preparing an interactive workshop on communication and assertiveness for a chapter for the Association of periOperative Registered Nurses (AORN), I asked their educational committee to share their most common communication challenges so that we could make our time as meaningful as possible. They replied with four scenarios.
These scenarios reveal layers of interwoven relationship patterns that are fraught with horizontal and vertical violence. Add to that more innocent unawareness about individual behaviors and their impact on others, along with lack of skills in self-reflection and expression, and the complexity of interactions and ramifications begins to emerge.
Team members vying for approval and leaders who are somehow gratified by giving or withholding approval are participating in relationship patterns that contribute to adverse events. Withholding information, setting up a colleague to work in a position without appropriate training and experience or using humiliating language and tone are not in the patients’ best interests.
As human beings, I believe we all want and deserve to feel respected and have a sense of power. Yet in our culture, some members and professions are valued more than others. This imbalance chips away at everyone’s self esteem and contributes to complex feelings and behaviors involving frustration and resentment.
In addition, relentless stress, gender, ego and self-esteem factors help set the stage for such aggressive, passive- aggressive or passive ways of obtaining power.
I hate to think of my colleagues in the nursing and medical professions behaving in these ways, yet I also feel a little defensive. I know how I feel along the course of a highly stressed shift as a per diem RN on an Alzheimer’s unit. I can practically watch my best self disintegrate with relentless alarms, interruptions, dementia behaviors, changing priorities and chronic understaffing. I’m pretty good at owning and apologizing for any irritability, but that may be after a sarcastic or short-tempered remark. Despite the fact that I can empathize with poor conduct, I passionately believe that individuals and organizations can do better.
Even under pressure, a mistake requiring an immediate substitution of staff can be handled with respect. A statement such as, “I need trained OR assistance, now!” is quite different from, “Get someone in here who knows what they are doing!” They both get the same problem addressed, but the first statement brings up an organizational responsibility regarding training, while the second is more blaming of the individual. Making sure the situation is followed up as soon as possible after surgery by debriefing with the surgeon, nurse manager and staff will identify training problems, seek solutions and practice giving and receiving constructive feedback.
Whenever I hear about situations like these, I look for individual and organizational factors. Solutions that consider less blaming are more likely to lead to long-term, meaningful change. Administrative leaders have a responsibility to advocate for resources required to focus on communication training, opportunities to practice skills and recognizing learning curves. Individuals have a responsibility to seek help, acknowledge limitations and develop their skills. Not everyone is cut out to work in the OR, (or on an Alzheimer’s unit) and career coaching and/or discipline also may be necessary.
I don’t know exactly what respectful communication looks like in the operating room, but I suspect there is a unique opportunity for peri-op professionals to define, develop and practice it. Facilitated discussion among OR staff about the following questions could be a rich process.
Positive outcomes such as creating new norms, safer surgery, increased collaboration, personal and professional growth and improved morale are all possible!