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Three reasons bullying exist in the operating room

They say what happens in the OR, stays in the OR

We will look at a few reasons why bullying exists in the operating room.  Bullying can happen for many reasons. Some of the reasons it happens in the operating room is uneven power structures, the familiarity of long hours spent together, and the isolation of the area. 

operating room laparoscopic case nurse, tech, surgeon and anesthesiologist
You can spend all day and most of the night with the same people

With all the bullying that takes place in an operating room, it is a wonder anyone will work there.  This is one reason I say it takes a very strong personality to work in the OR. You have to know your worth and be secure in your skill level.  Bullying can come from other staff members, surgeons and supervisors. .

I have worked in operating rooms since 1993 and I have worked in 6 facilities.  Bullying has been front and center all through the years, in different facilities and different states.  In each operating room bullying both horizontally and vertically was rampant. It is almost unfathomable that bullying still occurs with such frequency.

Many times, when I recalled the bullying, it sounds unbelievable.  I have occasionally shared how surgeons acted to various floor nurses.  Everytime I tell of the abuse rendered by individual surgeons, the floor nurses were incredulous.  They always made comments such as:

“He is such a gentleman on the floor.”  “That is just unbelievable, he is so nice.”

Why then is this surgeon such a jerk in the OR?  How is it that this is still going on in 2019? Can we do anything to prevent or lessen the bullying?

Uneven Power Structures

One reason bullying in the operating room persistes is the uneven power structure.  Although this is evening out as the years pass, traditionally it was always the surgeon is the “captain of the ship”.  This is a legal precedent was first used in a 1949 Supreme Court of Pennsylvania case that ruled that until the end of an operation the surgeon is liable for all actions performed in the specific operating room.  This included all actions of the surgeon, but also all actions of the other team members. Over the years this precedent was overturned by various lawsuits suing nurses and anesthesiologists in addition to the surgeon.  

Captain of the Ship

“Captain of the ship” is based on another legal precedent called the “borrowed servant doctrine”.   This doctrine states that a temporary employer is responsible for the actions of a temporary employee while that employee is under the control of the temporary employer

Let me explain this with the surgeon being the temporary employer and a surgical tech being the borrowed servant.  The surgeon personally directs all actions of the surgical tech and as such is responsible for anything wrong that happens until the end of surgery when the surgeon stops being the temporary employer.  

I used this doctrine once to my advantage, while I was working at an OR in New Mexico.  In this specific OR, the surgical techs were first assisting during the operations. Our policy read that the circulating nurse was in charge of the surgical tech and as such delegated actions they may perform.  Our surgeons were asking the techs to perform actions I was not comfortable with such as drilling and sawing in a total joint. Keep in mind that our techs were trained in our OR and not even certified, much less trained in anatomy and physiology.

I received a lot of flak (read bullying) over the fact that I did not want the techs first assisting in surgery.  It seemed everyone was against me because this is how it had always been done in this OR. Many techs took my discomfort as a personal insult.  I had to explain that it was not about the skill level, it was about what I was comfortable delegating. I was not comfortable delegating a task I did not know how to perform.  

I finally worked out a compromise.  The policy was changed to reflect that the surgical tech was working under the surgeon’s liability while at the table.  This way if something went wrong I would not be held liable and the surgeons could delegate any task they were comfortable with.  

Isolation

Another reason bullying occurs so often in the operating room is because of its isolation.  Only certain staff and certain doctors are allowed past those double doors and into this environment.  Once those double doors shut, anything goes. It is as if all rules end at the double doors. No-one worries they will be caught by outsiders.

Familiarity

Working closely with a small group of people will increase familiarity between individuals.  Increased familiarity can decrease inhibitions between individuals. I feel it is this familiarity that contributes to operating room bullying both from surgeons and between staff.  I have heard several OR staff state they spend more time with surgeons and staff than with their own families.

When people spend a lot of time together they discover things they do not like about another person.  Usually people only work with each other for 8 or 10 hours a day. In the operating room it is not abnormal to work with the same 3 people for 16 to 24 hours.  This combined with the lowering of inhibitions causes us to treat others like we treat our families. I am sure that the surgeons and staff who yell and bully are also that way in their personal lives at times.

Hostile work enviroment

Why do we put up with so much bullying in the operating room?  I know every time I have complained about being bullied my manager made excuses for the others involved.  From, “it’s just the way s/he is” to “just let it go”, I have not received much support when being bullied.  I think (hope) some of this has changed due to more people knowing that hostile work environments can be a sue-able offence, requiring managers to confront this issue.  

While none of these reasons are going to change, we still need to address bullying in the operating room.  Many OR nurses are retiring and more are needed to replace them. But, because of the bad rap the OR has, this is more difficult than it needs to be.



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