Perioperative nurses have a legal and moral duty to speak up when they believe patient safety is at risk. So you speak up...then what?
When a nurse or any member of the team speaks up, the actual or potential risk to the patient should be evaluated and followed with an appropriate intervention. For example, most operative teams correct a break in surgical technique immediately, or as soon as reasonably possible, without much discussion. In other situations, the team dynamics might not produce the same collegial, collaborative environment.
When is your duty fulfilled?
What happens when a member of the surgical team isn't satisfied with the response? For example, nurses may become frustrated because they don't believe their concerns are heard when they report that the surgical sponge count is off. Some RNs may bristle because a surgical technician questions the medication delivered to the field. Surgical technicians may become protective when the RN doubts whether all instrumentation is available on the field. If you bring a risk to the team's attention, but they don't listen, when have you fulfilled your duty in bringing an issue forward?
Collegiality in times of stress
Relationships in the perioperative setting are an intricate and dynamic process. The increasing complexity in operative cases, the necessity for efficiency, higher-acuity patients, striving to improve turnover time, combined with high technological equipment and instrumentation may put team members in a stressful environment. This requires the operative team to maintain collegiality and collaboration.
Collegiality is defined as shared power and authority among colleagues, but in the OR, the balance of power continues to belong to the surgeon. Ideally, an issue arising in the OR should be resolved to the satisfaction of the whole team. How issues are resolved depends on many factors. The relationships among the operative team can affect the decision-making process. Concerns are more likely to be addressed when the team is consistent, cohesive, and has well-established working bonds. The core team is more likely to be able to function with very little communication because everyone is familiar with their roles and individual function, and how they fit into the larger picture.
Although maintaining a consistent team is the ideal model, it's not always possible. Introducing a new member or members disrupts the team balance, and the time to build trust may be limited. As a result, perioperative team members may need to be more assertive in their practice and communication within the team-especially when they believe patient safety is at risk. That's why, beginning in this issue on page 48, we'll begin a series on communication, covering ways your OR can improve collegiality and trust within the surgical team. In November, the final article in this series will discuss the results of a recent survey we conducted on http://www.ornursejournal.com regarding real readers' communication techniques in the OR and whether or not they've helped or hurt their team.
My institution's primary value is that the patient's needs come first. Being mindful of this helps to keep the team focused, provides a common goal, and keeps the emotional element out of decision making, so that it's easier for nurses to speak up-and be heard-in the OR..
Elizabeth M. Thompson, MSN, RN, CNOR
Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]