Assertiveness training to prevent verbal abuse in the OR - Home Study Program

AORN Journal,  Jan, 2004  by Debra Buback

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EFFECTS OF ABUSE

Negative effects on patient care, work satisfaction, and turnover rates have been reported after episodes of verbal abuse. (6) One group of researchers identified decreased morale, decreased productivity, and increased errors related to verbal abuse) Verbal abuse frequently is unprovoked and unexpected, and victims of the attack often internalize the event. The initial reaction to the event may be anger, humiliation, shock, or surprise. The individual may think, "How could Dr Smith say something like that to me?" or "I didn't do anything to deserve that!"

Repeated events involving the same surgeon may lead to feelings of inadequacy, disgust, or frustration. The victim may begin to feel responsible for the event having occurred. The surgeon may enjoy the feeling of power he or she has over the victim. Common thoughts perioperative nurses may have after experiencing abuse include the following.

* "Why can I never do anything right when I work with Dr Smith?"

* "I never have problems with other surgeons."

* "I must be doing something wrong to cause this reaction."

* "Why is it always me she is upset with?"

* "She never yells at the other nurses."

* "I hate working in this room!"

* "Why am I so stupid when I work with Dr Smith?"

* "Why do I let her upset me so much that I start crying?"

The consequences of verbal abuse can have long-term effects on the working relationship of the OR team and on patient care. The OR requires a collaborative effort among surgeons, nurses, anesthesia care providers, and ancillary staff members to produce safe patient outcomes. Repeated verbal abuse may undermine staff members' self-esteem and confidence to perform their everyday work activities. A break in the collaborative effort may cause other team members to feel they are taking on part of the victim's responsibilities. The victim may not care if the OR is prepared correctly for a surgeon's procedure. The morale of the entire team may be affected. Decreased morale and productivity may contribute to errors caused in the OR. (1) Decreased morale ultimately may result in increased staff turnover rates. The remaining staff members may find themselves working longer hours and taking more on-call assignments. This contributes to decreased morale and job satisfaction.

A high turnover rate during the current nursing shortage can be costly. A cost-benefit analysis revealed an estimate of $64,900 per year was related to verbal abuse. (8) For example, a portion of the cost of verbal abuse that results in the need to replace one nurse has been estimated at approximately $16,000. (8) An inexperienced nurse requires a lengthy orientation, usually from six weeks to nine months, depending on the institution size and number of specialties involved.

An experienced nurse acts as a preceptor for the novice perioperative nurse for a minimum of two weeks in each specialty before the novice nurse begins to work independently. The novice nurse requires a minimum of six weeks before he or she is able to function independently of the preceptor and another six weeks before he or she can be assigned to the on-call team for emergency surgeries. The initial investment by the institution is a minimum of three months before the novice is able to function as a staff nurse in the perioperative setting. It is important, therefore, to prevent verbal abuse to limit the cost of recruiting and retention.