Ethics in perioperative practice—duty to foster an ethical environment

AORN Journal,  Sept, 2002  by Patricia C. Seifert

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All respondents saw a connection between disruptive physician behavior and nurse satisfaction and were concerned about the significance of nurse-physician relationships and their effect on the work environment; however, the study groups differed in their conclusions about responsibility, barriers, and solutions. For example, physicians were more positive than nurses or administrators in their responses to questions about the degree to which physicians value and respect nurses' input and collaboration and the overall atmosphere of nurse-physician relationships. Executives gave the highest rating, compared to nurses and physicians, to the overall significance of nurse-physician relationships. Executives also gave the highest rating to the question about the seriousness of disruptive physician behavior. With respect to administrative support of nurses in conflicts with physicians, nurses gave the lowest rating and administrators gave the highest rating. Nurses also gave the lowest rating to the question about physician support of nurses in nurse-physician conflicts, and nurses were least satisfied with the physician counseling process.

The survey suggests that although physicians seem to value nurses, physician behavior is not consistent with their stated beliefs. The survey recommends

* creating more opportunities for collaboration through open forums, group discussions, and workshops;

* providing training and education for nurses and physicians to improve teamwork and working relationships;

* requiring administrators to be more proactive in preventing nurse-physician confrontations related to RN staffing, scheduling, and equipment; and

* establishing a zero-tolerance policy for disruptive behavior by physicians and nurses. (17)

Institutions that claim to promote optimal patient care but fail to engage in similarly supportive behaviors toward staff members illustrate an intrinsic conflict between stated beliefs and demonstrated behaviors. When nurses are subject to verbal or physical abuse, they are less likely to stay in that practice setting, particularly if supervisors are not perceived as supportive. Unfair, illegal, or unethical practices challenge the creation of a moral environment. Work environments that reflect a culture of communication, collaboration, fairness, and respect for patients and all members of the health care team are more likely to support fulfillment of ethical obligations. Mechanisms for correcting abusive behavior, addressing grievances, or resolving ethical dilemmas should be available, including effective grievance procedures, consistent enforcement of policies and procedures, fair compensation systems, participatory governance structures, and adherence to standards promoting effective care. (18)

Positive working relationships with physicians, administrators, nurses, or other members of the health care team increase employee satisfaction and may have physiological benefits as well. Researchers have found that in positive and less stressful environments where administrators are supportive and the working relationships are collegial, study participants who perceived less stress were less likely to be infected with the common cold. (19)