Does violence still occur in the OR?

AORN Journal, Sept, 2004 by Nancy J. Girard

At the beginning of my surgical career in the late 1960s, I worked at a small hospital that had only two ORs. We performed every kind of surgery in the surgical unit, including cesarean sections.

One day, we had a C-section scheduled. The physician doing the procedure was known for his verbal abuse and belligerent attitude toward nurses. At the beginning of the procedure, he announced that he intended to beat his own time getting the baby out, so everyone needed to be prepared to work fast. I began prepping the patient's abdomen, but this physician did not want me to take tune to do this and was irate at the delay. He simmered, but set to work to beat his record. As soon as he made the initial incision, he threw the bloody knife at me in anger. Luckily, it did not hit me. This happened more than 30 years ago, and to this day, I remember it clearly.

We think that times have changed, behavior has improved, and this kind of violence toward nurses does not happen anymore. Are we wrong? We hear stories from colleagues and friends, see incidents reported on the Internet, and find out about verbal and other kinds of abuse during professional meetings, so we know some of this type of violence still must exist.

Violence is so prevalent in today's society that it almost has become a norm. There are laws, task forces, state and national policies, and professional groups concerned with violence. It permeates every social stratum, every economic group, and every culture. Prevention of violence has been a national goal for many years now. This includes prevention of intimate violence, adolescent violence, criminal violence, international violence, and workplace violence.

VIOLENCE IN THE OR

Although nurses may think physical violence in the OR has decreased over the years, it still exists. Pockets of it emerge in all parts of the United States and may occur in small, large, private, or community hospitals. Physical violence in the OR commonly seems to involve physicians and nurses, and when it happens, knowledge about the episode often may be confined to the organization. Few incidents become public knowledge. Perhaps violence in the OR should be reexamined today to determine if it still is prevalent or if it happens in isolated instances.

There are a number of articles on how individuals can protect themselves from violence perpetrated by hospital outsiders, as well as articles on how workers within a hospital can protect themselves from coworkers. Some health care organizations have well-developed policies on violence that include clear consequences. Some organizations, however, only give lip service to protecting those who are violated. Punishments may be mild, particularly if the violator is a surgeon who brings a lot of business to the hospital. Some organizations have no policy and turn their heads when a charge is filed.

PROTECT YOURSELF

The best defenses against violence in the OR are knowledge, awareness, and actions to defuse a situation or prevent violence from occurring. There are laws against physical violence, and victims have the right to file formal complaints. Nurses must defend themselves and others who are victims of violence, and they should support the victim when violence occurs. Victims also should be able to expect support from their colleagues and administrators at their facility. In addition, AORN should play a major role in assisting members and all perioperative nurses when violence occurs in the OR.

THE EXTENT OF THE PROBLEM

This commentary is not meant to provide "how tos," or give details on violence prevention. It is meant to stimulate interest in looking at this topic in depth to determine the true extent of the problem. It also is meant to encourage those who have been victims of violence to be unafraid of retribution if they speak out and to let them know they are not alone. Nurses are very caring people, and all nurses must band together strongly on this issue. Stay safe, my nursing colleagues.

NANCY J. GIRARD

RN, PHD, FAAN

EDITOR