Horizontal violence among nurses in the operating room

AORN Journal,  Dec, 2003  by Herbert Dunn

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DISCUSSION

The presence of sabotage in the perioperative environment is common as reported by the participants in this study. Although it was anticipated that a higher degree of reported sabotage would be inversely correlated to the participants' IWS scores, this study demonstrates a significant positive correlation (r = .35, P < .01) between these variables. The Theory of Cognitive Dissonance provides a possible explanation for this result. This theory is based on the concept of cognition, which is "any knowledge, opinion, or belief about the environment, about oneself, or about one's behavior." (27) The premise is that individuals strive toward consistency between cognitions by changing their opinions or beliefs to make them more consistent with each other. When two cognitions are incongruent, the outcome is psychological stress or discomfort. Reduction of this resulting inconsistency (ie, cognitive dissonance) is a basic process in humans.

The cognitive dissonance theory provides a plausible explanation about perioperative nurses' reporting sabotage in the workplace, their respective IWS scores, and the relationship between these variables. To reduce the inconsistency between the reported occurrence of sabotage and the fact that they remain in their positions, perioperative nurses might minimize or under-report the significance of sabotage and its relationship with the degree of work satisfaction. In an attempt to rationalize their happiness in the workplace, nurses may have altered their attitudes, beliefs, or values about the presence or absence of sabotage, the significance of work satisfaction, or both. An adjustment would be necessary with respect to the acknowledgement of sabotage and related reports of work satisfaction. Nurses may perceive sabotage as simply part of the job and even as part of fitting in. It may be too painful for participants to admit that the existence of sabotage should have a negative effect on their satisfaction with their current work situation.

More than one-third (ie, 37%; n = 54) of the respondents used the opportunity to add information not included in the set of questionnaires. Much of this feedback described feelings of anger and frustration toward nursing administrators, surgeons, and other nurses. Many of the respondents viewed nursing administrators as being absent from the day-to-day activities in the OR. Participants said they lack the support and recognition of their superiors, particularly when issues arise concerning inappropriate behavior of surgeons. In addition, more than one participant voiced resentment at not being consulted about decisions that directly affect staff members.

LIMITATIONS

A potential constraint of the study is that internal validity may be compromised due to the difficult nature of the information requested from the volunteers. Some of the participants may not have been able to remain objective when answering questions requiring acknowledgment of unethical and inappropriate behaviors (ie, sabotage) in the workplace. In addition, external validity also must be considered as a potential limitation. The sample size was obtained from AORN members from New Jersey, and attempts to generalize these findings to non-AORN members or to nurses in other states requires further research. It is particularly noteworthy to question whether replication studies would demonstrate a positive correlation between sabotage and IWS scores.