How to handle aggressive episode

[MeiLana]

I will try to make this as vague, but detail pertinent, as possible. I had a physician yank something out of my hands this week, yell at me in front of the entire room, and bully ahead into the procedure before timeout was even begun. He'd been rushing us and been grumpy all day which is somewhat "the norm" for him. His general grumpiness had been escalating all day.

I've been thinking about this for a while. I'm off work right now but the charge nurse recommended I report it to the chief of surgery when I return after holiday. I've had other nurses and techs tell me this behavior is normal and expected and reporting it will only make it worse -- that I should just brush it off and not take it personally.

I'm torn between letting it go for fear reporting it will make it worse (and therefore perpetuating the cycle of what I consider to be abusive and unprofessional behavior) or confronting it with probably a meeting between him, my manager, my director and the chief of surgery with who-knows-what will be the outcome. The thing is -- it feels like a negative and hostile work environment and is distracting -- it puts the focus on the tensions in the room and emanating from the surgeon, instead of the focus being on the patient. I thought we were supposed to be a "team", but I'm feeling that ... not in this case. I also realize that if I complain and his behavior gets worse, the likelihood of me being able to limit working with him is almost nonexistent unless he asks that I not be in his room. There is a definite power imbalance here and I suddenly feel a bit trapped.

I'm still new to the OR, so maybe this is just me not having grown a thick skin? I actually want this to work and I want to get through my days with him without the constant fear of him exploding, now. I have a lot of quandaries about the entire situation.

[Rose_Queen, BSN, MSN, RN]

Moving ahead with a procedure before the timeout occurs unless an absolute life/limb/sight emergency is something that should be addressed immediately by calling your charge nurse, and if the charge nurse can't help, the specialty coordinator, and then on to the nurse manager, and so on. An incident report should also be filled out immediately to alert risk management. This is something that everyone will take very seriously.

As for the surgeon's behavior, I wasn't there and I don't know the specifics. However, if the surgeon wasn't just venting about a situation but was verbally abusing you, that should be addressed by management at your facility.

[Lev, MSN, RN, NP]

Does your hospital have an anonymous reporting system?

[PediOR]

I dunno...his behavior was inappropriate but it sounds like he was impatient with you because you are newer. You would be totally justified going the behavior reporting route, but you might have a better working relationship with this surgeon in the future if you address it yourself.

I had a surgeon who would yell at me sometimes...finally one day I yelled back at him. It only took that one time. Not only did I never have a problem with him yelling again, we have a fun and friendly working relationship.

[SandraFenway]

I'm bothered that your charge nurse is telling you to go the chief. She should interface between her staff and the chief of surgery. There's a reason you're still thinking about this on your day off: your boss isn't doing her job.

[Argo]

Report it. Through the hospital report system.

[sop832]

Write it up. There should be a physician behavior form, or if not, write it in longhand or word processor. This should go through the chain of command, starting with the charge nurse, service co-ordinator or nurse manager. No one can do anything if there is no written evidence. And check with the nurse manager or HR to make sure that there is a no retaliation policy.

If you think about it, will this surgeon tiptoe around YOU if you are grumpy? I don't think so- you couldn't get away with that! And neither should he. This is a problem with the culture in your OR if this is brushed off as "That's just the way he is" . It will ultimately affect patient care. PS Keep at least one copy of what ever format you use to report this in a file in your desk or computer at home.

[kalycat, BSN, RN]

When I was still in the OR, we filled out an incident report for this type of behavior. It was then routed through the system to management and the physician was counseled, without further involvement by any circulator or scrub. The system seemed to work as several "problem children" we're reigned in through the process. They may not have been the warmest or fuzziest, but that type of behavior stopped.

No time out is a no-no. But I wouldn't engage in anything to try to resolve this that doesn't take place through established professional channels. Chances are, this isn't the first time. Let management have the uncomfortable conversations, though. Just my .02.