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Based on the results of the Clark Work Environment assessment, and the subsequent template to follow, it has been deemed that my workplace is, “mildly healthy.†The results are not surprising to me, as I am not a permanent staff member in my workplace and neither are 80% of my coworkers. The institution I am currently employed in has a large percentage of travel and agency nurses, essentially non-permanent staff. Their turnover rate is extremely high, and this is due to a multitude of factors. In the two years that I have been back and forth with this facility, there has been a change in director of the Operating Room four times, which says everything you need to know in my opinion. The hospital also has a history of corruption within administration, and this does not seem that far-fetched to me either. Why do I continue to return to this facility you may ask? For one, the financial compensation is totally worth it for my schedule, but more importantly it is the people that work there that do keep me coming back. The actual surgeons and staff members for the majority are excellent healthcare providers and wonderful human beings, I find that the majority of the issues lie within management and administration. I feel that they do not value their staff at all, and treat them as disposable items as opposed to actual dedicated workers. I have seen this type of behavior time and time again, even with surgeons who have worked there for twenty-plus years, or charge nurses who have spent their entire career within that health system. Needless to say, the attitude administration has towards their staff is nothing short of disheartening and almost repulsive but the spirit of the staff towards their work ethic and patient care is untainted.
The overall relationship between fellow staff members is pretty average, with so many different types of characters and personalities there is bound to be some conflict once in a while. A small but growing body of research suggests that incivility and disruptive behaviors are particularly commonplace to the new graduate nurse or nursing student within the clinical setting, (Clark, Olender, Cardoni, & Kenski, 2011). I have seen the staff make sometimes rude assessment of new travelers or new faces, whether is its a resident physician, nursing student, surgical tech traveler, etc, and it is something I do not keep quiet about. I believe we were all new once, and giving people the benefit of the doubt is necessary but there has to be a line maintained in order to prioritize patient safety. I have unfortunately witnessed extremely rude physician behavior not only to staff but to their fellow physicians as well. Not to mention witnessing the blatant bereavement to the resident physicians by their attending.
An incident that happened to me personally was between myself and a surgical assistant. This person’s role in the OR is to provide the staff with assistance to surgical equipment and specialized operating beds/tables, patient transfer and positioning, cleaning of the operating rooms, etc. I was doing a neuro-spine surgery, and my patient was in the prone position. As a neuro-spine nurse, one of my duties is to be aware of the patient position and be prepared with the proper patient bed when it comes time to flip the patient over to a supine position. Doing my due diligence, I had called the SSA (surgical assistant) for the patient bed 1 hour in advance. I always call extra early because I know how busy it gets, and I also know it can take some extra time to obtain the patient’s bed, (they arrived on a stretcher initially). I also periodically check on the status of the bed, and when I didn’t see it 15 min out, I called again to remind the SSA I need that patient bed because surgery is coming to an end. After checking a third time, I reached out to the front desk to make it known how urgent the need for a bed was. It makes a huge difference in every minute the patient is in a prone position as opposed to if they were supine on the surgical bed. When it came time to flip the patient from prone, I called overhead for moving help, and no one came. I waited a few minutes and called again, and finally only one person showed up. This SSA decided that he was going to start yelling at me and demanding to know why i had contacted the front desk for the patient bed, which we still never received. Unfortunately, this incident escalated because we had to flip the patient onto a stretcher which was inappropriate for the type of surgery they had. I voiced my concern and dismay, because every patient deserves to have a proper bed. I had done everything in my power to ensure my patient was receiving the proper care, and was being berated by a staff member for trying to do my job adequately but more importantly, do right by the patient. This SSA told me he was overworked and he purposely didn’t get the bed because I had called the front desk about the missing bed. I responded that I would not stand by and not be a patient advocate no matter the situation. This incident had eventually been escalated to management and this SSA was written up for such confrontational behavior and lack of responsibility. I had to remind him that the bed is not for me, and has nothing to do with me personally, this bed is for the patient. I find that very often the SSA’s will not help a nurse if they don’t like that nurse, which makes me furious. We cant base our fulfillment of job duties based on if we like someone or not, its based on delivering quality patient care. I do not stand down or remain quiet when I feel that an injustice has occurred, and for this I am sometimes faced with conflict. Generally, people know me as a very sweet and helpful person, but when the time comes to do the right thing, I am very vocal about it. I treat everyone with respect and do not tolerate any disrespect, no matter who it is coming from. This incident has remained ingrained in my memory, because it reminds me why I will never be staff there and why I will always remain a traveler in that facility.
Clark, C. M. , Olender, L. , Cardoni, C. & Kenski, D. (2011). Fostering Civility in Nursing Education and Practice. JONA: The Journal of Nursing Administration, 41 (7/8), 324-330. doi: 10.1097/NNA.0b013e31822509c4.
Clark, C. (2019). Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility. Nurse Educator, 44 (2), 64-68. doi: 10.1097/NNE.0000000000000563.
