Sometimes certain people have personality problems — and anger problems. If that person happens to be in a position of authority, the result can be violence. This was, indeed, the situation at X University Medical Center, and personnel in the OR Department, as well as nurses in the surgical department, were wary. In fact, they were afraid. One of the surgeons went far beyond being impolite: he was both verbally, and as the following case study illustrates, physically abusive.

In this case, a young nurse was doing the best she could. But it wasn’t good enough or fast enough to satisfy the surgeon who was making a postsurgical hospital visit to a patient. He was trying to remove the patient’s dressing, and the hemostat simply wouldn’t close correctly. As the surgeon became more and more agitated, the young nurse asked if she could help by finding him a new sterile hemostat. Instead of answering, he yelled and threw the hemostat at the nurse, hitting her in her right eye and tearing the skin, causing blood to run down her face. The patient was outraged and yelled at the physician who yelled more at the nurse, who stood there bleeding — too shocked to say anything.

All the noise attracted the attention of the nurse manager, who quickly took charge of the situation (the patient made clear what had happened). The manager had the nurse escorted to the emergency department for stitches and cornered the physician to tell him in no uncertain terms that he was never to assault one of the nurses (or anyone else for that matter). She reported the entire situation to administration and to the chief of surgery.

The nursing staff rallied around the injured nurse, offering help and support. The CNO was furious at what had happened, and the CEO was appalled. They insisted the nurse see a plastic surgeon and also saw to it that the surgeon who initiated the attack paid for it. The chief of surgery insisted the surgeon write a letter of apology to the nurse, which he refused to do. As a result, the surgeon lost his privileges at this hospital.

Commentary

Much has been written about violence in the workplace, and there is no doubt that violence is never acceptable. However, this is an ethics column and almost everyone agrees that violence in the workplace is wrong. What often is not addressed in the importance of collegial relationships in preventing and diffusing violence — and supporting one another in every way possible. “Understanding nurse-to-nurse relationships and their impact on work environments,” a 2013 study published in Med-Surg Nursing by Moore, Leahy, Sublett, and Lanig, found that many of the nurse participants had considered leaving the profession, had considered leaving a particular hospital, or had left a nursing unit because of poor nurse relationships. The crucial role nurse managers play in establishing good nurse relations was highlighted. Eighty-two staff registered nurses responded to a researcher-developed online questionnaire. The researchers performed a qualitative content analysis, categorizing data according to questions and then analyzing the information for key thoughts. They concluded that a healthy work environment requires sustained positive nurse-to-nurse relationships.

This certainly is one aspect of collegial relationships, but there are many more. What they all have in common is that each aspect ultimately benefits patient care. Nurses, as they assume their professional identities, are pledged to:

• the work of understanding, interpreting, and expanding the body of the profession’s knowledge.
• the equally disciplined work of criticism and self-regulation
• the work of developing and cultivating in themselves and their colleagues those character traits upon which personal and professional excellence depend.

The ethical principles that underlie the formulation of intraprofessional relationships derive from three sources: human rights, shared obligation to promote the public’s welfare, and the development and nurturing of a professional bond. Intraprofessional collegial relationships do not tell one how to act but rather to teach one how to be. To be a nurse is to share in creative, constructive intraprofessional relationships that encourage partnership in the development of a profession whose primary goal is to serve the health needs of others.

If nursing is to continue to evolve (this includes a legally recognized scope of practice, self-regulation, and more), then collegiality must be integrated into each nurse’s development at all levels of professional practice. Thus, faculty, management, and peers must nurture a sense of commitment to the profession and to all its members. Members at all levels of the profession need to own their mutual obligations to one another and to the profession, and nurses of all ranks and levels must seek to improve the systems, institutions, and structures that shape their school and work environments. This action will help our schools and colleges promote the development of critical intelligence and our workplaces promote excellence in practice so that our socialization process in both will support the development of the professional bond.

In this instance, nurses at all levels, ranks, and specialties sought to mitigate the damage and support the young nurse. The hospital and medical staff responded appropriately by removing the surgeon from their staff. However, one is left to wonder if this young nurse was encouraged by anyone to file criminal charges against the surgeon. For, while I am not a lawyer this was no accident. It was deliberate and I would call it assault and battery.

Leah Curtin is Executive Editor, Professional Outreach for American Nurse Today.