Staffing: Master Challenging Conversations Among Teams

Clear communication requires mutual understanding, grace and purpose.

Finding your voice as a new nurse in the operating room can be terrifying. It’s challenging to navigate all the different personalities, and it’s not something nursing school adequately prepares you to handle. When new OR nurses communicate, they must keep in mind that their colleagues and their patients may not share the same perspective.

In communication, “perception” refers to the way individuals interpret and make sense of information received through various channels. This process of selecting, organizing and interpreting sensory data to create a meaningful understanding of a message can be highly subjective and influenced by an individual’s experiences, attitudes, beliefs and cultural backgrounds.

One’s emotional state can impact perception too. The same person may interpret the same message differently based on their current emotional state, which can either enhance or hinder effective communication.

Understanding OR culture

As a new nurse in the OR, I once suggested a small change in how instruments were arranged on the back table. I thought it would improve efficiency, but the scrub nurse, who had been there for years, seemed frustrated and dismissed my idea.

At first, I felt discouraged, but later realized her response wasn’t about my suggestion, but was based on her own experience and routine. I thought I had found a way to help, but to her, my idea represented unnecessary change. This experience taught me that everyone’s perception is shaped by their own experiences and emotions.

Just as the OR has its own culture, perioperative nurses have their own family cultures in which they were raised. Likewise, our patients have either similar or different cultural backgrounds to our own.

For example, my family emigrated from Italy. In the Italian culture, expressive gestures, facial expressions and body language often are used to convey emotions. It’s common to hear raised voices, laughter and passionate discussions.

As a result of my heritage, I have often been called “overly dramatic,” or received comments such as “you are too much.” I have been called “the loudest person in this operating room,” to which I respond that I am one of the quietest ones in my family. In my culture, too, nonverbal cues play a significant role in communication, and decisions may involve input from multiple family members. I have found that understanding this family-centric approach is key to effective communication.

I’m often more direct with my communication and have been called “blunt.” As a result, I have been perceived as assertive, which is accurate.

Respect for elders is deeply ingrained in Italian culture. I find it is important to show deference to more experienced individuals and believe their opinions should carry significant weight in decision-making processes. Flexibility, openness and a willingness to appreciate cultural differences are essential for effective communication, no matter what cultures are involved.

A way forward

Perioperative nursing teams should always work on open communication, keeping it professional, building trust, aligning goals and sharing knowledge to foster an environment filled with mutual respect. The following practices will allow the team to work effectively, provide the best patient outcomes and create a healthy work environment.

• Maintain professionalism. Challenging situations require a combination of effective communication, conflict resolution skills and a focus on maintaining a collaborative and patient-centered environment. Professionalism plays a big role in this. OR team members must learn how to stay calm and composed in challenging situations. Look to limit, if not avoid, an emotional response in the moment, and refrain from engaging in a heated discussion or compounding a tense situation until you have had time to reflect on the situation. Saying nothing is all that is needed at times.

Another option is to say, “Let’s focus on addressing the patient’s needs first and circle back tomorrow after we have both had time to reflect on the problem.” Example: In the middle of a procedure, the anesthesiologist snaps at the nurse for asking about medication timing. Instead of engaging in conflict, the nurse responds calmly: “I want to make sure everything is accurate for the patient. Let’s make sure we’re aligned.” This neutral response recenters the conversation around the patient. The next day, that same team member should approach the individual who snapped and state, “I know I didn’t have much to say yesterday because I wanted to give it some thought first. Would you like to discuss this together today or tomorrow?” This gives the other person the time they need to reflect on the situation, leading to a mutual debriefing that will hopefully be productive, and maintains the relationship.

• Engage in mutual respect. Respect is a major component in creating a positive relationship between nurses. Each specialty has its own culture and norms but is expected to work harmoniously during times of patient handoff, critical situations involving quality-of-care evaluation and maintenance of patient safety goals. OR nurses and PACU nurses share patient goals that require them to work together effectively, but they may not always fully understand their colleagues’ specific roles, which can cause frustration and mistrust among the teams.

These divides can be bridged through the building of mutual respect. For example, during a PACU handoff, the PACU nurse questions the OR nurse’s patient report, saying it’s incomplete. The OR nurse maintains their professionalism and says, “I understand you have concerns. Let me clarify the details for you so the patient gets the best care.” This shows the OR nurse is willing to address the issue without letting emotions escalate, and both parties can quickly refocus on the patient care at hand. The goal is to encourage trust and create nonthreatening environments for your teams. Nursing handoffs are often times when tone or volume of voice, body language and cultural background can strain mutual respect and cause mistrust or even loss of knowledge.

Let’s return to our example. Imagine that if following the handoff, the PACU nurse continued to loudly ask questions that made the OR nurse feel threatened or interrogated. The PACU nurse may have believed they just needed to gather more information, but how that was communicated left the OR nurse feeling threatened or attacked. Situations when voice or tone are misinterpreted or when one’s norms are tested can easily affect the entire team.

Now imagine that the PACU nurse simply said she had a few more questions to better care for the patient and provide the best outcome. Would the OR nurse feel less threatened? Could the OR nurse state she would ask the surgeon to make the situation less threatening? This is just one of many situations that you can explore in your effort to preserve mutual respect among the various teams at your facility. OSM