Dealing with perioperative prima donnas in your OR
2005; Wiley; Volume: 82; Issue: 2 Linguagem: Inglês
10.1016/s0001-2092(06)60310-4
ISSN1878-0369
Autores Tópico(s)Medical History and Innovations
ResumoNancy J. Girard, RN Everyone at some time has worked with a prima donna. The term originated in the theater and meant someone who is a lead singer or ballerina. It also has come to mean “a vain or undisciplined person who finds it difficult to work under direction or as part of a team.”1(p985) Prima donnas can be male or female, young or old, nurses or other, workers. This article discusses prima donna nurses. Prima donnas are very good at what they do, and they know it. Some are the most brilliant and intelligent peri-operative nurses you will ever meet. With strong self-confidence and an assertive attitude, many receive praise from managers who see them as very important members of the OR team. Unfortunately, prima donnas do not really like to be part of a team. Don't get me wrong. I am not putting perioperative prima donnas down—actually anyone working in the operating arena tends to be something of an elitist. Perioperative prima donnas have strong perceptions about their worth. They are confident and self-assured. These same characteristics, however, can make them difficult people with whom to work. Perioperative prima donnas saunter into the OR, convinced that guidelines and protocols are for everyone else. They often believe that the rules do not pertain to them. For example, they may not cover their hair completely with their cap, let a mask hang around their neck, or wear artificial nails, and they give tons of advice and instructions to everyone else. Know-it-alls—These individuals repeatedly tell everyone that only they really know how to set up for specialized surgical procedures. They are haughty with colleagues, nasty to subordinates, and think they are the best thing since sliced bread. Although they may be excellent performers, they are not nearly as good as they think.2 Passive-aggressors—These prima donnas believe in strength through weakness. When asked to do something, they say they will do it but procrastinate until someone else does it. Then, these prima donnas criticize others for not performing the task correctly. They also require a tremendous amount of handholding and attention.2 Artistes—These people are creative, ambitious, and have a million ideas. Considering policies and procedures is not an important part of their day. They prefer to look at the the big picture and do not care about the details. They love thinking up projects that are expensive and disorganized. These people are tolerated because their underlying ideas are good.2 Old-timers—These individuals have been in the OR since needles had to be threaded. Everyone loves them; however, these nurses think that they have paid their dues and have worked more call, night, and swing shifts than anyone else, so they do not need to do it anymore. They may come in on time but spend time wandering from room-to-room and gossiping. It's been a long time since they were really productive.2 Bullies—These perioperative prima donnas are very productive, hard workers. The trouble is, they scream and yell at everyone. Everyone in the OR, including the surgeon, is afraid of their temper tantrums. They are a terror to new employees and students. People work like crazy around them because they do not want to be on the receiving end of their belligerent bellowing.2 Before tackling any problem, good nurses assess the situation.3 An analysis of a suspected perioperative prima donna is imperative. Characteristics of prima donnas can exist in each of us, but it is the quality and degree of behavior that separates perioperative prima donnas from regular perioperative nurses. Overt, aggressive perioperative prima donnas are easy to identify, and most of the other staff members will know them immediately. Unfortunately, the passive-aggressive and subtle ones are much harder to identify in an OR. Outwardly, prima donnas look like everyone else, but they may have different internal motivation. Look for what makes perioperative prima donnas tick. For example, some may need more recognition. Others may want more compensation for doing what everyone else does as part of their regular job. They may request special privileges, such as bonuses, time off, or floating work hours. After analyzing the situation and determining that perioperative prima donnas are present, the manager should assess their worth before deciding what to do.4 The manager must evaluate prima donnas with respect and consideration. After all, managers should not be perioperative prima donnas either and always should treat others fairly. It is important to determine how set perioperative prima donnas are in their ways. Are they good technicians and know it, or do they think they are the best in the world just because they exist? Does their performance negatively affect others in the OR? Managers must be sure that perioperative prima donnas can be trusted to perform correctly at all times and determine if they are accountable. Rough edges are one thing, but actively working against the smooth flow of safe patient care in the OR is another. There is no room in the high-stress, fast-paced atmosphere of the OR for people with faulty ethics or disregard for policies central to the health care institution's mission of quality and safe patient care. Almost all perioperative prima donnas can be salvaged if you have the time and energy to work with them. If perioperative prima donnas are only after attention and praise, it can be given to them if they are competent and performing well. If they are arrogant and brag to the point of distracting the rest of the team but are not unethical or unsafe, they might be useful in the OR. Managers must determine if a perioperative prima donna instigates unrest overtly or covertly or works against the good of the team and the department. Coworkers' complaints against perioperative prima donnas need to be investigated to determine whether the claims are true. If a negative situation exists, perioperative prima donnas must be confronted immediately and told in clear terms that the behavior must stop; then their actions must be monitored. Take control of perioperative prima donnas as soon as they are identified. The longer the behaviors have been in effect, the harder it will be to intervene. Perioperative prima donnas must demonstrate respect for coworkers and accept the rules or policies required in the OR. One method of handling perioperative prima donnas is to put them where they like to be, such as the plastics room, and confine them to that room rather than float them throughout all the services. Perioperative prima donnas like to be considered expert practitioners, and this gives them the opportunity to excel in the area of their choice. After appropriate interventions have been made, perioperative prima donnas may need testing. Can they now be a part of the team? Will they do what everyone else in the department has to do? Are they willing to stay in the trenches or make coffee if that is what the routine and organizational culture expects? Will they participate in committee meetings, projects with partners, or volunteer to help new perioperative nurses? Let them answer these questions, either directly or indirectly. Immerse them in team work and meetings. If you are not sure whether they can be part of the gang, let them work with even more of the OR team with whom they will have to cooperate. They will either sink or swim, and their coworkers may be the first to let someone know the outcome. Every OR has perioperative prima donnas. It is essential for the morale and the productivity of the OR to determine the status of perioperative prima donnas. Methods of managing perioperative prima donnas should be identified, and expectations must be clearly communicated to those involved. One final question needs to be answered by managers, “Do the headaches caused by perioperative prima donnas outweigh the benefits?” If so, ask yourself if perioperative prima donnas are worth the grief they cause, no matter how good they are.
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