Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
Commission Accreditation on Healthcare Organizations, 2004). In
theory and within the frame of a culture of safety, the surgeon is
supposed to initiate the use of Universal Protocol (i.e., the surgery
is about to happen on the correct patient and surgical site) in the
surgical suite immediately prior to the actual surgical incision to
ensure a safe patient outcome. However, in the reality of the OR
environment and in part due to resistance by many surgeons, it is
the nurse who initiates the use of Universal Protocol.
Issue
To initiate the use of Universal Protocol, the nurse has to be
assertive and at times a dominating presence with physicians. This
is a drastic change in traditional medical nurse-physician hierarchal
roles and in fact is a role reversal between nurse and physician. The
usual practice within the traditional medical healthcare delivery
model is reflected in the image of the physician who gives orders
and the nurse who takes them; in their interaction, the nurse is
expected to be submissive to the physician’s authoritative and
dominating presence.
Statistics and the use of Universal Protocol
Since the establishment of Universal Protocol in 2004, wrong
site surgeries have actually increased. During the same time, use of
Universal Protocol has decreased (OR Manager, 2006, pp. 1, 7).
Why did this happen? Why are wrong site surgeries increasing and
the use of Universal Protocol decreasing?
Thoughts Concerning Communication and Role Reversal
I believe that these troubling statistics report a situation that
has to do with communication and role reversal. I continued to
wonder how role reversals between nurse and physician affect the
communication patterns between team members within the
healthcare environment as related to a culture of safety. Also, I
wondered in a larger sense with the advent of this role reversal how
does the operating room team communicate in an effort to function
within the parameters of a culture of safety? And in particular, how
do the team members view their communication patterns in relation
to a culture of safety?
Communication and Role Change
The use of Universal Protocol is only one example of role
reversal between the nurse and physician which has created a
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