Dealing with perioperative prima donnas in your OR

AORN Journal,  August, 2005  by Nancy J. Girard

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Last winter, my husband came in from a walk and announced that a stray kitten had followed him home. I asked where it was. "Out on the porch," he said. I opened the door, and immediately, a little grey fur ball walked in. She gave a haughty glance at our three dogs, and essentially said, "Here I am. Where's the food?" The dogs immediately sat down and gazed incredulously at her, losing any power or control over the kitten. This cat, now ruling our house, is a true prima donna. She expects to be waited on, demands attention, tells the dogs when to play, and lets everyone know when she wants to be petted. She earns her keep though by competently catching all the bugs and critters that come into our Texas home. She is demanding, lovable, irritating, sweet, and useful. She reminds me of some people I have worked with over the years who also are prima donnas.

DEFINITION

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 perioperative 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.

PERIOPERATIVE PRIMA DONNA TYPES

There are many different types of perioperative prima donnas. The following types can be found in almost every facility.

* 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. Every one 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)

ANALYZE THE SITUATION

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.