Managing Safety in Perioperative Settings: Challenges and Strategies of Meso-Level Nurse Leaders

Abstract

Background: Perioperative nursing units have been described as one of the most challenging practice environments, characterized by a distinct hierarchal culture and a rapid pace. These dynamics create challenges for creating a culture of safety, and meso-level leaders must operate in the space between the micro-level of direct patient care and the macro-level administrative priorities. Yet, little is known about the strategies meso-level nurse leaders (MLNLs) use to facilitate a culture of safety in perioperative settings. Objective: Guided by complexity leadership theory, we sought to understand the strategies MLNLs used to facilitate a culture of safety in perioperative settings. Methods: A qualitative descriptive study was designed and semi-structured interviews were conducted. Inductive thematic analysis was used to analyze content from the interviews several techniques (audit trail, reflexivity, peer debriefing) were used to ensure rigor of the methods. Findings: Seventeen MLNLs completed an interview and analysis identified 4 strategies, or skills that MLNLs reported using to navigate the specific combination of pressures as meso-leaders in perioperative environments: (1) Recognizing the unique perioperative management environment (2) Learning not to take negative interactions personally; (3) Developing “super meso-level nurse leader” skills; and (4) Appealing to policies and patient safety. Conclusion: Our study also shows how clear organizational policies and procedures can serve as a vital tool for MLNLs who are trying to enforce behavior, especially of those over whom they have no technical authority. Clear and enforced policies can be used as powerful shields—moving attention away from a feeling of individual “policing” and toward a more impersonal discussion about shared patient safety goals, and ultimately support MLNLs in challenging perioperative work environments.