“There is a dark side to this profession,” said Col. Keith Essen, MSN, MSS, RN, CNOR, eliciting nods of agreement from attendees at the education session “Addressing Disruptive Staff: The No Alpha Hotel Rule,” which Col. Essen presented at AORN’s 57th Congress in Denver. He explained further by saying that the OR inherently attracts high-intensity people who are prone to conflict, physicians and nurses alike, and that it takes continual engagement to address disruptive behaviors and protect both patient and employee safety. Spotting “jerks” is fairly easy, Col. Essen said, because seeing the offender’s name on the schedule might cause an OR employee to consider taking a sick day to avoid him or her. “True jerks” are chronic offenders, and they make people feel depressed, targeted, and belittled. They also tend to aim at people who are less powerful—they “kiss up and kick down,” Col. Essen said. Bullying behavior is most often perpetrated by people in power, and women are the most frequent targets, Col. Essen stated. He also noted that about two-thirds of employees avoid the problem, and targets of bullying frequently have health problems. Bullying and disruptive behaviors affect teamwork, recruitment, and retention, and the secondand third-order effects of “alpha hotel” behaviors are job stress, depression, coronary heart disease, absenteeism, and turnover of both targets and those who witness the behaviors. Since the Joint Commission issued Sentinel Event Alert #40, addressing disruptive behavior is an accreditation concern. Additionally, as of March 2010, 15 states had introduced bills against bullying. The Joint Commission requires health care facilities to have policies in place to address disruptive behavior, as well as surveillance strategies for spotting these behaviors. Col. Essen stressed that having the policy is not sufficient on its own and that resources and effort, in addition to leadership support and a zero-tolerance policy for nonprofessional conduct, are required to make real changes. In implementing the “no alpha hotel rule,” the first discussion about disruptive behaviors may be a “coffee cup conversation” with the offender, something informal and maybe done in passing. The next step is to have a more formal discussion, and most people will self-correct after the first or second chat. Tactics to employ during discussions with a bully are to disengage from adversarial mode, use logic, and be process oriented. He also advised “your game face,” to not become emotional, and to try to empathize and understand the cause for the bad behavior. If there really is no way to work well with the offender, the health care organization leaders need to consider whether it’s worth it to have them working at the facility. But it’s not about hiring only nice people, Col. Essen continued, because the OR requires people who will speak up, and debate is necessary. “You want to be polite, but don’t replace the jerks with wimps and polite clones,” Col. Essen said. “You should be debating task-related conflicts. That’s okay, and it benefits the organization.” It is problematic, however, when people take these task-oriented debates personally. “We’re just starting out,” Col. Essen said, comparing this issue to the efforts to instate the time out process in every OR. As time goes on, the process will become clearer, he promised. True culture change is a process, a “perennial effort,” because addressing disruptive behavior is a very complex issue that often requires a case-by-case approach, but it does require continual engagement and a “no kidding” approach.