Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Alex Heckert, Ph.D.

Second Advisor

John A. Anderson, Ph.D.

Third Advisor

Robert Heasley, Ph.D.


Evidence suggests that disruptive communication patterns and disruptive behaviors exist in the OR in association with formal professional roles (Ong et al., 2010; Coe & Gould, 2007; Higgins & MacIntosh 2010, Leach et al., 2011). Highly educated professionals are not immune to disruptive and aggressive behavior (Straus, 2007). These behaviors include such actions as intimidation, bullying and hostility (Gilmore, 2003). The interaction between patient and nurse is absent in the OR because the patient is typically under the effects of anesthesia (Reynolds & Timmons, 2005). Interpersonal relationships, therefore, between nurses and physicians are more relevant in regard to nurse satisfaction. OR nursing has been described as mentally, physically and emotionally demanding (Higgins & MacIntosh, 2010). It is considered to be one of the most challenging and professionally stimulating departments for nurses to work within the hospital (Chen et al., 2009), as well as a critical and stressful area isolated from the rest of the hospital (Chen et al., 2009; Bianchi, 2008; Coe & Gould, 2007). OR nurses experience stress in part due to the critical nature of the work (Bianchi, 2008; Coe & Gould, 2008). Although nurses are trained to address and manage this job-related stress, unnecessary stress related to poor teamwork and conflict can be disruptive (Kane, 2009). International research has shown that nurse stress influences job satisfaction and intent to leave the job (Chen et al., 2007). Some of the least satisfied groups of nurses are those that work in the OR (Boyle et al., 2006, Utriainen & Kyngas, 2009). A nurse's intent to leave the job is often the precursor to job turnover. Research has shown that nurse-physician relationships are a factor (Wanzer et al., 2009; Rosenstein et al., 2002). This social research used the theory of stress to help understand the relationship between disruptive behavior in the OR and nurse satisfaction. The process of individual appraisal of stress was considered (Lazarus, 1966) and the role it plays in the personal evaluation of stress (Lazarus, 1999). This study into disruptive behaviors in the OR was conducted using a quantitative approach with a cross-sectional design. A questionnaire was distributed to OR nurses working at participating hospitals and was collected anonymously. In preparation for constructing and validating the questionnaire, a focus group discussion was conducted with three objectives: 1) the group's definition of disruptive behavior, 2) the coping skills used by the group members, and 3) how group members feel when they experience disruptive behaviors (stress). The resulting questionnaire included questions developed from the focus group as well as questions from The Nursing Stress Scale, the Ways of Coping Questionnaire, and The Index of Work Satisfaction. Five hospitals participated in the survey and 45 OR nurse respondents were included in the data analysis. Statistical analysis using univariate, bivariate and hierarchical multiple regressing was applied. Results showed statistically significant strong correlations between disruptive behavior and nurse satisfaction and statistically significant moderate correlations between disruptive behavior and intent to leave the job.