During the course of a working day, nurses participate in banter, gossip. teaching, flirting, verbal insults and professional exchanges. Often between themselves and the myriad of health professionals that present on the ward. A study into operating room behaviours looked at the information that occurred in that setting. While the setting was an operating room, the study is important because it looked at gender and hierarchies which are just as applicable in all other health care settings.


The majority of communication between individuals neither directly nor indirectly concerned case-related information. It will not surprise that the majority of communication was about personal lives, current events and popular culture. Cooperation occurred in 59% of instances while conflict occurred in 2.8% of the time. When conflict occurred, it ranged from constructive differences of opinion to discord and distraction that could jeopardize patient safety.

Conflict is inevitable and the trick is to get the balance right between cooperation and conflict. In this study, conflict was related to power negotiations and social relationships. Most conflicts occurred down the hierarchy and mostly against workers several positions below the conflict initiator.


And conflicts were more common when more males were present relative to females. Cooperation increased significantly when the attending surgeon’s gender differed from the majority of remaining clinicians in the room. The length of surgery also increased the probability for conflict. The study authors also noted there was a high frequency of team membership change during each case.

The team membership and structure was intermittent and ad hoc. The constant changes in team membership jumbles up the creation of a functioning team as it reduces familiarity and prevents the formation of shared goals.


This study confirms that gender and hierarchy are important considerations within a health care team. The effect upon cooperation and conflict is reduced when a team has a mixed gender balance. We can all agree upon that.

To learn more about the effect of gender and hierarchy. in nursing teams,

Jones, Laura K., et al. “Ethological observations of social behavior in the operating room.” Proceedings of the National Academy of Sciences (2018): 201716883.