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Commentary by Molzahn

Through this ethnographic study of an operating theater in Australia, we obtain a vivid description of an organizational culture in which bullying and horizontal violence is pervasive. It is apparent that issues of power underlie the themes that emerged from the data. The expert power of nurses (and others) in this setting is illuminated; the power relations contributed to the development of an organizational culture in which negative behaviors became institutionalized. High levels of horizontal violence and sabotage were also reported among operating room nurses in New Jersey (Dunn, 2003). Dunn (2003) postulated that in this setting, nurses “may perceive sabotage as simply part of the job and even as part of fitting in” (p. 986). From my discussions with colleagues working in other operating rooms, it seems that these are not isolated situations, and similar cultures exist in other operating rooms in North America. From the results of this study, I infer that power is attained through knowledge in this setting. Statements such as, “Collaboration was curtailed if there was a lack of knowledge and experience” and “the balance of power was subtly poised in favor of those who were ostensibly recognized as possessing greater knowledge and experience” support the salience of power relations in the study. Although the authors do not explicitly raise power as a major concern, the themes of primacy of knowledge, social order, and situational control all emphasize the role of power associated with expertise and knowledge. A research study conducted in a critical paradigm might have more explicitly illuminated the power relations in this operating theater. The researchers note that “the paradoxical nature of social order in the operating theater was not always demonstrated by professional status or traditionally defined structures of hierarchical influence.” It was interesting that legitimate power by virtue of professional status or established organizational hierarchies was not as visible as power associated with knowledge or expertise. This is in contrast with Namie’s (2003) findings from a Webbased survey that 71% of workplace bullies (in a variety of work settings) were of higher organizational rank. Although there was some reference to bullying of nurses by surgeons in this environment, it seems that the horizontal violence between nurses was more common. Western Journal of Nursing Research Volume 30 Number 2 March 2008 278-280 © 2008 Sage Publications 10.1177/0193945907303033 http://wjn.sagepub.com hosted at http://online.sagepub.com