Table 2 Coding system for the directed content analysis associated with inappropriate communication and relationship dynamics

Functional goal

The SG says, “I will stick to my fundamental views on this case in terms of unpacking. It is important to think about saving money; we just take the stuff into the OR and pack it up if we need it.” The CN replies, “Okay, but if it isn’t prepared, you’ll blame me if we need it during the intraoperative phase!” [Team 13]

Specialized knowledge

The SN says, “If it is surgeon x operating, he would like to have Number 4 [suturing thread] and he would like to have those knife blades!” “Okay, yes,” the CN answers and finds the thread and blades. “He has some whims, I think!” the SN says to her colleague. “I call it ideas,” the CN replies and continues, “In my opinion, you should adapt to the working place – to some degree. I have tried it once, I had been busy and had fetched lots of instruments and placed them in the box because he wanted them there. But he never used them. So, I am finished doing that!” [Team 18]

Disrespect

The AN nurses are preparing the patient for anaesthesia. The OR nurses are waiting, and one of them says, “These AN nurses are the sharpest. Look at them!” When asked, “In what sense, sharpest?” the OR nurse replies, “Look at her, look at her rapid movements. She is so rapid and…” She stops talking. The question was repeated, “In what sense? The most proficient or?” The OR nurse explains, “No, they are probably very skilled, but they are also very tough. I don’t say anything. You get yelled at if you do something. I am quiet when I am working with them!” [Team 16]

Inaccurate communication

A newly employed SN prepares for the surgical procedure and the CN [experienced supervisor] asks, “I need to know, should I keep an eye on you?” The SN asks, “What exactly do you mean?” The CN replies, “I am wondering, how far you are in your training and how much can you manage by yourself? Am I supposed to tell you what to do, or do you know what is going to happen?” The SN answers, “I am so far into my training that I know what to do and I would like to do it myself. But you should know that I perhaps need more time to prepare. You should tell me if I need to do something. I would like to do it myself; it is the best way of learning and training for me!” The CN replies, “You have to ask me if you need something.” “Okay, I will do so,” the SN says and continues, “Those articles we are going to use, is it x [hip replacement article]?” The CN answers, “I expect it is, I think, but I don’t know, I have never tried it before!” she shrugs and walks away. [Team 9]

Delayed communication

The CN says to the SG, “Could we talk about the next patient? She is going to have a cementless hip replacement. Do we have what is needed for that surgical procedure?” The SG answers, “I haven’t seen the patient, I must do that first!” The CN groans, “I am nearly losing my overview, we have so many things going on today!” [Team 12]

Finger-pointing communication

The AN nurse enters the OR and says to OR nurse, “I am sorry about my reaction before. It wasn’t good. But it is incredible that we had to stop because the INR hasn’t been controlled [INR levels - an essential component in the management of patients receiving blood- thinning treatment]. We have asked for it all day. So annoying! It is not my responsibility! Someone has been asleep, and so here we are!” [Team 31]