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A word of praise a scarce commodity “I need some strokes.”

It was a plaintive cry. Praise. Compliments. Positive feedback. Recognition. We all need it. Yet, it seems to be a scarce commodity. In contrast, flack is cheap and easy to come by. We hear quickly about the negative, the mis- takes, the things that go wrong. We don’t hear so readily about what turned out well. Bad news travels fast; good news sometimes never arrives.

Is it just human nature? As parents, we are quick to scold and criticize. We are slower to praise our children. They might get a swelled head. But we don’t consider that if we are overly critical, we may destroy their self- confidence. As supervisors, we are quick to point out faults and areas for improvement. We are slower to reinforce the virtues and tasks well done.

It is easier to recognize the negative. The positive is more elusive. We are confident in our judgment when we spot a flaw or mistake. But if we praise a job as well done, we might be wrong. We don’t want to have our judgment exposed by a bit of misplaced praise. A botched job often calls attention to itself. The consent form is wrong, the instrument is miss- ing. Phones ring, voices raise. When a job or procedure goes well, no mishap calls our at- tention to it.

Nurses have been criticized for not giving each other support, for looking to physicians for recognition or reward. Elliott writes:

In the operating room, competition for the surgeon’s praise often runs counter to col- laborative praise for nurse colleagues . . .

Nurses seek positive reinforcement from surgeons for a job well done because they are not accustomed to expressing positive feelings for each other and because the medical profession’s approval seems more prestigious.’

She also says that women often feel uncom- fortable with positive feelings, especially to- ward other women. “When,” she asks, “was the last time you openly and directly expressed genuine positive feelings for a job well done by another nurse without feeling threatened?”2

Lack of collegial support is a vestige of the handmaiden role-the nurse in a position of subordination and dependency on the physi- cian. But women’s attitudes are changing. They communicate more and look to each other for support. They are less dependent on the male-dominated society. Yet, they appar- ently do not feel completely comfortable in peer relationships. Looking at requirementsfor certification, one nurse questioned whether validation or peer review would be a psychological stumbling block for nurses. Would nurses find it difficult to make a bal- anced assessment of their colleagues’ profes- sional practice? It is sometimes easier to criticize negatively rather than evaluate posi- tive characteristics and practices. Yet by posi- tive reinforcement, nurses can strengthen each other’s professional self-confidence.

I am sure most of you can remember some time in your career when a teacher, a super- visor, or a colleague provided encouragement and support that gave you direction. The comments made you realize that you were really “good” at what you were doing. Positive comments often encourage a person to de- velop a skill or interest. If an OR nurse believes she is doing good patient assessments, she

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will make an effort to develop her natural abilities by learning more about interviewing or perhaps by studying the psychological re- sponses of surgical patients.

Praise doesn't always have to come down from on high. It can be just as effective travel- ing in the opposite direction. (A caution-the same does not necessarily apply to negative comments.) Your supervisor might appreciate knowing that you think she has done a good job or handled a problem well. It can help to reinforce her strong points. Do you ever think to tell a surgeon he did an exceptional job? He,

too, may benefit from some good words. A few positive words can have an amazing

effect. They can make people smile, feel more positive and confident, and work better. Try it.

Elinor S Schrader Editor

Notes 1. M Dianne Elliott, "Assertion opens options for

OR nurses," AORN Journal 28 (August 1978) 222. 2. /bid.

Surgery Factbook released by ACS The American College of Surgeons (ACS) has published its 1979 edition of the Socio-Economic Factbook for Surgery. The 95-page booklet provides descriptive and statistical information on surgical manpower, use of medical services, and medical economics. The data presented are not originated by the ACS, but are drawn from secondary sources such as the American Medical Association, the American Hospital Association, and the US Department of Health, Education, and Welfare.

Summarized below are highlights of the Factbook:

Medical Education. Between 1949-1 950 and 1977-1978, the total number of medical students in the US increased 141%. In 1949-1 950, women represented 7% of the total number of medical students; by 1977-1 978, they represented 24% of the total. In 1969-70, surgical residents made up 40% of all residency positions while in 1976-1 977, the percentage of residents in the surgical specialties was 31%. The percentage of residents in primary care specialties has increased from 26% to 42% in the same period.

Surgical Manpower. In 1977, there were 194 physicians per 100,000 population in the US, 47 surgeons per 100,000 population, and 65 primary care physicians per 100,000 population. Of the 101,153 surgeons in 1977, 3,720 (4%) were women, and 17,381 (1 7%) were foreign medical

graduates.

operations increased 34% from 15.8 million in 1971 to 21.2 million in 1977. The rate of tonsillectomies and adenoidectomies per 1,000 population decreased from 4.8 in 1971 to 2.9 in 1977. Appendectomy, which ranked as the ninth most frequently performed procedure in 1971, is no longer among the ten most frequently performed operations. The rate per 1,000 population for biopsy, dilatation and curretage, and hysterectomy have all increased from 1971 to 1977. In 1977, cesarean section was performed at the rate of 21.1 per 1,000 population and ranked eighth among the ten most frequently performed procedures. In 1971, cesarean section was not among the top ten.

Health Expenditures. National health expenditures increased from $69.2 billion in 1970 to $1 92.4 billion in 1978-an increase of 178%. Expenditures by the private sector increased 16O%, while expenditures by the public sector increased 217%. The federal portion of public expenditures increased from $13.4 billion to $46.5 billion, or 247%.

The Socio-Economic Factbook for Surgery, 7979 is available free of charge from the Department of Surgical Practice, American College of Surgeons, 55 E Erie St, Chicago, 111 6061 1.

Operations. The total number of

574 AORN Jourriol, March 1980, V a l 31, No 4