One of Northern Ireland’s most senior nurses has described a leaked inspection report into the Royal Victoria Hospital’s cardiac unit as “really damning”.

The report said that an “apparent power battle” has been unfolding between some senior doctors in the cardiac unit of the Royal Victoria Hospital in Belfast.

Royal College of Nursing (RCN) executive director, Rita Devlin, said the behaviour nurses had to deal with was “shocking”.

The Belfast Health Trust said its cardiac unit was “clinically safe with excellent outcomes”.

An independent review of the service was undertaken last year following long-running concerns about the culture, earlier in May UTV reported the review had concluded that behavioural issues were creating a significant risk to patient safety.

BBC News NI has now seen a leaked copy of the report, which lays bare bullying allegations and claims of a lack of trust among staff.

Some 70 staff spoke anonymously and the report states there are “clear tensions” between different groups of staff.

The report also detailed the throwing of instruments during surgery as well as “verbal abuse”, which in one case had resulted in an incident report in recent months.

“This behaviour is ongoing at the time of writing this report and was widely reported by all who worked in the theatre environment,” it added.

“Whilst there is one consultant who is particularly prone to throwing instruments in theatre, we were told that this behaviour is not unique.

“Staff described that the most common triggers for criticism were based around equipment and staffing. These patterns of behaviours were reported by staff as occurring on a predictable and repeated basis.”

The report said nursing staff presented an “invaluable source of observation of behaviours and practice within the department, as they are independent of the apparent power battle which has been unfolding between senior consultant medical factions”.

“It is the nursing staff in theatres who have borne the brunt of the bullying environment that all staff have been exposed to.

“Members of all professional groups interviewed reported that the atmosphere in theatres was tense and that some felt this pressure more than others.

“This precipitated some completely unacceptable behaviours, that were widely reported as being predominantly directed at the nursing staff, particularly more junior nurses.”

Rita Devlin, executive director of the RCN in Northern Ireland, said the “shocking” behaviour that nurses have to deal with “has been going on for so long”.

“And that means the result is we have this really damning report that we’re seeing today and the behaviours have gone unchecked and unchallenged,” she said.

Speaking to BBC Radio Ulster’s Talkback programme, she added: “We would have experienced behaviours like this from surgeons maybe 20, 30, 40 years ago”.

“What shocks me is that it’s still going on and what shocks me is somewhere like the Belfast Trust allowing it to happen, turning a blind eye and a deaf ear to the complaints that were being raised.”

The report also referenced powerful quotes from interviews with staff, including: “Nurses are often piggy in the middle, trying to referee disputes between surgeons and anaesthetists” and “I feel I have a target on my back”.

In one section of the report, one occasion was outlined where a management decision resulted in a brief period of unannounced absence by four of the cardiac surgeons.

Staff described the unit as being in “chaos” and said “even patients who had been prepped for theatre were cancelled as nursing staff tried to get hold of the consultants”.

In its conclusion, the report says the department is safe based on metrics, such as mortality data.

However, it goes on to say that cultural issues in the unit represent a significant risk to patient safety.

“We do believe, however, that there are areas where patients are placed at risk of harm, or where harm has occurred, as a result of tensions, poor behaviours and a severe reluctance amongst staff to raise concerns,” the reviewers said.

The Belfast Trust said: “We are reassured that the independent external review contains a universal recognition of the technical competence and clinical skills of all staff who work there.

“However, the trust fully acknowledges that the details in this independent review are appalling and the behaviour described within it is shocking and indefensible.”

The former chief executive of Northern Ireland’s Health and Social Care Board John Compton told Good Morning Ulster the report would raise “questions about leadership”.

“Problems of this nature don’t occur between a Friday night and a Monday morning,” he said.

They have been simmering, I would suggest for some considerable time”.

“The danger that this report has pointed out is that patients no longer become the centre of the unit, the centre of the unit becomes the personal, interpersonal relationships between senior staff, the behaviours that occurs between senior staff and junior staff in the middle of all of that and that carries with it an undoubted risk of patients’ safety.”

He said the implications were “profound” for the unit itself, the Trust and the Northern Ireland health and social care system.

“This is as difficult a read as you could possibly ask in terms of those sorts of reports”, he said.

Unison’s Patricia McKeown said for the people working inside the cardiac surgery unit “the very idea that you cannot face going to work because of a toxic atmosphere is utterly unacceptable”.

She told Good Morning Ulster that “this is not new, it’s not confined to one department, one hospital or indeed one Trust”.

“It’s a cultural problem that needs to be seriously tackled from the top and it hasn’t been,” she said.

She added that unison has experienced 20 years of “serious grievances” front line and support staff aimed at the “behaviour of some senior clinicians”.

“This behaviour includes bullying, harassment and quite a lot of it is rooted in misogyny and in racism…a statement we can back up with evidence,” she said.

The vice chairman of the Northern Ireland Assembly health committee said he was “absolutely appalled” by the report.

“To hear that surgeries were cancelled and that patients did not get there surgeries in a timely manner is incredibly concerning,” Danny Donnelly said.

The Alliance Party MLA described the behaviour as “unprofessional and almost unbelievable” and the throwing of instruments as “shocking”.

On Tuesday, Health Minister Mike Nesbitt described the situation as “appalling” and said behaviours must change.

The unit is a regional service for patients across Northern Ireland, with almost 1,000 operations carried out every year.