managing lateral violence and its impact on the team nurses and students final
DESCRIPTION
The effects of lateral violence can be catastrophic for students in preceptored relationships. We wanted to promote healthy learning workplaces, and support teaching and learning environments for quality learning outcomes - we delivered in-services on lateral violence to increase awareness and to support positive interactions between nurses and students, while addressing negative communication behaviours and lateral violence.TRANSCRIPT
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inspire Health Care Quality Summit April 11th, 2013 Regina Saskatchewan
Managing Lateral Violence and its Impact on the Team:
Nurses and Students Eli Ahlquist RN MPA
Greg Riehl RN BScN MA
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Outline
• What is lateral violence?
• What causes lateral violence?
• Who is doing it?
• Types.
• Effects.
• What can be done?
• Discussion.
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Objectives
1. Identify terms used to describe negative coworker behavior
2. Describe an experience with negative coworker behavior
3. Discuss strategies to manage negative coworker behavior
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Lateral Violence
• “Exists on a spectrum, from seemingly ordinary
behaviour such as gossiping or criticism, to intimidation, racism and outright physical intimidation or harm.”
Linda Rabyj, 2005
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Definition
Lateral Violence (LV), also called Horizontal violence, Nurse-to-Nurse violence, incivility, and disruptive behaviours, creates an unpleasant work environment and has harmful effects on individual nurses, patient safety, and health care organizations. Johnson, 2009 & Dimarino, 2011
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Building a culture of respect combats lateral violence
• A 2003 study in the Journal of Advanced Nursing found that half of newly qualified nurses report first-hand experience with lateral violence.
Linda Rabyj, 2005
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Who gets targeted?
Anyone who is different from the group norm on any major characteristic
Experience
Education
Race/ethnicity
Gender
Targeted person’s gender
79% Female
21% Male
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Who is Doing the Bullying?
2009 survey by Workplace Bullying Institute:
Main perpetrator’s gender
65% Female
35% Male
2009 WBI survey sited in New York Times:
Men target men and women equally
Women target women 70% of the time
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Why does this happen in the Workplace?
• Isolated from the public and other staff
• High-stress environment
• Limited autonomy in practice
• High-paced environment
• Lack of experienced staff
• Cliques or closely bonded groups
• Hierarchical climate
• Gender imbalance
• Attitudes to training
• Non acceptance of difference
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Why?
Nurses practice in a historically patriarchal environment.
Oppression leads to low-self esteem.
Nurse exert power over one another through lateral violence.
Lateral violence is perpetuated through the culture of nursing (new nurses, curriculum, etc).
“Nurses eat their own”
“See one do one teach one”
We now work with four different generations in the workforce, adding to the complexities of effective communication.
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Who is doing it?
Coworker-on-coworker aggression
Directed toward individuals at same power level
Intended to cause psychological pain
Does not include physical aggression
Intergroup conflict
Shift to shift/class to class/group to group…
Cliques within a workgroup
Department to department
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Conflict It’s not all Bad
Functional Conflict is considered positive, as it can increase performance, support change, and identify weaknesses or areas that need to be supported.
Dysfunctional Conflict is harmful to people and the organization. This type of confrontation does nothing to support goals or objectives.
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Workplace Violence & Harassment
Experts identify two primary categories of lateral violence.
Overt(direct)
Covert (passive)
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10 Most Common Forms of Lateral Violence in Nursing
1. Non-verbal innuendo,
2. Verbal affront,
3. Undermining activities,
4. Withholding information,
5. Sabotage,
Griffin. 2004
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10 Most Common Forms of Lateral Violence in Nursing
6. Infighting,
7. Scapegoating,
8. Backstabbing,
9. Failure to respect privacy, and
10.Broken confidences.
Griffin. 2004
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Mobbing
A group of coworkers gang up on another – often with the intent to force them to leave the work group
Five phases of Mobbing
1. Conflict
2. Aggressive acts
3. Management/Faculty Involvement
4. Branding as Difficult or Mentally ill
5. Expulsion
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Who else is involved?
• Students/Patients
• Quality care
• Nurses
• Co-workers as bystanders
• Preceptors
• Systems
• Employers
• Faculty
• The ‘System’
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Do Nurses eat their young – and each other…
This old adage should not be the price the next generation has to pay to join the nursing profession.
What stories do you want your students to talk about with their peers, co-workers, or at their 5 or 10 year reunion?
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Clinical Settings - Impacts on Patients
• Disruptive behavior linked to:
71%: medical errors
27%: patient mortality
18%: witnessed at least one mistake as a result of disruptive behavior Rosenstein & O’Daniel, 2008
• Ruminating about an event takes your attention off task and leads to increased errors and injuries
Porath & Erez, 2007
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Impacts on Nurses
• Physical
• Psychological
• Social
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Impact on Nurses/Students
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Impacts on Health Systems
• Dwindling workforce
1 in 3 nurses will leave the profession (2003)
• Reduced professional status
• Corrosion of recruitment and retention
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Impacts on Health Systems
Negative Impact on the work environment:
Communication and decision making
Collaboration and teamwork
Leading to:
⇑ employee disengagement
⇓ job satisfaction and performance
⇑ risk for physical and psychological health problems
⇑ absenteeism and turnover
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Impacts on Health Systems cont.
Cost of Lateral Violence:
• “Turnover costs up to two times a nurses salary, and the cost of replacing one RN ranges from $22,000 to $145,000 depending on geographic location and specialty area.”
Jones, C & Gates, M. (2007).
• The lag in time for a new nurse to become proficient is a significant consideration.
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Impacts on Student and Grad Nurses
• Students and grad nurses are extremely susceptible to Lateral Violence and experience more negative impacts than experienced nurses.
• Prevention Strategies are needed
• Top down and bottom up approaches
• Mentoring and investigation systems
• Role Models
• Education
• Empowerment
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We All need to ask ourselves:
“Did I participate in bullying?”
“Did I support this kind of behavior in others?”
“Did I intervene if and when I observed it?”
“We must work to uncover and reverse atrocities, one person, one company, and one law at a time”
Bullyproof Yourself at Work, G & R Namie
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What to do?
• Awareness
• Education
• Dialogue
• Zero tolerance policy
• Be confident
• Develop effective coping mechanisms
• Confront the situation
• Rehearsal
• Enact policy and procedure
• Code of conduct
• Don’t accept it!
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OMG a student Witnesses a Code Pink
• When there is an event that needs handling in the OR a
“Code Pink” is called.
• A group of available individuals from other theaters will come to the perpetrators theater and stand silently staring at them.
• As an example, the surgeon is shouting, being verbally abusive or throwing equipment.
Mehallow, C. Verbal Abuse in Healthcare. http://healthcare.monster.com/nursing/articles/verbalabuse/
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Zero Tolerance Policies
The Joint Commission and the American Association of Critical Care Nurses (AACN).
• 2008: mandate the development and implementation of processes to offset LV that enforce a code of conduct, teach employees communication skills, and supporting staff.
• 2009: advocates that communication skills should be as proficient as clinical skills.
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Culture of Silence
• “Because we set ourselves up to be healers, this kind of behaviour is in the shadows. We don’t know what to do about it, so we try to disown it.”
• In practice, this means nurses can’t stay silent when another nurse’s actions “makes them cringe”.
• Having the conversation is what matters . . . it shows that both professionals share responsibility for behaviour affecting staff and patients.
Monica Branigan, 2009
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Nursing Culture needs to change
• “New nurses personalize their experiences and assume they are unique to themselves”
• "Our program empowered nurses to advocate for themselves. As it liberated them, retention rates improved. We attribute this to recognition of lateral violence. Newer nurses can learn from those who've gone before.“
Dr. Martha Griffin, 2005
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Why Don’t We Stop Lateral Violence?
“It’s not a problem in our work area”
“Everybody does it – just get used to it”
“If I say anything, I’ll be the next target”
“We have policies but they aren’t enforced”
“She sets herself up for getting picked on”
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What can you do?
• Dialogue is ultimately far more effective than pointing fingers
• Cognitive Rehearsal Techniques
• Health care professionals across the spectrum working together more effectively, and patients receiving better care.
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Teamwork and Communication
• Involve everyone in solving problems
related to these issues.
• Develop a set of “RIGHTS” for everyone.
• Effective anti-bullying practices must include a statement of exactly what constitutes bullying.
• Communication needs to be a part of culture.
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Tackling a Culture of Intimidation
• Open communication and increased communication to nursing senior management.
• Providing accessible professional development opportunities for all staff.
• Developing a policy on bullying/lateral violence in the work-place and conflict resolution mechanisms.
• Self-reflection and active feedback from our peers to develop insight into our own b behaviour
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Lateral Violence and Students
https://www.youtube.com/watch?v=fTmyym7_-zQ
http://www.xtranormal.com/watch/11704905/nursenurse-bully
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Discussion, questions, comments!!!
Thank you for your participation
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Contact information
Eli Ahlquist RN, MPA
Program Head
Perioperative Nursing
SIAST, Wascana Campus
Email: [email protected]
Phone: 306.775.7568
Greg Riehl RN BScN MA
Aboriginal Nursing Student Advisor
Aboriginal Nursing Student Achievement Program
SIAST, Wascana Campus
Email: [email protected]
Phone: 306.775.7383
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References available on Request
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