Managing Lateral Violence and its ImpactGreg Riehl RN BScN MA

ACTC Education ConferenceCulture and HarmonyOctober 4th and 5th, 2012

Outline

• What is lateral violence?

• What causes of lateral violence?• Who is doing it?

• Types.

• Effects.

• What can be done?

• Discussion .

Objectives

1. Identify terms used to describe lateral violence.

2. Increase awareness.

3. Explore experiences with lateral violence.

4. Discuss strategies to manage lateral violence behavior.

Objectives

1. Describe the concept of lateral violence.

2. Recognize the presence of lateral violence in the workplace.

3. Apply current concepts believed to underlie lateral violence as a workplace problem.

4. Describe methods of dealing with lateral violence in the workplace.

Honesty Change Hope

Prisoners, vacationers, keeners,

Communication will be key for today’s work on Lateral Violence

We have 2 ears and one mouth, listening should always be 2:1

I do not have the power to fix Lateral Violence, but you do.

Bullying in School – is this learned?

Our politicians spew hate and lies and cannot work together

Our newscasts report violence first and foremost

Youth are preoccupied with violent video games and media in general

These negatives often outweigh any positive examples students encounter.

Myths

Lateral Violence can’t happen to me

Lateral Violence can’t be prevented

Dealing with Lateral Violence

Dealing with lateral violence is dealing with poorly expressed anger. Poorly expressed anger can be due to failure to recognize anger and take constructive action when possible or failure to find healthy ways to blow off some of the anger-related stress or failure to discuss the precipitating cause of the anger.

Expressing internalized anger is associated with less stress and depression, more optimism, and a stronger sense of self-efficacy.

(Thomas, 2003, 108).

Lateral Violence

• Exists on a spectrum, from seemingly ordinary behaviour such as gossiping or criticism, to intimidation, racism and outright physical intimidation or harm.

Definition for Where I Work

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

Who gets targeted?

Anyone who is different from the group norm on any major characteristicExperienceEducationRace/ethnicityGender

Targeted person’s gender79% Female21% Male

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

Canada ranks 4th in the world in workplace violence, USA 7th, Argentina #1

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”

Why?

Some professionals can receive preferential treatment from administration.

Crowded working conditions

Overworking conditions

Too many demands

Mistrust between experienced staff and the new staff

Mistrust between subordinate and supervisor

Ineffective classroom and or practice management skills

Luparell 2008

Who is doing it?

Coworker-on-coworker aggressionDirected toward individuals at same power

level

Intended to cause psychological pain

Does not include physical aggression

Intergroup conflictShift to shift

Cliques within a workgroup

Department to department

Risk Factors for Violence in Health• Working directly with volatile people especially if they are under the

influence of drugs or alcohol or have a history of violence or certain psychiatric diagnoses

• Working when understaffed especially during mealtimes, visiting hours, and when on call

• Transporting patients

• Long waits for service

• Overcrowded, uncomfortable waiting rooms

• Working alone

• Poor environmental design

• Inadequate security

• Lack of staff training and policies for preventing and managing crisis with potentially volatile patients

• Drug and alcohol abuse

• Access to firearms

• Unrestricted movement of the public

• Poorly lit corridor, rooms, parking lots, and other areasGoode, D. & Napolitano, L. (2007). Statement on violence in the workplace: the council on surgical & perioperative safety. Journal of perianesthesia nursing. 24(2), 72-74.

Warning Signs

Drugs and alcohol abuse

Gambling

Addiction

Sudden shifts in behaviour

Job performance goes down

Threats of violence

Preoccupation with violence

Co-workers complaining

Workplace Violence & Harassment

Experts identify two primary categories of lateral violence.

Overt(direct) Covert (passive)

Lateral Violence Overt

Verbal abuse from coworkers, abrupt responses, vulgar language

Refusing to perform assigned tasks, reluctance or refusal to answer questions, return phone calls or pages

Shouting, yelling or other intimidating behaviour

Physical violence Temper-tantrums Physical abuse, throwing, pushing &

inappropriate body contact

Lateral Violence Covert - Passive

Judging others on age, gender, sexual orientation, ethnicity or size

Failure to respect privacy, and broken confidences

Blaming and gossiping behind someone’s back Scapegoating and humiliation, Infighting and bickering Sabotage such as setting up a new hire for failure Withholding needed information or advice, or

taking credit Obnoxious behaviour making people feel

inadequate

10 Most Common Forms of Lateral Violence Where I Work

1. Non-verbal innuendo,

2. Verbal affront,

3. Undermining activities,

4. Withholding information,

5. Sabotage,

Griffin. 2004

10 Most Common Forms of Lateral Violence Where I Work

6. Infighting,

7. Scapegoating,

8. Backstabbing,

9. Failure to respect privacy, and

10. Broken confidences.

Griffin. 2004

Cyber Lateral Violence

Cyber bullying through email, internet, and social media, not just student to student . . .

Sometimes when you try and ‘fix’ things, you end up being the bully

Sending emails without greetings

CAPS LOCK, BOLD, etc

Words and Tone can cause a lot of trouble!!!!!!!!!!!!!!!!!!!!!!

What about ‘Sticks and Stones may break my bones, but names will never hurt me?” do you teach this? Does this work with freedom of speech and charter rights?

Mobbing

A group of coworkers, or students gang up on another person – often with the intent to force them to leave the group.

Emotional abuse committed directly or indirectly by a group

Five phases of Mobbing1. Conflict

2. Aggressive acts

3. Management Involvement

4. Branding as Difficult or Mentally ill

5. Expulsion

Who else is involved?

• Students? Parents? Friends?

• They may accept bad behaviors they witness because they believe professionals who display disruptive behaviors are very skilled, really care, and are aggressively advocating in their best interest.

Bystanders, Managers, Leaders

Sometimes staff witness lateral violence events but are not prepared to support their colleague for fear that they might be the next victim.

Ignoring the victim’s behavior & distress often seem to be the way staff and organizations respond to the issue.

There may be a style of management at various levels and within institutions that is based on fear rather than respect.

"Lateral violence cannot thrive when employers become ethically and legally responsible."

Dance of Incivility

… A dynamic interaction between people in conflict. When viewed as a dance rather than a struggle for power and control, the potential for healing is enhanced.

Health Impacts on Victims

• Physical/Body

• Emotional

• Mental/Mind

• Spiritual

Do Nothing

Research shows how targets deal with being bullied; "not doing anything about it (the bullying) was the most common method taken by a target in response to being bullied.

And, reporting the bullying or making a complaint were reported to be the most unsuccessful method taken in trying to resolve bullying.

The action deemed most successful by respondents were "no action" and "seeking a new job","

Impacts on Systems Negative Impact on the work environment:

Communication and decision makingCollaboration and teamwork

leading to:⇑ employee disengagement⇓ job satisfaction and performance⇑ risk for physical and psychological health

problems⇑ absenteeism and turnover

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

What to do?• Awareness

• Education

• Dialogue

• Zero tolerance policy

• Be confident

• Develop effective coping mechanisms

• Confront the situation

• Rehearsal

• Monitor for bullying groups/cliques

• Carefully select new employees

• Enact policy and procedure

• Refuse to be a victim

• Listen

• Code of conduct

• Don’t accept it!

Safe Place

Where is the safe place where you work?

What makes it “safe”?

Will you be able to respond to lateral violence when it happens?”

Cultural Security

A culturally secure environment cannot exist where external forces define and control cultural identities. The role for government and other third parties in creating cultural safety is ensuring that our voices are heard and respected in relation to our community challenges, aspirations and identities.

In this way cultural security is about government and third parties working with us to create an environment for a community to ‘exert ownership of ourselves’. Through this ownership we are empowered.

http://www.hreoc.gov.au/social_justice/sj_report/sjreport11/chap4.html

How do we deal with the stress?

75% talk to family, friends, colleagues

50% experience a desire to resign

49% lose interest in job, disengage

23% use more sick time

35% use formal channels 23% HR representative

12% Union or professional organization representative

Paulo Freire Methodology:

• In Pedagogy of the Oppressed, Freire says:

• SEE the problem or situation lived by clients

• ANALYZE the factors (personal, cultural, institutional) that contribute to the problem

• ACT to change the problem or situation

Colonialism is not over

The colonized man will first manifest this aggressiveness which has been deposited in his bones against his own people. This is the period when the [ ] beat each other up, and the police and magistrates do not know which way to turn when faced with the astonishing waves of crime in North Africa. ... While the settler or the policeman has the right the livelong day to strike the native, to insult him and to make him crawl to them, you will see the native reaching for his knife at the slightest hostile or aggressive glance cast on him by another native; for the last resort of the native is to defend his personality vis-a-vis his brother.

Pedagogy of the Oppressed, Freire

Lateral Violence in Students

The truth is that most of the violence in the world is committed not by bullies but by victims!

A student sees himself as a victim. He used to be the victim of the kids who enraged him by calling him names. Now, in addition, he feels himself to be the victim of the crooked adult society.

Society takes his tormentors' side against him and punishes him for trying to stop his bullies. He is now angrier and therefore more dangerous than before the wise adults disciplined him for being a bully!

Victims Bullies Hero’s

DESC COMMUNICATION MODEL

• Describe – the behavior

• Explain – the effect the behavior has on you, coworkers, patient care

• State – the desired outcome

• Consequences – what will happen if the behavior continues?

Are certain workplaces more susceptible?

Mellington believes there may be certain workplaces that are more susceptible to workplace bullying. Key indicators of what should be looked for are:

organizational change (such as a takeover or change in management);

workplace characteristics (for example, a greater representation of minority groups or high job instability and uncertainty about on-going employment);

workplace relationships (including low levels of consultation or poor communication); and

work systems and structures (for example, no policies or procedures, no clear job descriptions or insufficient training).

Culture of Silence

Because we set ourselves up to be healers, or helpers, 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 that we can’t stay silent when another person’s actions “makes us cringe.

•Having the conversation is what matters . . . it shows that both professionals share responsibility for behaviour affecting staff and students.

My Culture needs to change

• New nurses personalize their experiences and assume they are unique to themselves," she says.

• "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."

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”

What can you do?

• Dialogue is ultimately far more effective than pointing fingers

• Cognitive Rehearsal Techniques

Model the behaviour that you wantWhen adults deal with problems with violence, children learn to deal with their problems the same way, isolation, violence, etc.

http://www.authorsden.com/visit/viewArticle.asp?id=46624

What do we do with bullies?

Kick them out? Discipline? Isolate them? Dissocialize them?

Similar to a criminal, who has broken the law, punishment rarely has positive consequences

Dignity + Respect = no bullying

Dignity + Respect = no bullying

The solution or approach to address bullying is to promote its real enemy - dignity and respect;

because with these principles, bullying can not prevail.

Bullying is ultimately about isolation - isolating workers and making them feel inadequate. If this is so, then the antidote to bullying lies in working together.

Emotions

Anger is the emotion behind violence. It is the desire to destroy or defeat an opponent.

Our anger not only makes us become enemies, it escalates the problem and makes others continue doing exactly what we don’t want them to do!

It is time for us to start teaching our children, from the earliest ages, what Freedom of Speech really is. This means we have to solve our routine conflicts with our family members, our colleagues, and our students, without getting angry over the words they say.

Rehearsal

Research has demonstrated the benefit of rehearsal for new employees experiencing lateral violence.

i.e.

When a staff member makes a facial gesture (such as raising an eyebrow), the participant was instructed to say, “I see from your facial expression that there may be something you wanted to say to me. It’s OK to speak directly to me”.

Griffin, M. (2004) Teaching Cognitive rehearsal as a shield for lateral violence: An intervention for

newly licensed nurses. Journal of Continuing Education in Nursing, 35(6), 257-263.

Confront Behaviour . . . Really?

• If one speaks critically or takes a questioning stance then one may be positioned as disloyal, ungrateful or may even be labeled as the bully.

• The way forward is to focus on implementing strategies to reduce the opportunities for bullying behavior to occur.

• Take personal responsibility for the situation.

Confront Behaviour

• Confront behavior and acknowledge if it has been there for a long time but was never discussed.

• Take personal responsibility for the situation.

• Try to reach consensus to actively bring about change by developing, publishing, and implementing strategies.

• Some people are shocked to discover that they actually contribute, either inadvertently or otherwise, to a bullying culture by their actions or inactions.

Teamwork and Communication

• Teamwork in this area involves many staff in solving problems related to these issues.

• Policy documents on bullying and intimidation need to be developed. • Specify the sorts of behavior that will not be

tolerated, and include, within the policy, the "rights" of individuals to be treated fairly and with respect.

• Effective anti-bullying practices must include a statement of exactly what constitutes bullying.

• We need to work with everyone, bullies, targets, and bystanders.

Tackling a Culture of Intimidation

• Developing more open communication and increased access to senior management.

• Ensuring that supervisors receive adequate training and support for their role.

• Ensuring that policies refer specifically to managing bullying & that these standards are maintained through an effective performance management system.

• Providing accessible professional development opportunities for all staff.

• Developing policy on bullying/lateral violence in the work-place and conflict resolution mechanisms.

Discussion, questions, comments!!!

Thank you for your participation

Workshop

Objectives

1. Explore personal and community awareness of lateral violence.

2. Describe an experience with lateral violence behaviour.

3. Discuss strategies to manage lateral violence behaviour.

Review Workplace Bullies

Sydney-based clinical psychologist and workplace bullying specialist Keryl Egan has formulated three workplace bully profiles: the accidental bully, the narcissistic bully, and the serial bully. Egan describes the accidental bully as emotionally blunt, aggressive and demanding. "This person is task orientated and just wants to get things done, tends to panic when things are not getting done, and goes into a rage about it. This person is basically decent, they don't really think about the impact of what's happened or what they have done. They are responding to stress a lot of the time." Importantly, Egan believes this type of bully can be trained or coached out of the bullying behaviour.

Three Workplace Bullies

The second profile formulated by Egan is the narcissistic bully, who is grandiose and has fantasies of breath-taking achievement. "This type of bully feels they deserve power and position. They can fly into rages whenever reality confronts them. This person is very destructive and manipulative, they don't set out in a callous way to annihilate any other person - it's purely an expression of their superiority."

Three Workplace Bullies

Finally, Egan's third profile is that of the serial bully "who has a more sociopathic or psychopathic personality. This type of bully is intentional, systematic, and organised and the bullying is often relentless. They usually get things done in terms of self interest, not in the interest of the company." Egan's serial bully employs subtle techniques that are difficult to detect or prove and training or coaching is always unsuccessful; simply, the serial bully is often: grandiose yet charming, authoritative, aggressive and dominating, fearless and shameless, devoid of empathy or remorse, manipulative and deceptive; impulsive, chaotic or stimulus seeking; and a master of imitation and mimicry.

DESC COMMUNICATION MODEL

• Describe – the behavior

• Explain – the effect the behavior has on you, coworkers, patient care

• State – the desired outcome

• Consequences – what will happen if the behavior continues?

Goal

This is for you to decide . . .

Cycle for program development

1. PROBLEM DEFINITION VALUES/NEEDS

► Community values are key in identifying problems.

► In sub-groups, describe your community’s values when it comes to lateral violence.

► How do you feel about lateral violence?

► What is the perception of the situation within the community?

► What does your community need in order to reach the goal?

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1.Problem DefinitionSpecificity, values,

define needs

2. Problem Analysis

3. Work Plan

5. Evaluation

4. Implementation of the Action Plan

Small Group Work

In sub-groups, describe your community’s values when it comes to lateral violence.

How do you feel about lateral violence?

What is the perception of the situation within the community?

What does your community need in order to change?

Defining the Problem

Examples of VALUES & Community SPECIFICITIES facing lateral violence

•Importance of the elders as role models.

•Role of enlarged family (grand-parents, parents and children).

•Conservative communities are not overly enthusiastic about hearing more ‘bad’ news.

•FEAR of the unknown.

•Judging, stigmatizing, isolation of bullies and victims.

•Don’t know that there is even a problem.

•Not much dialogue or communication among community members.

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Defining the problem

• We need to learn about the services available and services needed.

• We need to stop the propagation of lateral violence among each other.

• We need to reduce the risk factors and increase communication.

• We need to know who’s affected. Bullies, victims, targets, and heroes.

• We need to better accompany our community members.

Confrontation is difficult but results in the resolution of lateral violence behaviour.

Cognitive Rehearsal Techniques

• Recognize the behavior when it occurs

• Plan ahead for ways to respond

• Practice new responses before you need them

Questions

Have you witnessed anyone practice lateral violence since you have started your employment?

Did you respond to the lateral violence when it happened?

What tools have you used to respond to lateral violence?

Have you ever thought about leaving your position at the school?

Did any of the lateral violence keep you from learning what you needed to know?

Do you have any recommendations?

Contact information

Greg Riehl RN BScN MA

Aboriginal Nursing Student Advisor

Aboriginal Nursing Student Achievement Program

SIAST, Wascana Campus

Email: greg.riehl@siast.sk.ca

Email: gregriehl@sasktel.net

Ph:  306.775.7383 w

Ph: 306.529.4783 c