Zero Tolerance for Lateral Violence:

Changing the Culture of Nursing

Practice

Welcome to Today’s Webinar

Lori Ingram MSN, RN, CNOR, CNML

• Lori Ingram is the Nurse Manager of PeriOperative Services at Novant Health Matthews Medical Center, in

Matthews, NC. Her responsibilities include overall accountability for operations of the OR, Admission & Discharge

Area, PACU, Sterile Processing, Endoscopy, Lithotripsy and Pain Management services. During her perioperative

career, Lori has held the positions of Nurse Manger, Clinical Nurse Specialist, Educator and staff nurse. Lori holds

specialty certification in the OR (CNOR) and in Nursing Management & Leadership, (CNML).

• Lori is an active member of the Dogwood Chapter of AORN, is the immediate past president and is the Chair–

Elect for the North Carolina Council of PeriOperative Registered Nurses, where she is actively involved in the

legislative efforts focused on the RN Circulator Bill passage. Lori has presented at AORN Congress and

presented two research posters at Congress. Lori was a member of the AORN National Congress Planning

committee for three years and is currently a member of the AORN National Committee on Education. She is also a

member of Sigma Theta Tau, the American Organization of Nurse Executives (AONE), and the American Society

of PeriAnesthesia Nurses (ASPAN). Lori has received the NC Council and the Georgia Council of OR Nurses,

Perioperative Nurse of the Year Award and was selected as one of the “Great 100” Nurses in NC. She is a

recipient of the Novant Health Circle of Excellence Award.

• Lori had a research article published in Journal for PeriAnesthesia Nursing and received the third place editor’s

award for research articles in 2012. She has another research article accepted for publication in 2014. She enjoys

participating with her perioperative colleagues in research and evidence based practice initiatives, along with

mentoring new nurses in the OR and encouraging their career growth.

Judith Seltzer, MS, BSN, RN, CNOR

• Judith Seltzer is the Surgical Clinical Director, National Accounts for Molnlycke Health Care. Her responsibilities include education,

program development, and research facilitation regarding latex allergies, glove powder, barrier protection issues and antiseptic agents.

This includes planning, producing and implementing clinical education for nurses and other health care professionals. Judi also serves as

an expert clinical specialist for acute and non-acute healthcare facilities, and hospital administrative professionals. Judi is based in the

Mid-Atlantic, and provides clinical expertise for the US Surgical Molnlycke Health Care team.

• Judi received both her Bachelor’s and Master’s degrees in Nursing Informatics from the University of Maryland School of Nursing. During

her career as a perioperative nurse, she has held the position of Nurse Manager of Cardio-thoracic Services, Clinical Educator of

Perioperative Services and Professional Development Coordinator. During her tenure, Judi was responsible for the development of many

educational offerings. She was awarded the University of Maryland Medical Center’s President’s Award in 2001 for the implementation of

a Surgical Technology program working in partnership with the University of Maryland Medical Center and the City of Baltimore’s Office of

Employment Development within the Mayor’s Office.

• She is a member of the Baltimore, Maryland chapter of the Association of periOperative Registered Nurses (AORN) during which she

presented a poster presentation for the 2004 and 2011 AORN Congress. Judi is also a member of the Baltimore APIC chapter. In

addition, she is a member of the Sigma Theta Tau International Honor Society of Nursing. Judi has held faculty nursing appointments at

Villa Julie College and Baltimore City Community College in Baltimore.

• Judi has had several publications including, Advance for Nurses, Forming a Perioperative Consortium, (1999); AORN, Initiating a Clinical

Research Project in the Operating Room (2001); AACN Clinical Issues, Awareness of Surgical Site Infections for Advanced Practice

Nurses, (2002) and Perioperative Nursing Clinics Skin Antisepsis: First Line of Defense / Set Skin Preparation in Motion before the

Incision (2011). Most recently, she is the chapter author of Infection Control Principles for Long-term Care Environments and Infection

Control in the Ambulatory Surgical Centers, in a recently published text book titled: Infection Control for Advance Practitioners, edited by

Denise Korniewicz, 2013.

• She continues to speak across the country for AORN chapters including the AORN Fall Conference (2007) in San Antonio, Texas; AVIR

conference in Washington, DC in (2008), AORN Congress in Denver (2010) and AORN Congress in New Orleans (2012) where she

presented Nurses in Industry on the Move: Transatlantic Differences While Competent Nursing Practices Prevail. Judi is a member of the

AORN National Committee on Education (NCE) and most recently accepted the position of Chairperson of Communications for the

AORN Business and Industry SA Committee (BIC).

Angela Walsh, MA, BSN, RN,CNOR

• Angi is an active member of Massachusetts Chapter I (37 years). She is currently a Perioperative

Clinical educator in a 497 bed teaching hospital. She is a Master TEAMStepps Trainer, Certified

Bariatric Surgery Support Group Facilitator and avid quilter.

• Angi has held a variety of education positions both in the clinical (patient & staff ed) and

classroom (RN, surgical technologist & high school) setting over the past 37 years. Angi has a

masters degree in Critical & Creative Thinking with emphasis on Patient & Family Education, and

is currently facilitating a Perioperative 101 “Grow Your Own“ training program to provide internal

succession.

Disclosure Information

Speaker:

Lori Ingram, MSN, RN, CNOR

Judi Seltzer, MS, BSN, RN, CNOR

Angi Walsh, MA, BSN, RN, CNOR

All Speakers Disclose No Conflict

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AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019.

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Planning Committee:

Susan D. Root, MSN, RN, CNOR

Manager Perioperative Education, AORN

Discloses No Conflict

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in a company providing grant funds and/or a company whose product(s) may be discussed or used

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Successful completion of this educational activity includes attendance at 90% of the webinar and completion of the

evaluation form.

• Discuss three assessment skills nurses can

utilize that will alert them to potential dangers

from lateral violence within the workplace

and at home.

• List five of the most prevalent examples of

lateral violence and bullying occurring in the

workplace today.

• Identify three strategies for achieving

professional and personal emotional health.

Objectives

Take Out….

Objective 1:

Discuss three assessment

skills nurses can utilize that will

alert them to potential dangers

within the workplace and at

home.

Situational Awareness

Recognize Higher Risk Environments:

• Healthcare workers / Service focus

• Working with volatile/unstable people

• Working in Isolated Areas or Alone

• Working Late at night

• Working in High Crime Rate Areas

Workplace Violence can strike

Anytime, Anywhere.

Disruptive Behavior

Recognizing Early Warning Signs:

• Mood changes, behavior out of character

• Increased aggressive behavior

• Passive-Aggressive behavior

• Uncooperative or intimidating behavior

• Verbal outbursts or abusive language

• Physical threats

Imminent Violence

Recognize Non-Verbal Cues:

• Lowering of the head

• Tucking in the chin so the bottom

whites of the eyes are showing

• Clenching & Re-clenching fists

• Touching their head or pulling hair

• Difficulty controlling fine motor skills.

2 Million American workers are victims of workplace

violence each year. (OSHA -Workplace Violence, 2012)

Take Out….

Objective 2:

List five of the most prevalent

examples of lateral violence

and bullying occurring in the

workplace today

Consequences

Absenteeism

High Turnover

Job dissatisfaction

Poor performance

Change in work culture

Increased medical errors

Perpetuated By…

• Physicians

• Nurses

• Managers

• Allied Health

Providers

• Patients

STRESS

ADDICTIVE

BEHAVIOR

POOR

MANAGEMENT

SKILLS

WHAT WOULD YOU DO?

On one particular night, the shift included three nurses: a

newly licensed nurse, her preceptor who spoke English

as a second language, and another nurse who also

spoke the preceptor’s native language and English as a

second language.

The newly licensed nurse felt that the two experienced

nurses were talking about her shortcomings in their

native language and that they excluded her from general

conversation for the entire shift.

Doreen, an experienced new RN

The MD

Jill, the circulator

Take Out….

Objective 3:

Identify three strategies for

achieving professional and

personal emotional health

Calling out the Elephant in the room…Objective 3: Lateral Violence

Identify three strategies for achieving

professional and emotional health

Sincox, A & Fitzpatrick, M, Michigan Nurse, 2013. Lateral

violence: Calling out the elephant in the room

Workplace Violence Incidence

1.7 million healthcare workers annually

Acute care

Nursing Homes

Is it simply part of the

job?

How Can You Stop It?

De-Escalation Techniques

Training on Reporting

Written and Implemented Policies

Nursece4less.com, 2013

Guidelines for Preventing Workplace Violence for Health Care and Social Workers, OSHA , 2012

Better Patient Assessment

Access: In and Around

Environment

Staff Issues and

Consequences

Environment of Care Processes

Constructive Peer Relationships

“Eating Our Young”

Code of Conduct

Color Code

OSHA WHOJoint

CommissionAORN AACN ANA ENA

Guidelines for Preventing Workplace Violence for Health Care and Social Workers, OSHA , 2012

Nursece4less.com, 2013

Recognize early behavior signs

Immediately Initiate defense

actions

Assemble crisis response kits

Create a Continuity of

Operations Plan (COOP)

Have a well developed plan on

hand

Know when

Violence is

ImminentIncorporate

early

defensive

action

Be familiar with Law

Enforcement

responses

Educate and Train

LiveProcess Emergency Preparedness, January 2013

Key Take Away

Workplace violence between patients and staff; as well as between staff with other staff members is a phenomenon affecting every country, and every workplace.

Make the changes necessary in your workplace to stop the Violence Now!

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