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.
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Managing lateral violence and its impact on the team nurses and students final
1. 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
2. Outline
โข What is lateral violence?
โข What causes lateral violence?
โข Who is doing it?
โข Types.
โข Effects.
โข What can be done?
โข Discussion.
3. 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
4.
5. Lateral Violence
โข โExists on a spectrum, from seemingly ordinary
behaviour such as gossiping or criticism, to intimidation,
racism and outright physical intimidation or harm.โ
๏ Linda Rabyj, 2005
6. 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
7. Building a culture of respect
combats lateral violence
โข 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
8. Who gets targeted?
๏ Anyone who is different from the group
norm on any major characteristic
๏ Experience
๏ Education
๏ Race/ethnicity
๏ Gender
๏ Targeted personโs gender
๏ 79% Female
๏ 21% Male
9. Who is Doing the Bullying?
๏ 2009 survey by Workplace Bullying Institute:
๏ Main perpetratorโs 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
10. Why does this happen in the
Workplace?
โข Isolated from the public and other staff
โข High-stress environment
โข Limited autonomy in practice
โข High-paced environment
โข Lack of experienced staff
โข Cliques or closely bonded groups
โข Hierarchical climate
โข Gender imbalance
โข Attitudes to training
โข Non acceptance of difference
11. 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).
๏ โNurses eat their ownโ
๏ โSee one do one teach oneโ
๏ We now work with four different generations in the
workforce, adding to the complexities of effective
communication.
12. 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 groupโฆ
๏ Cliques within a workgroup
๏ Department to department
13. Conflict Itโs 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.
14. Workplace Violence & Harassment
Experts identify two primary
categories of lateral violence.
Overt(direct)
Covert (passive)
15.
16. 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
17. 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
18. Mobbing
A group of coworkers gang up on another
โ 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
19. Who else is involved?
โข Students/Patients
โข Quality care
โข Nurses
โข Co-workers as bystanders
โข Preceptors
โข Systems
โข Employers
โข Faculty
โข The โSystemโ
20. Do Nurses eat their young โ and
each otherโฆ
๏ 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?
21. Clinical Settings - Impacts on
Patients
โข Disruptive behavior linked to:
๏ 71%: medical errors
๏ 27%: patient mortality
๏ 18%: witnessed at least one mistake as a result
of disruptive behavior Rosenstein & OโDaniel, 2008
โข Ruminating about an event takes your
attention off task and leads to increased
errors and injuries
Porath & Erez, 2007
25. Impacts on Health Systems
โข Dwindling workforce
๏ 1 in 3 nurses will leave the profession
(2003)
โข Reduced professional status
โข Corrosion of recruitment and retention
26. Impacts on Health Systems
๏ Negative Impact on the work environment:
๏ Communication and decision making
๏ Collaboration and teamwork
๏ Leading to:
โ employee disengagement
โ job satisfaction and performance
โ risk for physical and psychological health problems
โ absenteeism and turnover
27. Impacts on Health Systems cont.
Cost of Lateral Violence:
โข โTurnover 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.โ
๏Jones, C & Gates, M. (2007).
โข The lag in time for a new nurse to become
proficient is a significant consideration.
28. Impacts on Student and Grad
Nurses
โข Students and grad nurses are extremely
susceptible to Lateral Violence and
experience more negative impacts than
experienced nurses.
โข Prevention Strategies are needed
โข Top down and bottom up approaches
โข Mentoring and investigation systems
โข Role Models
โข Education
โข Empowerment
29. We All need to ask ourselves:
โDid I participate in bullying?โ
โDid I support this kind of behavior in
others?โ
โDid I intervene if and when I observed
it?โ
โWe must work to uncover and reverse
atrocities, one person, one company, and
one law at a timeโ
Bullyproof Yourself at Work, G & R Namie
30. What to do?
โข Awareness
โข Education
โข Dialogue
โข Zero tolerance policy
โข Be confident
โข Develop effective coping mechanisms
โข Confront the situation
โข Rehearsal
โข Enact policy and procedure
โข Code of conduct
โข Donโt accept it!
31. OMG a student Witnesses
a Code Pink
โข When there is an event that needs handling in the OR a
โCode Pinkโ is called.
โข A group of available individuals from other theaters will
come to the perpetrators theater and stand silently
staring at them.
โข 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/
32. Zero Tolerance Policies
๏ The Joint Commission and the American Association of
Critical Care Nurses (AACN).
โข 2008: mandate the development and implementation of
processes to offset LV that enforce a code of conduct,
teach employees communication skills, and supporting
staff.
โข 2009: advocates that communication skills should be as
proficient as clinical skills.
33. Culture of Silence
โข โBecause we set ourselves up to be healers,
this kind of behaviour is in the shadows. We
donโt know what to do about it, so we try to
disown it.โ
โข In practice, this means nurses canโt stay silent
when another nurseโs actions โmakes them
cringeโ.
โข Having the conversation is what matters . . . it
shows that both professionals share
responsibility for behaviour affecting staff and
patients.
๏Monica Branigan, 2009
34. Nursing Culture needs to change
โข โNew nurses personalize their
experiences and assume they are
unique to themselvesโ
โข "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.โ
๏Dr. Martha Griffin, 2005
35. Why Donโt We Stop Lateral Violence?
โItโs not a problem in our work areaโ
โEverybody does it โ just get used to itโ
โIf I say anything, Iโll be the next targetโ
โWe have policies but they arenโt enforcedโ
โShe sets herself up for getting picked onโ
36. What can you do?
โข Dialogue is ultimately far more effective
than pointing fingers
โข Cognitive Rehearsal Techniques
โข Health care professionals across the
spectrum working together more
effectively, and patients receiving better
care.
37. Teamwork and Communication
โข Involve everyone in solving problems
related to these issues.
โข Develop a set of โRIGHTSโ for everyone.
โข Effective anti-bullying practices must
include a statement of exactly what
constitutes bullying.
โข Communication needs to be a part of
culture.
38. Tackling a Culture of
Intimidation
โข Open communication and increased communication to
nursing senior management.
โข Providing accessible professional development
opportunities for all staff.
โข Developing a policy on bullying/lateral violence in the
work-place and conflict resolution mechanisms.
โข Self-reflection and active feedback from our peers to
develop insight into our own b behaviour