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

Outline

• What is lateral violence?

• What causes lateral violence?

• Who is doing it?

• Types.

• Effects.

• What can be done?

• Discussion.

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

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

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

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

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

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

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

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.

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

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.

Workplace Violence & Harassment

Experts identify two primary categories of lateral violence.

Overt(direct)

Covert (passive)

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

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

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

Who else is involved?

• Students/Patients

• Quality care

• Nurses

• Co-workers as bystanders

• Preceptors

• Systems

• Employers

• Faculty

• The ‘System’

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?

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

Impacts on Nurses

• Physical

• Psychological

• Social

Impact on Nurses/Students

Impacts on Health Systems

• Dwindling workforce

1 in 3 nurses will leave the profession (2003)

• Reduced professional status

• Corrosion of recruitment and retention

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

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.

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

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

• Enact policy and procedure

• Code of conduct

• Don’t accept it!

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/

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.

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

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

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

• Health care professionals across the spectrum working together more effectively, and patients receiving better care.

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.

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

Lateral Violence and Students

https://www.youtube.com/watch?v=fTmyym7_-zQ

http://www.xtranormal.com/watch/11704905/nursenurse-bully

Discussion, questions, comments!!!

Thank you for your participation

Contact information

Eli Ahlquist RN, MPA

Program Head

Perioperative Nursing

SIAST, Wascana Campus

Email: ahlquist@siast.sk.ca

Phone: 306.775.7568

Greg Riehl RN BScN MA

Aboriginal Nursing Student Advisor

Aboriginal Nursing Student Achievement Program

SIAST, Wascana Campus

Email: greg.riehl@siast.sk.ca

Phone: 306.775.7383

References available on Request

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