terry clifford, msn, rn, cpan portland, maine, usa aspan immediate past president “managing...

TERRY CLIFFORD, MSN, RN, CPANPORTLAND, MAINE, USA

ASPAN IMMEDIATE PAST PRESIDENT

“MANAGING HORIZONTAL VIOLENCE”

Objectives

Review definition and behaviors associated with ‘Horizontal Violence’ (HV)

Review theoretical causes of HV Review consequences of HV Review strategies for managing HV

What is Horizontal Violence?

Horizontal violence or lateral violence can be described as overt or covert aggressive and destructive behavior of nurses against each other.

It’s more than ‘Nurses eat their young’….

Alternative terms

MobbingBullyingLateral ViolenceNurse HazingHorizontal ViolenceVerbal AbuseWorkplace ViolenceWorkplace Aggression

Types of Behaviors

Types of Behaviors

Types of Behaviors

BackstabbingScapegoatingInfightingDisrespectful

behaviorsFailure to respect

privacyBroken confidencesWithholding

information

Verbal affrontsBelittling remarksPersistant criticismHumiliationIntitmidationFalse accusationsSocial isolationUnreasonable

workloads

Incidence

Scandinavian Countries – 1 to 5 %

UK and US – 10 to 38 %

Austrailia – 50 to 57%

Turkey – 86.5%

Causes

Apathy towards ‘bad’ behaviors Desensitized “It is what it is.”

Enabling “That’s just the way she/he is” “She/he is just having a bad day”

Complacency “I don’t have time to deal with it” “I don’t want to get involved” “A silent witness”

Fear of retaliation “If I say something, I’ll be the next target”

Causes

Subservient role to MDs (oppressed-group model = perceived lack of power)

Nursing, under Florence Nightingale, developed as a very hierarchical system where submission was ‘expected, encouraged, indeed, demanded’.

Low self esteemLeadership too authoritarian/too ‘laissez-faire’Stressful work environment – volatility

Shrinking resources Downsizing Restructuring

Demanding work

Consequences at work

Adverse affects on teamworkAdverse effect on patient care/safety

Nurses stressed by the effects of a hostile environment are more likely to make errors.

Unreported errors/near missesNurse retention issues

60% of nurses new to practice leave their first positions within six months because of some form of lateral violence being perpetrated against them

Excessive sick timeLack of trustLack of respect

Consequences to the nurse

Stress related illnesses: PHYSICAL

Weight loss Weight gain Hypertension Cardiac palpitations Irritable bowel syndrome

EMOTIONAL Depression and/or anxiety Humiliation Feeling alienation

Job dissatisfaction

Management tips

Integration of TEAM BUILDINGEducate all healthcare team members on

appropriate professional behavior/code of conduct

Train leaders in conflict management – giving feedback, assessing unit culture

Reduce fear of intimidation and retribution for those who report disruptive behaviors (“Just” Culture)

Develop a “ZERO” Tolerance policy

SAMPLE

Is this happening to you???

Gain control. Realize that the aggressor is at fault, not you.

Get help from your employer. Make a plan for action.

Talk with family, friends, and co-workers Get info from books and Websites Seek advice and support from others who’ve had similar

experiences Talk with a counselor or call an advice line.

Take action. Keep a detailed log of all incidents, with names of witnesses. Keep written records so you’ll have substantive and quantifiable

evidence. If these incidents are affecting your health, see your health

care provider. If an illness is diagnosed, make sure the cause is recorded; for

example, stress in the workplace.

Is this happening to you???

Confront the aggressor. Make it clear that this behavior is offensive and must

stop.

Make a formal written complaint. By taking this step, you transfer the onus of taking

action to the organization. Follow the grievance procedures provided by your

organization or union.

Take legal action. As a last resort, consider consulting an experienced

lawyer about your legal options.

Tips to change this pattern…

Lead by example For instance, if a colleague lashes out at you regarding your

opinion on a unit issue, you should hear the person out, think about what and why it was said, then respond to your colleague in a non-judgmental and non-argumentative tone.

Learn to identify and deal with your own triggers and emotions at work

Changing the cycle of negative behavior requires personal and professional self-reflection

Find BALANCE Don’t work when you are home – rest, play, eat well….

Culture of Caring

Initiate and participate in workplace celebrations

Compliment your colleagues

Encourage respect for each other’s ideas

Think before you respond

Support colleagues who are struggling with personal or workplace issues

Thank you!

“Take care of yourself, always take the high road, assume that a workable relationship can be established, and reach out to experts for advice.”

C Kerfoot, 2008

Questions?

tclifford@aspan.org