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February, March, April 2016 Utah Nurse • Page 1
current resident or
Presort StandardUS Postage
PAIDPermit #14
Princeton, MN55371
Volume 25 • Number 1February, March, April 2016
UTAH NURSEMany Roles. One Profession.
www.utnurse.org
A Day in the Life of a
Utah Nurse
Page 3
Vax Facts for Nurses
Page 5
CE: Breaking the Cycle of Horizontal Violence
Page 6
Co
nte
nt
Inside
The Official Publication of the Utah Nurses Association
Quarterly publication direct mailed to approximately 30,000 RNs and LPNs in Utah.
PRESIDENT’S MESSAGE
1 President’s Message
2 From the Editor
3 In Memoriam
A Day in the Life of a Utah Nurse
4 From the Membership Committee
GRC Committee News
5 Vax Facts for Nurses
On the National Front
6 Continuing Education: Breaking the Cycle of Horizontal Violence
11 Utah Nurses Foundation Scholarship Guidelines
UNF News
Attention UNA Members
You can now find us on Facebook. Just search Utah Nurses Association and look for the page with the
UNA logo. We will be posting updates for upcoming events and information on conventions in our blog.
Aimee McLean, BSN, RN, CCHPPresident
Hello Utah Nurses! The end of this last year was full of changes. Last month we welcomed in the newly elected board members. We are off to a fantastic start this year with highly motivated and dedicated board members and committee chairs. CJ Ewell and Diane Forester Burke stepped up to serve as GRC co-chairs last December and they have both been incredibly responsive to the needs of the board already. I am thankful for their dedicated service to the organization. Sharon Dingman and Peggy Anderson continue to work hard to improve member benefits on the membership committee as well. We are working hard to bring members of the UNA the best value for their membership as well as providing a
publication with content that every nurse can benefit from. It is an important part of our mission to provide our publication service to all nurses in the state as well as provide useful benefits to our members. We aim to represent Utah nurses at the national, state and local levels. Please contact me with any issues you would like the association to look into or any ideas for increasing the value of membership. Thank you to the membership for electing me to this position. It is an honor and a pleasure to serve.
Aimee McLean
Congratulations to our new Board of Directors
Aimee McLean, BSN, RN, CCHPPresident
Peggy H. Anderson, DNP, MS, RNFirst Vice President
Claire LeAnn Schupbach, RN, CPC, CHPSecond Vice President
Donna Schweitzer, BSN, RNSecretary
Karen de la Cruz, MSN, RN, AACNP/FNPTreasurer
Sharon K. Dingman, DNP, RN
Director at Large
Aimee McLean Peggy H. Anderson
Claire LeAnn Schupbach
Sharon K. DingmanKaren de la CruzDonna
Schweitzer
CE
Page 2 • Utah Nurse February, March, April 2016
Published by:Arthur L. Davis
Publishing Agency, Inc.
utnurse.org
The Utah Nurse Publication Schedule for 2016
Issue Material Due to UNA OfficeMay/June/July 2016 March 10, 2016
Guidelines for Article DevelopmentThe UNA welcomes articles for publication. There is no payment for articles published in the Utah Nurse.1. Articles should be Microsoft Word using a 12 point
font.2. Article length should not exceed five (5) pages
8 x 113. All references should be cited at the end of the
article.4. Articles (if possible) should be submitted
electronically.
Submissions should be sent to: [email protected] orAttn: Editorial Committee | Utah Nurses Association
4505 S. Wasatch Blvd., Suite 330BSalt Lake City, UT 84124
Phone: 801-272-4510
PUBLICATION
NIGHTINGALE TRIBUTE
The basic Nightingale Tribute to be offered in
a nurses funeral will take about two minutes to deliver
and can fit in many different areas of any funeral service. The
words, pronouns and content can and should be changed to meet the circumstances. The presentation of a white rose by the speaker or by all nurses in attendance is an optional salute to the nurse. To read and print the basic tribute, please go to: http://ksnurses.com/ and select The Nightingale Tribute under the Resources tab.
2016 BOARD OF DIRECTORSPresident Aimee McLean, BSN, RN, CCHPFirst Vice President Peggy H. Anderson, DNP, MS, RNSecond Vice President Claire LeAnn Schupbach, RN, CPC, CHPSecretary Donna Schweitzer, BSN, RNTreasurer Karen de la Cruz, MSN, RN, AACNP/FNPDirector at Large Sharon K. Dingman, DNP, RN
STAFF MEMBERSOffice Manager Lisa TrimLobbyist Justin StewartEditor Aimee McLean, BSN, RN, CCHP
COMMITTEECHAIRS & LIAISONSBy-Laws Open - If interested please email resume to UNA Finance Karen de la Cruz, MSN, RN, AACNP/FNPGovernment Relations CJ Ewell, MS, APRN-BC and Diane Forster Burke, MS, RNMembership Sharon K. Dingman, DNP, RN Nominating Ginette (Ginny) Pepper PhD, RN, FAAN, FGSA Marguerite Brown, MS, RN Monte Roberts DNP, RN
UTAH NURSES FOUNDATIONPresident Marianne Craven, PhD, RN Aimee McLean, BSN, RN, CCHP
ANA MEMBERSHIPASSEMBLY REPRESENTATIVESAimee McLean, BSN, RN, CCHPDonna Richards, PhD, RN
PRODUCTIONPublisher Arthur L. Davis Publishing Agency, Inc.
Editor and Publisher are not responsible nor liable for editorial or news content.
Utah Nurse is published four times a year, February, May, August, November, for the Utah Nurses Association, a constituent member of the American Nurses Association. Utah Nurse provides a forum for members to express their opinions. Views expressed are the responsibility of the authors and are not necessarily those of the members of the UNA.
Articles and letters for publication are welcomed by the editorial committee. UNA Editorial Committee reserves the right to accept of reject articles, advertisements, editorials, and letters for the Utah Nurse. The editorial committee reserves the right to edit articles, editorials, and letters.
Address editorial comments and inquiries to the following address: Utah Nurses Association, Attn: Editorial Committee 4505 S. Wasatch Blvd., Suite 330B Salt Lake City, UT 84124 [email protected], 801-272-4510
No parts of this publication may be reproduced without permission.
Subscription to Utah Nurse is included with membership to the Utah Nurses Association. Complementary copies are sent to all registered nurses in Utah. Subscriptions available to non-nurse or nurses outside Utah for $25. Circulation 27,000.
All address changes should be directed to DOPL at (801) 530-6628.
For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. UNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.
Acceptance of advertising does not imply endorsement or approval by the Utah Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. UNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of UNA or those of the national or local associations.
Utah Nurses Association Biannual conference will be October 28, 2016.
As always, we will offer Continuing Education credits. Number of credits
will vary depending on individual session selection and attendance. Average credit earned last conference was 6.5 CE.
Save the Date
FROM THE EDITOR
Aimee McLean, BSN, RN, CCHP
Welcome to the New Year! We are excited to present some significant changes to the quarterly publication of the Utah Nurse. We will offer at least one continuing education credit each issue as well as highlighting additional continuing education opportunities across the state. With this issue, we send our kindest regards and thanks to the Ohio Nurses Association for helping to provide that service. We are bringing back the Nurses on the National Front section to help keep Utah Nurses up to date on Nursing across the country. The Governmental Relations Committee column and the Membership Committee Columns will be continued and provide valuable information to our readers. You will also notice the inclusion of two new series. One which highlights the day of an individual nurse in the state of Utah in order to showcase all the various facets of nursing across our great state. We will continue to honor deceased nurses and would ask for each of you to let us know if there is someone to honor that we may have overlooked. As always we welcome suggestions for future publications and letters to the editor. We would love to hear from YOU!
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We offer a comprehensive benefit package and a healthy working environment. The entire family will enjoy our small-town lifestyle, world-class ski resort, recreational & cultural activities and scenic
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YVMC is a drug free workplace and applicants must pass a pre-employment drug screen. EOE.
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Utah Navajo Health System, Inc.We are a not-for-profit Community Health Center providing medical, dental and behavioral health care in neighborhoods throughout the northern portion of the Navajo Nation and southeastern Utah. We provide primary health care to men, women, and children, regardless of citizenship status, nationality or ability to pay.
To view current openings and apply online, visit
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February, March, April 2016 Utah Nurse • Page 3
INTERNET NURSINGUTAH NURSES ASSOCIATION receives its Internet services due to a generous grant from XMission,
Utah’s largest and best local Internet Service Provider. For more information on XMission’s
services and pricing visit XMission on the Web at www.xmission.com or call 801-539-0852.
Please visit the Utah Nurses Association’s Web Page!
utnurse.org
Visit our site regularly for the most current updates and information on UNA activities. You can
obtain a listing of Continuing Education Modules available through UNA or a listing of seminars and
conferences that offer CE credits.
Angela K. York BSN
As a recent BSN graduate from the University Of Utah School Of Nursing, I am the Wellness Director for The Avenues Courtyard, a Type II Assisted Living--located in downtown Salt Lake City. My previous degree was in Health Promotion and Education with a Consumer Emphasis that was also obtained from the University of Utah.
My patient population preference includes geriatric patients and elderly veterans. I am particularly passionate about providing care in a community setting and promoting independent living for the elderly. Currently, I am working on obtaining an Assisted Living Certification through the American Assisted Living Nursing Association (AALNA) and plan to become a geriatric nurse practitioner.
In my current position, each day I manage and oversee the medical needs of approximately forty residents. In the morning, I review the event report from the night shift CNA’s, resident observation notes, e-mails and the medication administration report from the previous day. After reviewing the reports, I attend a daily 15-20 minute meeting with all department heads including Administration, Maintenance, Nursing, Dietary, Housekeeping, Activities and CNA Coordinator. Following that meeting, I head to my office that is located centrally in our beautiful naturally lit atrium. My office location is ideal as it gives me the opportunity to develop face-to-face relationships with the residents, their families and health care professionals that visit the building.
My day may take a variety of directions such as performing one to two nursing assessments that include mental health evaluation, end-of-life wishes, medication review, memory evaluation, and ADL assistance reviews. Each resident requires an assessment every six months. Our building does not contract with specific providers or agencies so I am in communication coordinating care with each resident’s unique care team. A resident’s care team may consist
of a single primary care provider, home health team, hospice organization, and/or multiple specialists. Numerous communications via text or call throughout the day can include pharmacy technicians, physical therapists, insurance companies, social workers, CNA’s, occupational therapists, family members, medical assistants, nurses and many other specialties.
I frequently travel to various locations for evaluation of potential move-in candidates. Occasionally, I am able to attend medical appointments with current residents. The position has rewarding attributes that include: celebrating simple gains in physical therapy, comforting a resident during their last breathes, addressing important health concerns such as bowel movements or diabetes management, providing end-of-life care options, and congratulating the latest BINGO champion. In addition, I have the opportunity to “guest” teach an occasional exercise class and lead monthly educational discussions with residents on health topics of their choice.
While I never know what my day may have in store, it is extremely rewarding and fulfilling to be the Wellness Director as it allows me to provide people with the tools to live the most fulfilling and independent life as possible. This makes every day unique and I am grateful to be a nurse.
A Day in the Life of a Utah Nurse
IN MEMORIAMMarjorie Hope Delong Newman passed away June
3, 2015. Marjorie graduated from the University of Utah in 1954 with a BS in Nursing. She worked at the Salt Lake County Hospital and on the perinatal unit at the University of Utah Medical Center for 32 years. She was a member of the Perinatal AIRMED team, transporting high-risk maternity patients in the intermountain west. She loved her profession and was creative, sensitive, and a calm and reassuring presence for families during their birthing experiences.
Nga trieu Carman passed away September 4, 2015. She attended, graduated from, and was honored by the University of Utah College of Nursing. She then spent years caring for others and worked in various areas such as the ICU, mental health, pediatrics, and hospice. She later attended and graduated from Westminster to become a Family Nurse Practitioner, continuing her mission to nurture the world and care for those in need.
Maxine Gardner Charlier passed away September 21, 2015. She became a Registered Nurse after completion of a three year clinical studies program at the LDS Hospital in 1943.
Genevieve Isom Gardner passed away October 3, 2015. She graduated from the LDS School of Nursing in Salt Lake City. Gen was a nurse at College of Southern Utah preschool and student health center. She was also involved in fostering healthcare in the Iron County public school system, participating in Red Cross blood drives and working at several of the local doctor’s offices.
Barbara Smedley passed away September 25, 2015. She was a graduate of Brigham Young University, receiving an Associate Degree in nursing, after which she spent many years working at LDS and St Marks Hospitals in Salt Lake City, Utah. She excelled as an operating room nurse, becoming one of a few nurses able to work on the most complex hand and heart surgeries. She retired in 1993.
Jacqueline Marie Augason passed away November 7, 2015. She dedicated 30+ years of her life to her nursing career, serving as Director of Surgical Services at LDS Hospital.
Mary M. Ciet passed away November 2015. Mary was a nurse and worked in labor and delivery, caring for the elderly, and, her favorite calling, caring for disabled children at home and in schools. She made many friends as a nurse and impacted many lives.
Jacque Frei passed away November 10, 2015. Jacque attended the University of Utah (Go Utes!) where she graduated with a nursing degree in 1971. She was an RN working first at Hoag Hospital in Newport Beach and later at St. Luke’s Hospital in Boise. As the family grew by the addition of two daughters, Jacque shifted to part-time nursing in hospitals, emergency rooms and clinics. Her medical knowledge was a blessing to many and was a “calling” from which she was never fully released.
Ludean Griffin Hulse passed away November 04, 2015. She joined the Cadet Nursing program at the William Budge Hospital in Logan. She graduated from Utah State University in 1948 as valedictorian of her nursing class. In 1967, she returned to nursing at Deaconess Hospital in Great Falls, Montana. Upon the family’s return to Utah, she worked at Saint Marks Hospital, South Davis Community Hospital and Lakeview Hospital as a supervisor.
Yvonne Daynes passed away November 23, 2015. She was in the Army Air Corps as a nurse during WWII. She graduated from the L.D.S. Hospital School of Nursing and spent her life dedicated to giving compassionate care to others, both in hospitals and the Salt Lake County Health Department. She was an active member of the L.D.S.H. Nurses Alumnae Association.
Vicki Lynn “Gertie” Gibson passed away December 07, 2015. She went on to graduate with her master degree in nursing administration from the University of Utah. She worked at the U of U Rehab before going to work at the VA Hospital.
The American Nurse: Film Presentation and Panel DiscussionPresented by Utah Nurses Association, Utah Action Coalition
for Health, and the University of Utah College of Nursing
The American Nurse Project aims to elevate the voice of nurses in this country by capturing their personal stories through photography and film. In early 2012, photographer Carolyn Jones and her team began a journey across the United States, recording the unique experiences of nurses at work.
Thursday, April 21, 2016 5:30pm: Social6:00pm: Film presentation with panel discussion to follow
University of Utah College of Nursing Annette Poulson Cumming Building 2nd Floor Eccles Auditorium10 South 2000 East, Salt Lake City, UT
To [email protected] or call (801) 581-5109 by Friday, April 8, 2016
WHAT
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Searching for the perfect career?
• Search job listings in all 50 states, and filter by location & credentials
• Browse our online database of articles and content
• Find events for nursing professionals in your area
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Page 4 • Utah Nurse February, March, April 2016
FROM THE MEMBERSHIP COMMITTEEHope your New Year has been wonderful and fulfilling
in your efforts as nurses in Utah. By way of an update for our membership, we want to give you an opportunity to mark your calendars for some important opportunities for nursing presence throughout the state in 2016. This year the Utah Nurses Association (UNA) has partnered with Utah Organization of Nurse Leaders (UONL), Utah Action Coalition for Health (UACH), and Health Insight in getting information to our memberships, and plan to continue to grow these partnerships and others for nurses in Utah.
On Thursday, November 19, 2015 the UNA, UACH, UONL and Utah Student Nurses Association (USNA) sponsored a showing of The American Nurse Movie at the University of Utah, College of Nursing. This epic film documents the lives and professional roles of five nurses in the United States and showcases the intensity, emotion, knowledge, and sacrifices of the nursing profession. Following the showing, participants discussed the essence of nursing including the science and art of the profession
and the cultural and community impact of nurses upon healthcare. The evening provided new insights to the nursing profession and was felt to be empowering for all attending the film. Future showings of The American Nurse are planned throughout the year, including Nurses Week 2016 and the UNA Conference in October 2016.
We encourage your participation in the following:Nurses Day at the Legislature – Friday, February
5, 2016 – There will be a gathering at 10:00 am on the Capitol Steps (front) for a group picture. Come prepared to share your perspectives on the current legislative initiatives (House and Senate Health related Bills).
Enjoy a showing of The American Nurse (TAN) in various locations throughout the State during Utah Nurses Week, May 6-12, 2016. We are looking for UNA members to facilitate (member host) a showing of TAN film in their geographical locations, such as Ogden area, Salt Lake City, Provo, Southern Utah, and other locations. We plan to invite nurses, local legislators, and community leaders to join with us for these showings. If you are interested in assisting with one of these showings, please contact Lisa
Trim in the UNA office: 801-272-4510, Monday-Thursday 9 am to 3 pm, [email protected]; or Dr. Sharon Dingman at [email protected] or [email protected]; or Dr. Peggy Anderson at [email protected].
Join nurses throughout the state as we gather for the UNA Conference on October 28, 2016. We are looking forward to educational and inspiring updates regarding nursing in Utah. SAVE THE DATE – more information regarding the conference will be coming!
Update on MembershipContinuing efforts are in flow to update and revamp our
online presence per request from the 2014 membership survey. Increased collaboration with our neighboring states is also underway with the Western Multi-State Division (Western MSD) to streamline welcoming materials for new members and create easy-to-use tools for current members.
Also, one of the requests from the Membership Survey in 2014-15 was to provide opportunities for membership participation. We encourage you to renew your memberships using the monthly fee schedule or with an annual fee for this year. If you have any questions about payment of fees, please contact Lisa Trim in the UNA office.
VisitJoin UNA Today!
www.utnurse.org
GRC COMMITTEE NEWSLast year, there was an attempt to open the Nurse
Practice Act (NPA) and return full regulatory authority to the BON. This effort was conceded due to the Director of DOPL already working with Rep DiCaro to modify language in the NPA to permit unaccredited programs to have a pathway for students to graduate and the program to have a longer time frame to become accredited.
Donna Lister, of Southern Utah University and chair of the Education Committee of the BON, has worked with Senator Vickers regarding an effort to bring nursing education programs in line with medicine and pharmacy programs, in that all educational programs must be accredited for graduates to become licensed.
It is imperative that nurse education and licensure be brought in line with that of medicine and pharmacy, due to the responsibility for safe practice and patient outcomes within the nursing community.
Recent legislative changes to the pharmacy act require that pharmacy technician programs expand to 600 contact hours, be accredited by one of two national accrediting agencies, and require pharmacy technician students to obtain a student license from DOPL before entering the externship phase of their education. The 600 contact hour programs (about 40 credit hours) under the new requirements will be far less than even practical nursing programs, but they are required to be accredited. Other states insist of BON oversight, while Utah does not.
There is also the potential problem of Utah nurses who graduate from unaccredited programs running into problems when relying on the interstate compact to practice in other states.
Legislation currently being watched and further evaluated by the GRC Committee:
HB 58 Hemp Extract Amendments — G FroererHB 18 Medicaid Preferred Drug List Amendment — R WardSB 32 Reauthorization of Hospital Provider Assessment Act — B ShiozawaSB 39 Medicaid Coverage for Adult Dental Services — S UrquhartHB 75 Epilepsy Training in Public Schools — D SagersHB 79 Non-patient cause of action — K McIffHB 68 Post exposure blood testing amendments — E ReddHB 100 Emergency Medical Services Personnel Licensure Interstate Compact – M Schultz
Other legislation on the horizion:A Romero & D Pitcher — Protective Order AmendmentsN Thurston — Community Choice First Program for
DisabledC Bramble — Health Care AmendmentsM Kennedy — Health Care Sharing Organization
AmendmentsE Redd — Pharmacy Service for Hospitalized PatientsR Spendlove — Utah Medicaid Reform AmendmentsC Moss — Midwife Practice Act AmendmentsR Chavez-Houck — Joint Resolution on Medicaid
ExpansionG Davis — Medicaid Expansion Proposal M Roberts — Proposal to Amend Utah Constitution;
Right to FoodR Chavez-Houck — Death with Dignity ActL Perry — Firearm safety and violence prevention in
public schools act
As well as any legislation related to removal of collaborative agreements with MDs for NPs
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February, March, April 2016 Utah Nurse • Page 5
ON THE NATIONAL FRONTVAX FACTSfor Nurses
Audrey M. Stevenson PhD, FNP-BC
Vaccines are listed as the number 1 public health achievement of the 20th Century. Over the past century vaccines have been developed to prevent many diseases. Despite this success, more than 3 million people worldwide die from vaccine-preventable diseases each year. Approximately 1.5 million of these deaths are in children less than 5 years old.
Currently, the U.S. childhood vaccination schedule for children between birth and six years of age recommends immunizations for 14 different diseases. Additionally, there are vaccines that are recommended for teens and adults. Some individuals don’t feel that all of these vaccines are necessary since some of the diseases being vaccinated against are now extremely rare in the United States.
Each disease for which vaccinations are recommended, however, can cause serious illness or death in unvaccinated populations, and might quickly begin to reappear if vaccination rates drop. Each vaccine on the schedule continues to be recommended because of the risks posed by wild infection. Recent outbreaks are a reminder that these diseases can quickly spread if the level of immunity in a community falls.
Nurses continue to be the most trusted profession in the United States and are in the perfect position to advocate for vaccines. We can do this by first ensuring that we are fully vaccinated to protect our own health and the health of those we come in contact with. We have each heard stories of nurses or other healthcare providers spreading vaccine-preventable diseases, such as influenza or pertussis in the newborn nursery, long-term care facility or other patient setting. In some cases the spread of disease to these vulnerable patients has been deadly.
We should also ensure that our families and loved ones are fully vaccinated and protected. We should also make a habit of using each and every patient encounter as an opportunity to determine the patient’s vaccine status. Ask if they have had the seasonal flu vaccine and if they are up-to-date on all of the recommended vaccines. Your recommendation matters. In some studies it was found that the recommendation of a nurse or healthcare provider substantially increased the number of individuals receiving a flu vaccine. Many individuals haven’t been vaccinated because no one has educated them that they needed a vaccine.
Be informed about the recommended vaccines for the ages of patients in your care. If you work in a setting that doesn’t provide vaccines educate your patients about vaccinating pharmacies, local health departments and other vaccine providers. Also, be educated about the myths and other misinformation that abounds on the internet and other sources. Nurses can provide accurate information about the benefits of vaccines and put the risks in perspective.
Vaccines are important in the health of patients, our families and ourselves. As nurses we can truly make a difference in the health of the community by ensuring that all we come in contact are adequately vaccinated.
SILVER SPRING, MD – Nursing continues to be rated the most trusted profession, according to the annual Gallup poll ranking of honesty and ethics in various fields.
For the past 14 years, the public has voted nurses as the most honest and ethical profession in America. This year, 85 percent of Americans rated nurses’ honesty and ethical standards as “very high” or “high,” tying a nurses’ high point on the Gallup poll and 17 percentage points above any other profession.
“It’s essential that we leverage this trust to lead and implement change in the health care system,” said Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association (ANA). “Hospitals, health care systems and other organizations are lacking an important perspective and can’t make fully competent decisions if they don’t have registered nurses at the board table or in the C-Suite. That’s why ANA is a member of the Nurses on Boards Coalition, working to place 10,000 nurses on boards by 2020.”
Ethics is an essential part of nursing practice. This includes an ethical responsibility to ensure the safety of patients and the health and wellness of nurses and other health care providers. In 2015, ANA released a revision of its Code of Ethics for Nurses with Interpretive Statements, a cornerstone document of the nursing profession that
reflects many changes and evolutions in health care and considers the most current ethical challenges nurses face in practice. The release was just one component of the “Year of Ethics,” a series of activities emphasizing the importance of ethics in nursing practice.
In 2016, ANA will build on this concept of ethical and shared responsibility by launching a year-long “Culture of Safety” campaign to drive changes leading to a safer health care system. The campaign will also highlight how patients, communities and the nursing profession can benefit from efforts to foster a culture of safety in health care. For more information, please visit NursingWorld.org.
Reprinted with permission of the American Nurses Association
Nurses Rank as Most Honest, Ethical Profession for 14th Straight Year
Ranking Reflects High Regard for Nursing Profession
Nurses Day at the Legislature
February 5th, 2016
8:30 am – 10:30 amUtah State Capitol Rotunda
All nurses are encouraged to attend!
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Page 6 • Utah Nurse February, March, April 2016
This independent study has been developed to enable nurses to recognize and deal with horizontal violence. 1.0 contact hour will be awarded for successful completion of this independent study.
The Ohio Nurses Association (OBN-001-91) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Expires: 4/2017.Ohio Nurses Association, 4000 East Main
Street, Columbus, OH 43213 \ 614-237-5414 \ www.ohnurses.org. Copyright © 2010, 2012, 2015 Ohio Nurses Association.
DIRECTIONS1. Please read carefully the enclosed article
“Breaking the Cycle of Horizontal Violence.”2. Complete the post-test, evaluation form and the
registration form.3. When you have completed all of the information,
return the following to the Utah Nurses Association at 4505 S. Wasatch Blvd., Suite 330B, Salt Lake City, UT 84124.A. The post-test; completed registration form; and
evaluation form.
The post-test will be reviewed. If a score of 70 percent or better is achieved, a certificate will be sent to you. If a score of 70 percent is not achieved, a letter of notification of the final score and a second post-test will be sent to you. We recommend that this independent study be reviewed prior to taking the second post-test. If a score of 70 percent is achieved on the second post-test, a certificate will be issued.
If you have any questions, please feel free to call Zandra Ohri, MA, MS, RN, Director, Nursing Education, [email protected], 614-448-1027, or Sandy Swearingen, [email protected]. 614-448-1030, Ohio Nurses Association at (614) 237-5414.
OBJECTIVES1. Describe horizontal violence in healthcare.2. Describe strategies to deal with horizontal violence.
This independent study was developed by: Barbara Brunt, MA, MN, RN-BC, NE-BC, Director, Nursing Education and Staff Development, Summa Health System. The author and planning committee members have declared no conflict of interest.
Disclaimer: Information in this study is intended for educational purposes only. It is not intended to provide legal and/or medical advice.
Breaking the Cycle of Horizontal ViolenceHorizontal violence and bullying has been extensively
reported and documented in healthcare, with serious negative outcomes for registered nurses, their patients, and health care employers. In this article horizontal violence (HV) will be defined and some of the theories behind it will be reviewed. Behaviors exhibited with horizontal violence will be discussed and various strategies to deal with it will be described. There has been quite a bit of research done on this topic and several studies will be highlighted. The Joint Commission (TJC) standards on maintaining a culture of safety will also be reviewed.
On the international level, one out of every three nurses plan to leave his or her position due to HV. In the United States, 90 - 97% of nurses report experiencing verbal abuse from physicians (Bartholomew, 2014). The effects of HV are reflected in poor patient and employee satisfaction scores and ultimately in the reputation of the hospital or setting. Hutchinson, Vickers, Jackson, and Wilkes (2006) suggested that violent behavior among nurses is “accepted” within the profession, and, as a result, bullying is considered an under-reported phenomenon. According to a survey conducted by the Workplace Bulllying Institute, 27% of Americans have suffered abusive conduct or incivility at work (Griffin & Clark, 2014).
There are several terms used to describe this phenomenon: interactive workplace trauma, bullying, horizontal hostility, bullying, incivility, and horizontal or lateral violence (Bartholomew, 2014). Bullying is defined as “repeated offensive, abusive, intimidating, or insulting behaviors; abuse of power, or unfair sanctions that make recipients feel, humiliated, vulnerable, or threatened, thus creating stress and undermining their self-confidence” (Townsend, 2012. p. 1).
Lateral Violence, horizontal violence, and horizontal hostility are used to portray aggressive behavior between individuals on the same power level, such as nurse-to-nurse and manager-to-manager. Definitions of bullying share three elements that come from racial and sexual harassment law:
1. Bullying is defined in terms of its effect of the recipient, not the intention of the bully
2. There must be a negative effect on the victim3. The bullying behavior must be persistent
(Bartholomew, 2014)
Both overt and covert behaviors are included. Overt behaviors would include name-calling, bickering, fault-finding, backstabbing, criticism, intimidation, gossip, shouting, blaming, using put-downs, raising eyebrows, ignoring someone’s greeting, nicknames, and failing to give credit when due. Covert behaviors would include unfair assignments, sarcasm, ignoring, eye rolling or making faces behind someone’s back, refusing to help, sighing, whining, refusing to work with someone, sabotage, isolation, exclusion, and fabrication (Bartholomew, 2014).
Another definition of HV is unwanted behavior, whether physical or verbal, which is offensive, humiliating, and viewed as unacceptable to the recipient. Both intrinsic and extrinsic factors play a role in perpetuating HV. Intrinsic factors include emotional sate (e.g. anger, burnout), personality style, beliefs and expectations, inadequate communication/conflict management skills, generational differences, diversity, and racioethnic differences. Extrinsic factors include violent workplace, poor nurse-physician relationships, task and time imperatives, culture, and demands for efficiency/productivity. (Bartholomew, 2014). Can you think of a time you either observed or experienced HV?
A number of nursing organizations have issue statements regarding the detrimental effect of disruptive behavior on both patients and nurses and have called for solutions to address the problem (American Association of Critical Care Nurses (AACN), 2004; Association of Perioperative Registered Nurses (AORN), 2011; American Nurses Association (2011) International Council of Nurses (ICN), 2006; National Student Nurses Association (NSNA), 2010). It is imperative that definitive action be taken to address the problem of HV and its impact on health professionals and patients.
Raynor and Keashly (2005) identified common elements seen in HV. These included experience of negative behaviors, many of which are nonphysical, passive and indirect and are patterns of behaviors that show a set of negative effect. Persistency is another element with HV, which occurs over time. The damage from HV is largely stress-related, resulting in anxiety, sleeplessness, and dread of going to work. Also the victims of HV often identify themselves as being bullied.
Oakley (2009) identified typical behaviors of a disruptive person as blame-shifting, gas lighting (denying obvious reality), black-and-white thinking (seeing things as all back or all white, with no shades of gray), and situational competence (being very competent in one role but not in another setting). According to Hague (2010) chronic anger is prominent in healthcare today. Research indicates that nurses often see their work environment as hostile, feel that disrespect is common, and restructuring has compromised patient safety. Nurses feel they have been excluded from decision-making which has resulted in a feeling of powerlessness expressed in the form of HV. This atmosphere has the potential to have a negative impact on patient care.
Often the theory of oppression is used to explain HV. Oppression exists when a power prestigious group controls and exploits a less powerful group. Nursing characteristics, such as being warm, nurturing, sensitive, passive and submissive caregivers, are viewed as less important or negative characteristics when compared with those of medical practitioners, who are often seen as the dominant culture. The image of the nurse is frequently seen as a handmaiden. The result is that nurses often lack autonomy, accountability, control over their practice, and are excluded from the power structure. Characteristics of an oppressed group are low self-esteem, self-hatred, feelings of powerlessness, and a weakened sense of identity. Women are often considered to be a subordinate group within society in general, and the health care arena in particular, because women comprise at least 90% of the nursing profession (Bartholomew, 2014).
Disenfranchising work practices can also contribute to HV. This would include task and time imperatives, where patients are seen as tasks rather than people. Generational and hierarchical abuse is often exhibited when nurses eat their young because they were treated badly when they started. Other factors are clique formation and low self-
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esteem. Nurses who are the most vulnerable to HV are newly hired nurses, temporarily assigned nurses such as floats, newly licensed nurses, and nurses from a different group or culture, such as male nurses (Griffin, 2006).
Education and increased awareness is the key to dealing with HV. The incidence of abuse and intimidating behaviors are not isolated events in the healthcare setting. Studies have shown that verbal abuse and disrespectful behavior significantly impact the workplace by decreasing morale, increasing job dissatisfaction and creating a hostile work climate. When nurses are intimidated about communicating with other team members, quality care is endangered. Current literature and data suggest that abusiveness will continue unless education program for skill development are instituted and actions to establish, enforce and measure zero-tolerance policies are implemented. (AACN, 2004).
Not only do people need to understand was HV is, but also what it IS NOT. Serantes and Suarez (2006) identified myths about violence, harassment, and bullying.
• Physical violence or harassment at work is onlycarried out by colleagues within the organization.
• Thelevelofphysicalviolenceatworkhasnotchanged(it actually increased by 1/3 of its previous rates from 1996 to 2000).
• Workplaceviolenceisonlyphysical(a lot of workplace violence is psychological)
• All workplace violence is reported by the victims(in 1996 the US Dept of Justice found that more than 50% of acts of violence in the workplace go unreported).
• Victims of workplace violence have only themselvesto blame. (In general 50% of individuals blame themselves for their mishap).
• Violenceisnotdestructive• Workplaceviolenceisinevitable• Prevention is more expensive than repairing the
damage.• Victimsofworkplaceviolencebelieveinjusticeandits
support The ten most frequent forms of HV as described by
Bartholonew (2014) include the following behaviors, listed in order from the most to the least frequently encountered: nonverbal innuendos, (raising of eyebrows, making faces) verbal affronts (snide remarks, lack of openness, and abrupt responses) and undermining activities (turning away or not being available). Withholding information, sabotage (deliberately setting up a negative situation), infighting (bickering) and scapegoating (attributing ALL that goes wrong to one individual) are other forms of HV. Backbiting (complaining to others about an individuals and not speaking directly to that individual), failure to respect privacy, and broken confidences are the last three forms of HV identified.
Impact of Horizontal ViolenceHV has individual, organizational, and financial impacts.
Individual impact includes emotional aspects, such as anger, decreased self-esteem and lack of motivation. Social impact includes strained relationships and low interpersonal support. Depression, stress and burnout create a psychological impact, which can result in physical manifestations of illness (Bartholomew, 2014). Patient safety is also at risk. Bullying reduces patient safety by interfering with teamwork, communication, and collaboration. Nurses who have been bullied feel isolated from the coworkers;
they’re reluctant to ask questions and afraid to speak up to advocate for patients. High nurse turnover jeopardizes continuity on the unit, and may leave nurses without adequate experience or knowledge to recognize or act quickly on potential patient problems. (Townsend, 2012).
Nursing leaders are becoming more aware of the costs and consequences of hostility among nurses in the healthcare system. Some economic effects, such as high turnover rates are obvious. Significant literature also validates the effects of stress and burnout on nurses. For example, when positions need to be filled due to sick calls, compensations claims, and family medical leaves of absence, overtime and agency costs accrue. An Australian study showed that 34% of nurses who experienced bullying took off more than 50 sick days in a year. (Bartholomew, 2014).
Horizontal violence takes a toll on the individual affected. The victim may experience physical problems that include dry throat, frequent headaches, gastrointestinal problems, and a change in body weight, sleep disturbances, and decreased energy. Psychological effects may include stress, fear, anxiety, sadness, depression, frustration, and mistrust, loss of self-esteem and confidence, and nervousness. (Longo, 2012)
There are also costs to the organization related to HV. These would include the mental and physical health problems of those individuals targeted, taking time off work, leaving the organization or profession, decreased productivity, high turnover rates, and decreased morale.
The number one strategy to deal with HV is to increase awareness of the problem. This would include education of staff, development and communication of policies/procedures, etc. Individuals need to take responsibility for their own professional behavior, and become an individual change agent. Seeking out help and creating an action plan are other strategies.
Organizational StrategiesManagers have an important role to play in identifying
and responding to any problems. According to Bartholomew (2014), managers need to be able to identify indications of HV, such as poor employee satisfaction scores, high turnover rates, dueling shifts, cliques, and absenteeism. There are questionnaires that are available to assess the cohesiveness of the group. Managers also need to create an environment where staff members feel comfortable coming to the managers with concerns. To deal with HV, managers need to decrease negativity, gossip, and a culture of blame by maintaining zero tolerance for any communication that is unhealthy, disrespectful or spoken to people other than the person(s) directly involved. They also need to create a climate of safety and healthy communication by role modeling and using as many opportunities as possible to teach interpersonal and confrontational skills.
Strategies to stop the cycle of HV at the organizational level include adopting a zero tolerance policy, embracing transformational leadership, developing a strong policy to deal with incidents of hostility, developing institutional policies that are proactive, not reactive, and empowering staff to speak without fear of reprisal (Longo, 2012).
Suggestions for increasing a healthy culture are listed below:
• Firmly establish board and senior leadership teamcommitment
• Make harm visible: frame disruptive behavior as asafety issues, and create infrastructure to support managers and staff
• Shift thepowerstructure fromahierarchytoa team/tribe by providing a constructive feedback system, providing leadership/conflict management training for managers, providing assertiveness training and crucial conversations training for staff, monitoring
Independent Study continued on page 8
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the organizational climate, and increasing social capital by building a strong internal network. (Bartholomew, 2014)
In addition to the institution adopting a zero tolerance policy for HV, other strategies identified by the International Council of Nurses (ICN) include sensitizing the public and the nursing community to the various manifestations of violence against nursing personnel, supporting nurses, including facilitating access to legal aid when appropriate, ensuring awareness of and access to existent resources available to nurses to deal with workplace abuse, and providing improved education and on-going training in the recognition and management of workplace abuse and violence (ICN, 2004).
Some institutions have instituted a code pink, which is a technique nurses employ to address unacceptable behavior in hospitals and other settings. It works like this: RNs go to a location where their nurse colleague is being verbally abused and stand in support of their peer and against the bullying that is taking place. (Trossman, 2014).
Individual StrategiesIndividual strategies include courageous leadership. Every nurse must lead this cultural
change. Working cooperatively despite feelings of dislike, not speaking negatively about superiors, addressing co-workers by the first name and asking for help as necessary, and looking people in the eye when having conversation with them are other strategies that can be used. Not being overly inquisitive about each other’s lives, repaying favors and complements, not engaging in a conversation about a co-worker with another co-worker, standing up for the “absent member” in a conversation where they are not present, and not criticizing publically are other effective strategies (Bartholomew, 2014).
Strategies identified by the Center for American Nurses (2008) included: nurses adopting and modeling professional ethical behavior, recognizing and addressing bullying and disruptive behaviors in the workplace, reflecting on own behavior and communicating respectfully, participating in collaborative interdisciplinary initiative to prevent abuse, and working to ensure the mission, vision and values of their workplaces are reflective of the Code of Ethics for Nurses and standards set by the profession in order to eliminate disruptive behavior.
Evinrude (2008) shared how journaling helped her deal with a personal case of bullying in the workplace. Journaling helps the individual reflect on the situation and think of ways to deal with issues over time. It also is helpful to keep track of the nature, time, date, place and names of all individuals who were present.
Strategies to stop the cycle at the individual level include:• Gaincontrolandrecognizethattheaggressorisatfaultnotyou• Gethelp fromyouremployer– readyourworkplacepolicyonHVorharassment to
understand your options• Makeanactionplan,after seekingadvice fromotherswithsimilarexperiences, talk to
your manager, and take advantage of employee assistance programs.• Implementtheplan• Confront theaggressor–make itclear that thebehavior isoffensiveandmuststop
using “I” messages and describing the behavior and how it made you feel.• Makeaformalwrittenconflict,followingthegrievancepolicy• Asalastresort,seekoutlegaladviceifthesituationwarrants(Leiper,2005).
Additional suggestions offered by Bartholomew (2009b) when confronting a bully, include:
• Don’twait–thesooneryouconfrontthebehavior,thebetter• Alwaysasktospeaktothepersoninprivate• Takeafewdeep,centeringbreathsbeforeyoubegintheconversation• Ifyouaresettingdown,sitatrightanglesinsteadofacrossfromeachother• Rememberthegoal:speakyourtruth.• Remember when someone is loud, aggressive, or mean they are angry or afraid.
Anger is the secondary emotion; try to get to the primary emotion, which is hurt.• Wheneveryoudon’tknowwhattodo,repeatwhattheotherpersonsaid:Letmeget
this straight. You are saying that . . . “ (p. 3)
The American Nurses Association has a publication titled Bullying in the Workplace: Reversing a Culture (Longo, 2012) to help nurses increase their professional awareness and knowledge to develop the skills needed to create a safe workplace. There is a checklist which outlines common acts of bullying, contributing factors that increase the risk for bullying behaviors, and strategies to eliminate bullying in the workplace.
Research StudiesThere have been numerous research studies looking at HV. Griffin described a research
study in 2004 on cognitive rehearsal she conducted with 26 newly registered nurses hired for their first position at a Boston tertiary hospital. Ten years later, Griffin and Clark (2014) reviewed the literature on cognitive rehearsal as an evidence-based strategy to address incivility and bullying behaviors in nursing. In the initial study, nurses spent two hours learning to recognize HV and then practiced techniques to confront it. Participants were given cue cards to use when they were experiencing the various types of HV. Examples of constructive responses on the cards for each of the behaviors seen in HV are listed below:Nonverbal innuendo – I sense (I see) from your facial expressions that there may be
something you wanted to say to me. It’s OK to speak directly to me.Verbal affront – The individuals I learn the most from are clearer in their directions and
feedback. Is there some way we can structure this type of situation?Undermining activities - When something happens that is “different” or “contrary” to
what I understood, it leave me with questions. Help me understand how this situation may have happened.
Withholding information – It is my understanding that there was (is) more information available regarding the situation, and I believe if I had known that (more), it would (will) affect how I learn
Sabotage – There is more to this situation than meets the eye. Could “you and I’ (whatever, whoever) meet in private and explore what happened?
Infighting – Always avoid unprofessional discussion in nonprivate places. This is not the time or place. Please stop (physically walk away or move to a neutral spot)
Scapegoating – I don’t think that is the right connectionBackstabbing – I don’t feel right talking about him/her/the situation when I wasn’t there or
don’t know the facts. Have you spoken to him/her?Failure to respect privacy – It bothers me to talk about that without his/her permission or
I only overheard that – it shouldn’t be repeated.Broken confidences – Wasn’t that said in confidence? Or that sounds like information
that should remain confidential (Griffin & Clark, 2014).
Johnson (2009) examined the literature on workplace bullying among nurses with the aim of reaching a better understanding of the phenomenon. Workplace bullying occurs in many occupations and workplaces, including nursing. It is more than a simple conflict between two individuals. It is a complex phenomenon that can only be understood through an examination of social, individual and organizational factors. Workplace bulling has been shown to impact the physical and psychological health of victims, as well as their performance at work. Workplace bullying impacts the organization through decreased productivity, increased sick time and employee attrition. More nurse-specific research is needed. Research needs to be conducted in a systematic and uniform manner so that generalizations across studies can be made.
Bigony et al. (2009) further discussed the issue of lateral violence in the perioperative setting and concluded that support from administration and continuing education with the aim of increasing awareness, together with a zero tolerance policy, should be the standard for all health care organizations. HV threatens the health and well-being of all nurses and becomes a patient safety issue.
Thomas and Burk (2009) did a content analysis of stories written by junior nursing students about incidents of injustice perpetrated by staff RNs during their clinical experiences. Four levels of injustice were described: “we were unwanted and ignored,” ‘our assessments were distrusted and disbelieved,” “we were unfairly blamed,” and “I was publicly humiliated.” Nursing leadership, both in hospitals and educational institutions, must become engaged in efforts to eradicate HV towards students.
Purpora, Blegen, and Stotts (2012) studied the incidence of horizontal violence among hospital RNs and looked at the effects on patient care. They tested two hypotheses about the social origins of this behavior. A randomized sample of 175 hospital staff RNs drawn from the California Boar of Registered Nursing’s mailing list was surveyed. Horizontal violence was reported by 21% (n=37) of participating nurses. Findings suggested a positive relationship between beliefs consistent with an oppressed self and horizontal violence and also a positive relationship between beliefs consistent with those of an oppressed group and horizontal violence. A change in the oppressive social structure in hospitals may be needed to address horizontal violence.
Recent research supports earlier findings. A 2012 study of the psychological consequences of bullying in Australia found that impact varied depending on whether the nurses worked in the hospital or aged care, and full- or part-time. Full time aged care nurses
Independent Study continued from page 7
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reported higher psychological distress than part-timers. Hospital nurses reported higher psychological distress, while aged care nurses reported higher depression. More than half of those people who experienced hostility at work reported that they lost time worrying about the uncivil incident and its future consequences. After three studies investigating the objective consequences of both direct and indirect rude experiences, researchers found that both were harmful to task performance. Even a one-time event can affect objective cognitive functioning and creativity. (Bartholomew, 2014)
Woelfle and McCaffrey (2007) reviewed five research studies published in 2003 and 2004 to better understand the reasons for impaired personal relationships among nurses and to provide evidence for change in the nursing environment. Based on that review, they concluded that HV is prevalent in nursing and it is experienced by student nurses as well as novice and veteran nurses. There should be policies in organizations relating to HV, protecting staff from and holding staff accountable for workplace violence. It is impossible to deliver compassionate, high-quality patient care when staff members work in an atmosphere of fear and intimidation. Management must take action to fight HV.
Establishing a culture that fosters a sense of cohesiveness among staff is a critical link in improving patient satisfaction and decreasing HV. Barrett, Piatek, Korber, and Padula (2009) completed a study that included both quantitative and qualitative components. A pre-post design was used, with a targeted intervention that focused on teambuilding. Six to eight nurses from 4 different units in a private not-for-profit teaching hospital participated. Two two-hour sessions were presented by a trained group facilitator. The first session included information on HV, as well as a discussion of their personal experiences with it. Participants completed the Myer-Briggs Type Indicator (MBTI) and there was a skill-building session on giving and receiving feedback and managing conflict. The qualitative component focused on the impact of the intervention of overall group dynamics and processes. RN scores on the Group Cohesion Scale (p=.037) and the RN/LPN interaction scores improved post-intervention.
Bally (2007) described the role of nursing leadership in creating a mentoring culture in acute care environments. High rates of retirement among older nurses and HV among younger nurses heightens the importance of mentoring in the context of overall organizational stability and performance. If this is a long-term commitment and solution, it will lead to improve staff retention, satisfaction and better patient outcomes. Mentoring cultures depend upon elements of a stable infrastructure such as managerial and executive support, scheduling flexibility, incentives, and recognition. Transformational leadership practices are critical to achieving
the sustainable effect of mentoring programs that are rooted deeply in organizational culture.
The Joint Commission Culture of SafetyThe Joint Commission [TJC] (2014) has recognized the
impact of poor interpersonal relationships on patient safety and quality and created several standards relating to this. They have a chapter on Patient Safety Systems. The quality of care and the safety of patients are core values of The Joint Commission accreditation process. This is a commitment The Joint Commission has made to patients, families, health care practitioners, staff, and health care organization leaders. The intent of this “Patient Safety Systems” (PS) chapter is to provide health care organizations with a proactive approach to designing or re-designing a patient-centered system that aims to improve quality of care and patient safety, an approach that aligns with The Joint Commission’s mission and its standards.
The ultimate purpose of The Joint Commission’s accreditation process is to enhance quality of care and patient safety. Each requirement or standard, the survey process, the Sentinel Event Policy, and other Joint Commission initiatives are designed to help organizations reduce variation, reduce risk, and improve quality. Hospitals should have an integrated approach to patient safety so that high levels of safe patient care can be rovided for every patient in every care setting and service. (TJC, 2014)
A culture of safety is characterized by open and respectful communication among all members of the healthcare team in order to provide safe patient care. It is a culture that supports organizational commitment to continually seeking to improve safety. Verbal abuse is communication perceived by a person to be a harsh, condemnatory attack, either professional or personal, or language intended to cause distress to a target (Bartholomew, 2014).
Ignoring bad behavior has potentially serious consequences for patients. Aleccia (2008) stated about 70 percent of nurses studied believe there’s a link between disruptive behavior and adverse outcomes, and nearly 25 percent said there was a direct tie between the bad acts and patient mortality. In an Institute for Safe Medication Practices study of about 2,000 clinicians more than 90 percent said they’d experienced condescending language or voice intonation; nearly 60 percent
had experienced strong verbal abuse and nearly half had encountered negative or threatening body language (Institute of Medicine, 2007).
Bartholomew (2009a) discussed how nurse managers can create collaborative relationships on their unit with physicians. Research shows that 1-3% of physicians are disruptive, yet this group causes exponentially devastating effects on morale, retention, and patient safety. Managers must take the necessary actions to demonstrate to nurses and physicians the standard of acceptable behavior and set the tone for collegiality on the unit. Nothing is more powerful than staff witnessing a manager approaching a disruptive physician and saying, “Can I speak to you for a minute in my office?”
Suggestions given by Lindeke (2008) to develop collaborative relationships grouped strategies into three categories: self-development, team development, and communication development. Self development strategies included developing emotional maturity, understanding the perspectives of others, and avoiding compassion fatigue. Team development strategies included building the team, negotiating respectfully, managing conflict wisely, avoiding negative behaviors, and designing facilities for collaboration. Communication development strategies included communicating effectively in emergencies, and using electronic communication thoughtfully.
Horizontal violence is a phenomenon that is detrimental to patient safety and should not be allowed to continue. This is a serious problem and it is imperative that the profession addresses this problem. Various organizational and individual strategies were outlined to combat HV and minimize its impact on staff. Organizations need to create a culture where HV is not tolerated. Nurses and students need to be given tools that provide information on how to address conflicts and change disruptive behavior in the workplace. Nurses, individually and collectively, must enhance their knowledge and skills in managing conflicts and promote workplace policies to eliminate HV.
Independent Study Post-Test continued on page 10
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DIRECTIONS: Please complete the post-test and evaluation form. There is only one answer per question. The evaluation questions must be completed and returned with the post-test to receive a certificate.
Name: ______________________________________
Date: ___________________ Final Score: ________
Please circle one answer.
1. Bullying is behavior which is generally persistent, systematic, and ongoing.a. Trueb. False
2. Name-calling, backstabbing, and gossip are three examples of what type of hostility? a. Overt b. Covert c. Severe d. Illegal
3. Which of the following is an example of covert behavior? a. Fault-finding b. Criticism c. Sabotage d. Shouting
4. Associations that have issued statements regarding horizontal violence include all of the following EXCEPT: a. American Nurses Association b. American Nurses Credentialing Center c. American Association of Critical Care Nurses d. International Council of Nurses
5. Characteristics of an oppressed group include: a. High self-esteem b. Self-hatred c. Heightened sense of identity d. Sense of power and control
6. Nurses who are most vulnerable to horizontal violence are newly hired or licensed nurses, float nurses, and male nurses. a. True b. False
7. There are numerous myths about horizontal violence. Which of the following statements is true and is not a myth? a. Workplace violence is only physical b. Workplace violence is inevitable c. Prevention is more expensive than repairing the
damage d. The level of physical violence at work has
changed
8. According to Bartholomew, the most frequent form of horizontal violence is: a. Backbiting b. Broken confidences c. Non-verbal innuendos d. Withholding information
9. The number one strategy to deal with horizontal violence is to: a. Increase awareness of the problem b. Report incidences to management c. Monitor employee satisfaction scores d. Maintain culture of blame
10. Individual impacts of horizontal violence include: a. Increased self-esteem b. Increased motivation c. Anger d. Decreased absenteeism
11. Organizational strategies to deal with horizontal violence include all of the following EXCEPT: a. Adopting a zero tolerance policy b. Embracing transformational leadership c. Promoting a culture of safety d. Developing reactive institutional policies
12. Individual strategies to deal with horizontal violence, as identified by the Center for American Nurses, include: a. Keeping a journal b. Adopting and modeling professional ethical behavior c. Accepting a fair share of the workload d. Reflecting on the behavior of others
13. In the study by Baily a mentoring culture included all of the following EXCEPT:, a. Management and executive support b. Incentives and recognition c. Inflexible schedules d. Transformation leadership
14. The organization that recognized the impact of poor interpersonal relationships on patient safety and quality and created several standards relating to this was: a. The American Hospital Association b. The Occupational Safety and Health Administration c. The Joint Commission d. The American Medical Association
15. Suggestions given by Lindeke to develop collaborative relationships included all of the following EXCEPT: a. Self-development b. Team development c. Communication development d. Organizational development
Evaluation1. Were you able to achieve the following objectives? Yes No
a. Describe horizontal violence in healthcare. o o b. Describe strategies to deal with horizontal violence. o o
2. Was this independent study an effective method of learning? o o If no, please comment:
3. How long did it take you to complete the study, the post-test, and the evaluation form?
4. What other topics would you like to see addressed in an independent study?
Registration FormName: ___________________________________________
(Please print clearly)
Address: _________________________________________Street
_________________________________________________City/State/Zip
Daytime phone number: ___________________________
_________ RN ________ LPN
Email address: ____________________________________
Please return: – Completed Post-test and Evaluation Form– Registration Form
Utah Nurses Association4505 S. Wasatch Blvd., Suite 330B
Salt Lake City, UT 84124.
Breaking the Cycle of Horizontal ViolencePost Test and Evaluation
( )
Additional CE Opportunities
We would like to advertise CE opportunities for nurses. Please email any opportunities your organization has to [email protected]. Copy space may be limited and submissions will be prioritized by opportunity for the most nurses across the state.
RN–BSN
Already licensed as a Registered Nurse?If you are looking to expand your
education and take the next step in your nursing career, contact us today.
Online Classes Available
Applications will be accepted for FALL 2016 from April 18 – July 1.
Contact us for more information
www.uvu.edu/nursing
Nephi, Utah
Orthopedic Surgery | General Surgery24/7 Emergency Department
Obstetrical Care | Radiology w/MRIRespiratory Therapy | Full-Service Lab
Physical & Occupational Therapy Home Health & Hospice
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Our Nurses Make A Difference
Become Part of Our Team!Located just off Interstate 15 and only 30
minutes from Provo, Utah’s third largest city, Nephi offers a quiet, small town lifestyle with
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It’s the perfect place to live and work.
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State of Wyoming, Department of Health, Aging Division, Healthcare Licensing and Surveys is recruiting for
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For more information or to apply online go to:http://www.governmentjobs.com/careers/wyoming/
jobs/1312649/hshp09-03898-health-facility-surveyor-cheyenne
Open until filled. EEO/ADA Employer.
February, March, April 2016 Utah Nurse • Page 11
The guidelines listed below shall be followed to assist in ensuring the best possible coordination of efforts in receiving and processing nursing student requests for scholarships. Scholarships will be awarded for tuition and books only.
SCHOLARSHIP INFORMATION• Scholarships must be postmarked by June 1 or October 1 of each calendar year to
be considered.• ApplicantswillreceivenoticeoftheBoard’srecommendationsbyJuly15andOctober15
of each calendar year. • Recipientsareonlyeligibletoreceivescholarshipstwice.• Applicantsmustabidebythecriterialistedbelow.
GENERAL SCHOLARSHIP CRITERIA The applicant must:• Have a cumulative gradepoint average,which is equivalent to a 3.0 or higher on a 4.0
scale. • BeaUnitedStatescitizenandaresidentofUtah.• Havecompletedaminimumofonesemesterofcorenursingcoursespriortoapplication.• Ifastudentinundergraduatenursingprograms,beinvolvedintheschool’schapterofthe
National Student Nurses Association. • IfaregisterednursecompletingaBaccalaureateDegreeoranAdvancedNursingDegree,
be a member of Utah Nurses Association (state only) or a member of Utah Nurses Association/American Nurses Association.
• Submit apersonal narrativedescribinghis/her anticipated role in nursing in the state ofUtah, which will be evaluated by the Scholarship Committee.
• Submit three original letters of recommendation. Letters submitted from faculty advisorand employer must be originals addressed to the Utah Nurses Foundation Scholarship Committee.
• Beenrolledinsixcredithoursormorepersemestertobeconsidered.Preferencewillbegiven to applicants engaged in full-time study.
• Demonstrate a financial need. All of the applicant’s resources for financial aid(scholarships, loans, wages, gifts, etc.) must be clearly and correctly listed (and include dollar amounts and duration of each source of aid) on the application
• TheScholarshipCommittee shall consider the following priorities inmaking scholarshiprecommendations to the Board of Trustees¡ RNs pursuing BSN ¡ Graduate and postgraduate nursing study ¡ Formal nursing programs - advanced practice nurses ¡ Students enrolled in undergraduate nursing programs
• TheApplicantisrequiredtosubmitthefollowingwiththecompletedapplicationform:• Copyofcurrentofficialtranscriptofgrades(nogradereports).• Threelettersofrecommendation.¡ One must be from a faculty advisor and ¡ One must be from an employer. (If the applicant has been unemployed for greater
than 1 year, one must be from someone who can address the applicant’s work ethic, either through volunteer service or some other form.)
¡ At least one should reflect applicant’s commitment to nursing. ¡ All must be in original form and must be ¡ Signed and addressed to the UNF scholarship committee.
• NarrativestatementdescribingyouranticipatedroleinnursinginUtah,uponcompletionof
the nursing program. • Letterfromtheschoolverifyingtheapplicant’sacceptanceinthenursingprogram.• Copy of ID fromNational Student Nurses Association or Utah Nurses Association with
membership number.
AGREEMENTIn the event of a scholarship award, the nursing student agrees to work for a Utah Health
Care Facility or Utah Educational Institution as a full-time employee for a period of one year, or part-time for a period of two years.
Student recipient agrees to join the Utah Nurses Association within 6 months of graduation at the advertised reduced rate.
If for any reason the educational program and/or work in Utah is not completed, the scholarship monies will be reimbursed to the Utah Nurses Foundation by the nursing student.
Nursing Grant-in-Aid Scholarships Utah Nurses Foundation
Guidelines UNF NEWSMarianne Craven, PhD, RN
UNF President
The Utah Nurses Foundation (UNF) had a great year in 2015. The UNF was developed to help nursing students obtain their degrees and to help nurses gain graduate degrees. The UNF also supports nurses who are doing nursing research. Check out some of those who received assistance during 2015. Names are not given as permission was not obtained to share the individuals’ information (that will change with 2016 application processes).
• Agraduatenursingstudentwhodesirestohelp improveandbettermanagethe healthcare of the incarcerated youth of the state.
• Anursingstudentwho is “passionateabout theprofessionofnursing.”Sheincluded the following objectives for receiving her degree: a) promoting the role of nurses in leadership positions, b) increasing the voice of nursing into applicable legislation, and c) advocating for the rights of our aging population--particularly those in long-term care.
• A minority graduate student who desires to advocate for, listen to, andunderstand the concerns of the minority populations in the state of Utah. She states her goal is “to become a change agent by spearheading health disparities and improving health conditions in [Utah’s] underserved communities.”
• A male nursing student who has a special interest in end-of-life care.He desires to continue to graduate school and hopefully become a nurse educator so that he can promote greater understanding among nurses through education in end-of-life issues.
• A nurse researcher who is studying the impacts of supplementing school-age children with multivitamin & iron compounds on anemia in Ghana, Africa.
Applications are accepted twice each year (June 1st and October 1st deadlines) so that the UNF can provide the “best of the best” with assistance in their educational pursuits and research aims. All nursing students who have completed at least 1 semester of nursing school are eligible to apply. If you have questions, please feel free to contact the UNF through the UNA at [email protected].
Marianne Craven
To download application, visit www.utnurse.org.
UTAH STATE UNIVERSITY IS SEEKING APPLICANTS for Various Part-Time and Full-Time Nursing Faculty and Leadership Positions
at Our Utah Campuses.
For more information about available opportunities, please visit jobs.usu.edu.
NURSING EDUCATION
Exceptional People,Extraordinary Care
Bring your talents to Western Alaska
CONTACT US: [email protected] is an equal opportunity employer affording native preference under PL93-638. AA/M/F/D. We are a Drug Free Workplace and background checks are required for all positions.
APPLY NOW
We are seeking: CNAs, RNs, mid-levels, physicians & pharmacists.
• Competitive Wages• Generous Benefits• Hiring Bonuses
877.538.3142
VISIT: w w w.nor tonsoundhea l th.org
Page 12 • Utah Nurse February, March, April 2016
Apply Today:
USAJobs.gov
Follow VA Careers
With more than 80,000 RNs, APNs, LPNs/LVNs and nursing assistants, VA is the Nation’s largest employer of nurses. Join us in serving those who have unselfishly served our country.
At VA, you’ll be given the tools and training you need to provide our Veterans with the best care possible. You will have the chance to participate in research initiatives focused on enhancing health and preventing disease among our Nation’s heroes. And, you’ll be able to further your career through our various nursing leadership and clinical development programs.
What’s more, you will have the freedom to practice at any one of the over 1,400 VA medical facilities throughout the 50 states, the District of Columbia, and other U.S. territories—with only one active state license.
George E. Wahlen VA Medical Center
VA nurses earn a competitive salary, plus many other benefits:• Generous annual and sick leave accrual • Shift/Weekend Differentials • Pension and Matching Funds for TSP (similar to 401k)• 10 Paid Federal Holidays a year• Health, Dental and Eye Benefits
For more information, contact Amber Brennan, RN - Nurse RecruiterPhone: 801-582-1565 ext 1128 or email [email protected]
George E. Wahlen, VAMC (118)500 Foothill DriveSalt Lake City, UT 84148