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