7. Nurse-NurseInteractions
◦ Lateral Violence: an aggressive&
destructivebehavior of nursesagainst each
other.
Woelfle& McCaffrey 2007
◦ Resultsin injuring thedignity of another
◦ Reducesone’sconfidenceand self esteem
8. Oppressed population concept
Cyclical
Exclusion from thepower structure
Seen as“Right of Passage”
“Thisishow peoplewereto mewhen I was
learning”
New-to-practiceRNsand new-to-practice-
areaareat greatest risk
9. Talking behind one’sback
Discouragement; humiliation
Blocking chancefor promotion
Scapegoating; innuendo
Belittling or criticizing acolleaguein front of others
Isolating or freezing acolleagueout of group activities;
exclusion
Sabotage; withholding pertinent information
In-fighting
Failureto respect confidencesand privacy
Eyebrow raising, snideremarks, turning away, making
faces
10. Cyclical repetition
Physical symptoms
Useof sick days
Extremecasessuicide
Nursesleavetheprofession (1 in 3 internationally)
30% leave1st
new grad position within 1 year
(Bowles& Candela, 2005)
Nursesaren’t at their best so patient caresuffers
11. Lateral violenceviolates The Co de o f Ethics fo r Nurses
with Interpretive Statements (ANA, 2001)
http://www.nursingworld.org/codeofethics
Barriersimpedeknowledge& skill acquisition
To improveprofessional practicelife
To stressfor new to practicenurses
To improveconflict resolution skills
To attrition
To stop new generationsof nursesfrom being socialized
into negativepractices
TheJoint Commission mandateschangefor
patient safety in Sentinel Alert 40
12. Accept one’sfair shareof the
workload.
Respect theprivacy of others.
Becooperativewith regard to the
shared
physical working conditions(noise,
temp).
Bewilling to help when requested.
Keep confidences.
Work cooperatively despite
feelingsof dislike.
Don’t denigrateto superiors
(speak negatively about, haveapet
namefor)
Do addressco-workersby their first
name,
ask for help and advicewhen necessary.
Makeeyecontact with co-workerswhen
speaking.
Don’t beoverly inquisitiveabout each
other’slives.
Repay debts, favors, compliments.
Don’t converseabout aco-worker with
another co-worker.
Stand up for the“absent member” in a
conversation when he/sheisnot present.
Don’t criticizepublicly.
Griffin, 2004
13. Cognition: obtaining, organizing & using
intellectual knowledge
Self reflection both personal and professional
Liberatetheoppressed by not letting it
continue
14. Rehearsed direct responses
◦ I seefrom your expression thereissomething…….
◦ I learn most from peoplewho communicatedirectly..
◦ When thingsaredifferent from what I learned…..
◦ It ismy understanding that therewasmoreinformation…….
◦ I don’t feel right talking about this….
◦ I don’t feel right talking about him/her….
Griffin, 2004
15. ◦ Stopstheautomatic processof theevent
◦ Consciously not responding or not reacting
◦ Allowing timeto processinformation previously
taught
The event is no t a perso nal affro nt
◦ Allowsindividual to respond differently to harmful
inferenceof lateral violence
◦ Liberatestheoppressed by not letting it continue
16. Reframing conversation using safety strategies
◦ Debriefing
Feedback whether positiveor negativeshould alwaysbean
unbiased reflection of eventsand open thedoor to discussion of
evidence-based practice
◦ Two Challenge Rule
◦ CUS
Concerned, uncomfortable, safety
◦ Check back
◦ Time-o ut
◦ CriticalLanguage
“I need someclarification.”
18. De-escalation techniquesfor aggressivebehaviors
Takethefocusoff thepower struggle
Refocusdiscussion back to thepatient needs
Enlist thesupport of thosemoresenior
Identify thosereceptiveto questions
Listen to concernsof others
End conversationswhereco-workersarebeing discussed
Reflection
Challengeyourself to remain civil in thefaceof
incivility
Ask yourself what went well? What went poorly?
What could I havedonedifferently?
22. Difficult Communication patternsareapatient safety
threat
Createsfear of ridiculefor asking questions
Strategy: Alwaysbring focusback to thepatient
Education hasapositiveeffect
◦ Empowersnursesto know that it isnot personal
◦ Breaksthecycle; it can bestopped
◦ Contributesto making team membersaccountableto each
other
◦ Encouragesaprofessional dialogue
23. Woelfle, C. & McCaffrey, R. (2007). Nurseon nurse. Nursing
Fo rum, 42(3), 123-31.
Griffin, M. (2004). Teaching cognitiverehearsal asashield for
lateral violence: An intervention for newly licensed nurses.
The Jo urnalo f Co ntinuing Educatio n in Nursing, 35(6), 257-
263.
BowlesC. & Candela, L. (2005). First job experiencesof recent
graduates: Improving thework environment. Nevada Nurses
Asso ciation ISSN: 0273-4117