Managing lateral violence and its impact on the team la ronge november 2013


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Lateral violence is a reality for many people working in the health care field. This presentation looks at causes and looks at ways to addresses bullying behavior.

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  • Need to look to the past and the presentAnswers are all within your community
  • Tackling the nursing shortage and addressing retention and recruitment requires action. It is not enough to train RNs and LPNs with skills and competencies.We need to make it easier for them to stay and be a part of the team. Many senior nurses expect graduates to hit the ground running," says Judith Tompkins, chief of Nursing Practice and Professional Services and executive vice-president of Programs at the Centre for Addiction and Mental Health (CAMH) in Toronto. "When there is a lack of collegiality and mentoring from peers, young nurses are thrown into the workforce and are left feeling unsupported."
  • Women were more often the perpetrator – 65%Men target men and women equallyWomen target other women 70% of the time
  • Image To effectively intervene in situations where toxic work environments lead nurses to exit the profession, understanding the dynamics of relational aggression (RA) can be helpful.Females and males express negative feelings differently across different ages and stages of development. This is relevant to female-dominated professions like nursing.
  • Persistent attitude of the role of Nurses being hand-maidens,Image
  • Mellington believes there may be certain workplaces that are more susceptible to workplace bullying. Key indicators of what should be looked for are:- organisational change (such as a takeover or change in management);- workplace characteristics (for example, a greater representation of minority groups or high job instability and uncertainty about on-going employment);- workplace relationships (including low levels of consultation or poor communication); and- work systems and structures (for example, no policies or procedures, no clear job descriptions or insufficient training).
  • Major characteristics of oppressedbehavior stem from the ability of dominantgroups to identify the “right” norms andvalues and from their power to enforceThem.Connection of lateral violence in nursing to the behaviors of oppressed groups, where inter-group conflict is seen in the context of being excluded from the power structure. Nurses generally don't have sufficient control over their work environment and have a high degree of accountability coupled with a low degree of autonomy.
  • Undermining behaviour such as ignoring questions, constantly criticizing or excluding individuals from discussion, quietly exhibiting uncooperative attitudes during routine activitiesAggressive or mocking body language such as non-verbal innuendo, raising eyebrows or making faces, condescending language or voice intonation
  • Emotional abuse committed directly or indirectly by a group.
  • Do our student witness bad behaviour, and do they learn bad behaviour?
  • PhysicalFatigue or insomniaStressGI distressHeadaches, depressionIncreased blood pressurePsychologicalShame or guiltProlonged duress stress disorder or post traumatic stress disorderSubstance abuse.Increased stress, anxiety, irritabilityPoor concentration, feeling overwhelmedInability to concentrateSocialIsolation Loss of libidoLoss of self confidence, decreased self esteemAvoidance and withdrawal behaviors, disconnection from othersIncreased use of tobacco, alcohol, and other substancesGriffin, m. Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. Journal of continuing nursing. 2004; 35(6): 257-263.Cortina & Magley, 2003; Gilmour & Hamlin, 2003; Longo & Sherman, 2007; Normandale & Davies, 2002May also be PTSD and suicidal ideationIndividual factors:Type A personalityEmotional state – anger, burnoutInadequate conflict management skillsBeliefs and expectationsNo time for reflectionNo acknowledgement of the emotional work required
  • Karen
  • Pui Ling Fung The Open University of Hong Kong
  • What to do?When nurses don't have control but must be accountable, you can see where they might not be happy with one another. Other unhealthy coping strategies include taking up smoking, using alcohol excessively and abusing prescription medication. Anti-harassment and diversity initiatives can make a big difference.
  • great resource for parents and teachers
  • Collectivism vs individualism
  • Denial that behavior is a problemManager condones the behaviorManager exhibits the behaviorNegative behavior is accepted as the normInformationabout negative behaviors is suppressedManager protecting someone with good clinical skillsEmployee fear of retaliation causes ‘silencing of voice’Policies are in place but not enforcedManager lacks confrontation skillsTime pressure used as an excuse not to confront perpetratorsHuman resources department not consulted or not helpfulBlame is shifted to the victim
  • Cognitive Rehearsal TechniquesIntroduced by Dr. Martha Griffin in her study with new graduate nurses Taught nurses about the behaviorsProvided suggestions for what to say in response to each behaviorProvided laminated cards with the information that nurse could put behind her ID badgeGave nurses the opportunity to practice responding to lateral violence behaviorsImage
  • Drama triangle hereGary Harper’s drama triangle can be helpful to start discussions on bullying.
  • Managing lateral violence and its impact on the team la ronge november 2013

    1. 1. Mamawetan Churchill River Health Region November 8, 2013 Managing Lateral Violence and its Impact on the Team: Eli Ahlquist RN MPA Greg Riehl RN BScN MA
    2. 2. Outline  What is lateral violence?  What causes lateral violence?  Who is doing it?  Types.  Effects.  What can be done?  Discussion.
    3. 3. 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
    4. 4. Honesty Change Hope  Prisoners, vacationers, keeners,  Communication will be key for today’s work on Lateral Violence  We have 2 ears and one mouth, listening should always be 2:1  I do not have the power to fix Lateral Violence, but you do.
    5. 5. 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
    6. 6. 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
    7. 7. Building a culture of respect combats lateral violence  A study in the Journal of Advanced Nursing found that half of newly qualified nurses report first-hand experience with lateral violence.  Linda Rabyj, 2005
    8. 8. 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
    9. 9. 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
    10. 10. 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
    11. 11. 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.
    12. 12. Why?  Some professionals can receive preferential treatment from administration.  Crowded working conditions  Overworking conditions  Too many demands  Mistrust between experienced staff and the new staff  Mistrust between subordinate and supervisor  Ineffective classroom and or practice management skills Luparell 2008
    13. 13. Warning Signs  Drugs and alcohol abuse  Gambling  Addiction  Sudden shifts in behaviour  Job performance goes down  Threats of violence  Preoccupation with violence  Co-workers complaining
    14. 14. 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
    15. 15. Bystanders, Managers, Leaders  Sometimes staff witness lateral violence events but are not prepared to support their colleague for fear that they might be the next victim.  Ignoring the victim’s behavior & distress often seem to be the way staff and organizations respond to the issue.  There may be a style of management at various levels and within institutions that is based on fear rather than respect.
    16. 16. 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.
    17. 17. Workplace Violence & Harassment Experts identify two primary categories of lateral violence. 1. Overt(direct) 2. Covert (passive)
    18. 18. Lateral Violence Covert - Passive  Judging others on age, gender, sexual orientation, ethnicity or size  Failure to respect privacy, and broken confidences  Blaming and gossiping behind someone’s back  Scapegoating and humiliation,  Infighting and bickering  Sabotage such as setting up a new hire for failure  Withholding needed information or advice, or taking credit  Obnoxious behaviour making people feel inadequate
    19. 19. 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
    20. 20. 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
    21. 21. 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. 2. 3. 4. 5. Conflict Aggressive acts Management/Faculty Involvement Branding as Difficult or Mentally ill Expulsion
    22. 22. Who else is involved? • Patients • Quality care • Staff • Co-workers as bystanders • Management • Systems • Employers • Faculty • The ‘System’
    23. 23. 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?
    24. 24. 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
    25. 25. Health Impacts on Staff/Victims  Physical/Body  Emotional  Mental/Mind  Spiritual
    26. 26. Impact on Nurses/Students
    27. 27. Impacts on Health Systems  Dwindling workforce  1 in 3 nurses will leave the profession (2003)  Reduced professional status  Corrosion of recruitment and retention
    28. 28. 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
    29. 29. 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.
    30. 30. Impacts on Students and New Hires  Students and new hires are extremely susceptible to Lateral Violence and experience more negative impacts than experienced workers.  Prevention Strategies are needed • • • • • Top down and bottom up approaches Mentoring and investigation systems Role Models Education Empowerment
    31. 31. 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
    32. 32. 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!
    33. 33. 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.
    34. 34. What do we do with bullies?  Kick them out? Discipline? Isolate them? Dissocialize them?  Similar to a criminal, who has broken the law, punishment rarely has positive consequences  Dignity + Respect = no bullying
    35. 35. Dignity + Respect = no bullying  The solution or approach to address bullying is to promote its real enemy - dignity and respect;  because with these principles, bullying can not prevail.  Bullying is ultimately about isolation - isolating workers and making them feel inadequate. If this is so, then the antidote to bullying lies in working together.
    36. 36. 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
    37. 37. Our Culture needs to change  “We 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
    38. 38. 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”
    39. 39. 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.
    40. 40. Rehearsal  Research has demonstrated the benefit of rehearsal for new employees experiencing lateral violence.  i.e.  When a staff member makes a facial gesture (such as raising an eyebrow), the participant was instructed to say, “I see from your facial expression that there may be something you wanted to say to me. It’s OK to speak directly to me”. Griffin, M. (2004) Teaching Cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. Journal of Continuing Education in Nursing, 35(6), 257-263.
    41. 41. DESC COMMUNICATION MODEL  Describe – the behavior  Explain – the effect the behavior has on you, coworkers, patient care  State – the desired outcome  Consequences – what will happen if the behavior continues?
    42. 42. Lateral Violence personal level  The truth is that most of the violence in the world is committed not by bullies but by victims!  A person may see himself as a victim. They used to be the victim of the kids who enraged him by calling him names. Now, in addition, he feels himself to be the victim of the crooked adult society.  Society takes his tormentors' side against him and punishes him for trying to stop his bullies. He is now angrier and therefore more dangerous than before the wise adults disciplined him for being a bully!  Victims Bullies Hero’s
    43. 43. Review Workplace Bullies  Sydney-based clinical psychologist and workplace bullying specialist Keryl Egan has formulated three workplace bully profiles: 1) accidental bully, 2) narcissistic bully, and 3)serial bully. Egan describes the accidental bully as emotionally blunt, aggressive and demanding. "This person is task orientated and just wants to get things done, tends to panic when things are not getting done, and goes into a rage about it. This person is basically decent, they don't really think about the impact of what's happened or what they have done. They are responding to stress a lot of the time." Importantly, Egan believes this type of bully can be trained or coached out of the bullying behaviour.
    44. 44. Three Workplace Bullies  The second profile formulated by Egan is the narcissistic bully, who is grandiose and has fantasies of breathtaking achievement. "This type of bully feels they deserve power and position. They can fly into rages whenever reality confronts them. This person is very destructive and manipulative, they don't set out in a callous way to annihilate any other person - it's purely an expression of their superiority."
    45. 45. Three Workplace Bullies  Finally, Egan's third profile is that of the serial bully "who has a more sociopathic or psychopathic personality. This type of bully is intentional, systematic, and organized and the bullying is often relentless. They usually get things done in terms of self interest, not in the interest of the company." Egan's serial bully employs subtle techniques that are difficult to detect or prove and training or coaching is always unsuccessful; simply, the serial bully is often:  grandiose yet charming,  authoritative, aggressive and dominating,  fearless and shameless,  devoid of empathy or remorse,  manipulative and deceptive;  impulsive, chaotic or stimulus seeking; and  a master of imitation and mimicry.
    46. 46. 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.
    47. 47. Teamwork and Communication  Teamwork in this area involves many staff in solving problems related to these issues.  Policy documents on bullying and intimidation need to be developed.  Specify the sorts of behavior that will not be tolerated, and include, within the policy, the "rights" of individuals to be treated fairly and with respect.  Effective anti-bullying practices must include a statement of exactly what constitutes bullying.  We need to work with everyone, bullies, targets, and bystanders.
    48. 48. Tackling a Culture of Intimidation  Developing more open communication and increased access to senior management.  Ensuring that supervisors receive adequate training and support for their role.  Ensuring that policies refer specifically to managing bullying & that these standards are maintained through an effective performance management system.  Providing accessible professional development opportunities for all staff.  Developing 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 behavior
    49. 49. Safe Place  Where is the safe place where you work?  What makes it “safe”?  Will you be able to respond to lateral violence when it happens?”
    50. 50. Discussion, questions, comments!!! Thank you for your participation
    51. 51. Contact information Eli Ahlquist RN, MPA Greg Riehl RN BScN MA Program Head Aboriginal Nursing Student Advisor Perioperative Nursing Aboriginal Nursing Student Achievement Program SIAST, Wascana Campus SIAST, Wascana Campus Email: Email: Phone: 306.775.7568 Phone: 306.775.7383
    52. 52. References available on Request Find our Presentation on slideshare