inspireHealth Care Quality Summit April 11th, 2013Regina Saskatchewan   Managing Lateral Violence  and its Impact on the T...
Outline•   What is lateral violence?•   What causes lateral violence?     •   Who is doing it?     •   Types.•   Effects.•...
Objectives1.   Identify terms used to describe negative coworker     behavior2.   Describe an experience with negative cow...
Lateral Violence•   “Exists on a spectrum, from seemingly ordinary    behaviour such as gossiping or criticism, to intimid...
Definition Lateral Violence (LV), also called Horizontal violence,  Nurse-to-Nurse violence, incivility, and disruptive  ...
Building a culture of respectcombats lateral violence• A 2003 study in the Journal of  Advanced Nursing found that half  o...
Who gets targeted? Anyone who is different from the group  norm on any major characteristic   Experience   Education  ...
Who is Doing the Bullying? 2009 survey by Workplace Bullying Institute:    Main perpetrator’s gender       65% Female  ...
Why does this happen in the           Workplace?•    Isolated from the public and other staff•    High-stress environment•...
Why? Nurses practice in a historically patriarchal environment.    Oppression leads to low-self esteem.    Nurse exert ...
Who is doing it? Coworker-on-coworker aggression    Directed toward individuals at same power level    Intended to caus...
Conflict It’s not all Bad Functional Conflict is considered positive,  as it can increase performance, support  change, a...
Workplace Violence & Harassment    Experts identify two primary     categories of lateral violence.             Overt(dire...
10 Most Common Forms of Lateral         Violence in Nursing1. Non-verbal innuendo,2. Verbal affront,3. Undermining activit...
10 Most Common Forms of Lateral         Violence in Nursing6. Infighting,7. Scapegoating,8. Backstabbing,9. Failure to res...
MobbingA group of coworkers gang up on another  – often with the intent to force them to  leave the work groupFive phases ...
Who else is involved?•   Students/Patients       • Quality care•     Nurses       • Co-workers as bystanders       • Prece...
Do Nurses eat their young – andeach other… This old adage should not be the price the  next generation has to pay to join...
Clinical Settings - Impacts on               Patients• Disruptive behavior linked to:       71%: medical errors       27...
Impacts on Nurses  • Physical  • Psychological  • Social
Impact on Nurses/Students
Impacts on Health Systems•   Dwindling workforce     1 in 3 nurses will leave the profession      (2003)•   Reduced profe...
Impacts on Health Systems Negative Impact on the work environment:   Communication and decision making   Collaboration ...
Impacts on Health Systems                      cont.Cost of Lateral Violence:• “Turnover costs up to two times a nurses  s...
Impacts on Student and GradNurses•   Students and grad nurses are extremely    susceptible to Lateral Violence and    expe...
We All need to ask ourselves:“Did I participate in bullying?”“Did I support this kind of behavior inothers?”“Did I interve...
What to do?•   Awareness•   Education•   Dialogue•   Zero tolerance policy•   Be confident•   Develop effective coping mec...
OMG a student Witnesses             a Code Pink•   When there is an event that needs handling in the OR a    “Code   Pink”...
Zero Tolerance Policies The Joint Commission and the American Association of  Critical Care Nurses (AACN).•   2008: manda...
Culture of Silence• “Because we set ourselves up to be healers,  this kind of behaviour is in the shadows. We  don’t know ...
Nursing Culture needs to change• “New nurses personalize their  experiences and assume they are  unique to themselves”• "O...
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...
What can you do?• Dialogue is ultimately far more effective  than pointing fingers• Cognitive Rehearsal Techniques• Health...
Teamwork and Communication• Involve everyone in solving problems  related to these issues.• Develop a set of “RIGHTS” for ...
Tackling a Culture ofIntimidation•   Open communication and increased communication to    nursing senior management.•   Pr...
https://www.youtube.com/watch?v=fTmyym7_-zQhttp://www.xtranormal.com/watch/11704905/nursenurse-bullyLateral Violence and S...
Discussion, questions,   comments!!!Thank you for your participation
Contact informationEli Ahlquist RN, MPA          Greg Riehl RN BScN MAProgram Head                  Aboriginal Nursing Stu...
References available on RequestFind our Presentation on   slideshare
Managing lateral violence and its impact on the team  nurses and students final
Managing lateral violence and its impact on the team  nurses and students final
Managing lateral violence and its impact on the team  nurses and students final
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Managing lateral violence and its impact on the team nurses and students final

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The effects of lateral violence can be catastrophic for students in preceptored relationships. We wanted to promote healthy learning workplaces, and support teaching and learning environments for quality learning outcomes - we delivered in-services on lateral violence to increase awareness and to support positive interactions between nurses and students, while addressing negative communication behaviours and lateral violence.

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Managing lateral violence and its impact on the team nurses and students final

  1. 1. inspireHealth Care Quality Summit April 11th, 2013Regina Saskatchewan Managing Lateral Violence and its Impact on the Team: Nurses and Students 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. Objectives1. Identify terms used to describe negative coworker behavior2. Describe an experience with negative coworker behavior3. Discuss strategies to manage negative coworker behavior
  4. 4. 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
  5. 5. 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
  6. 6. Building a culture of respectcombats lateral violence• A 2003 study in the Journal of Advanced Nursing found that half of newly qualified nurses report first-hand experience with lateral violence. Linda Rabyj, 2005
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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.
  11. 11. 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
  12. 12. 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.
  13. 13. Workplace Violence & Harassment Experts identify two primary categories of lateral violence. Overt(direct) Covert (passive)
  14. 14. 10 Most Common Forms of Lateral Violence in Nursing1. Non-verbal innuendo,2. Verbal affront,3. Undermining activities,4. Withholding information,5. Sabotage, Griffin. 2004
  15. 15. 10 Most Common Forms of Lateral Violence in Nursing6. Infighting,7. Scapegoating,8. Backstabbing,9. Failure to respect privacy, and10.Broken confidences.  Griffin. 2004
  16. 16. MobbingA group of coworkers gang up on another – often with the intent to force them to leave the work groupFive phases of Mobbing 1. Conflict 2. Aggressive acts 3. Management/Faculty Involvement 4. Branding as Difficult or Mentally ill 5. Expulsion
  17. 17. Who else is involved?• Students/Patients • Quality care• Nurses • Co-workers as bystanders • Preceptors• Systems • Employers • Faculty • The ‘System’
  18. 18. Do Nurses eat their young – andeach 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?
  19. 19. 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
  20. 20. Impacts on Nurses • Physical • Psychological • Social
  21. 21. Impact on Nurses/Students
  22. 22. Impacts on Health Systems• Dwindling workforce  1 in 3 nurses will leave the profession (2003)• Reduced professional status• Corrosion of recruitment and retention
  23. 23. 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
  24. 24. 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.
  25. 25. Impacts on Student and GradNurses• Students and grad nurses are extremely susceptible to Lateral Violence and experience more negative impacts than experienced nurses.• Prevention Strategies are needed • Top down and bottom up approaches • Mentoring and investigation systems • Role Models • Education • Empowerment
  26. 26. We All need to ask ourselves:“Did I participate in bullying?”“Did I support this kind of behavior inothers?”“Did I intervene if and when I observedit?”“We must work to uncover and reverseatrocities, one person, one company, andone law at a time” Bullyproof Yourself at Work, G & R Namie
  27. 27. 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!
  28. 28. OMG a student Witnesses a Code Pink• When there is an event that needs handling in the OR a “Code Pink” is called.• A group of available individuals from other theaters will come to the perpetrators theater and stand silently staring at them.• As an example, the surgeon is shouting, being verbally abusive or throwing equipment. Mehallow, C. Verbal Abuse in Healthcare. http://healthcare.monster.com/nursing/articles/verbalabuse/
  29. 29. 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.
  30. 30. 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
  31. 31. Nursing Culture needs to change• “New nurses 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 whove gone before.“ Dr. Martha Griffin, 2005
  32. 32. 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”
  33. 33. 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.
  34. 34. 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.
  35. 35. Tackling a Culture ofIntimidation• Open communication and increased communication to nursing senior management.• Providing accessible professional development opportunities for all staff.• Developing a 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 b behaviour
  36. 36. https://www.youtube.com/watch?v=fTmyym7_-zQhttp://www.xtranormal.com/watch/11704905/nursenurse-bullyLateral Violence and Students
  37. 37. Discussion, questions, comments!!!Thank you for your participation
  38. 38. Contact informationEli Ahlquist RN, MPA Greg Riehl RN BScN MAProgram Head Aboriginal Nursing Student AdvisorPerioperative Nursing Aboriginal Nursing Student Achievement ProgramSIAST, Wascana Campus SIAST, Wascana CampusEmail: ahlquist@siast.sk.ca Email: greg.riehl@siast.sk.caPhone: 306.775.7568 Phone: 306.775.7383
  39. 39. References available on RequestFind our Presentation on slideshare

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