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Managing Lateral Violence and its Impact on the Team: Nurses and Students


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Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit Follow @QualitySummit on Twitter.

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.
Better Teams

Greg A. Riehl; Eli Ahlquist

Published in: Health & Medicine
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Managing Lateral Violence and its Impact on the Team: Nurses and Students

  1. 1. Managing Lateral Violence and its Impact onthe Team: Nurses and StudentsElijah Ahlquist, Greg RiehlThis Session is sponsored by:
  2. 2. Health Quality CouncilManaging Lateral Violenceand its Impact on the Team:Nurses and StudentsEli Ahlquist RN MPAGreg Riehl RN BScN MA
  3. 3. Outline• What is lateral violence?• What causes lateral violence?• Who is doing it?• Types.• Effects.• What can be done?• Discussion.
  4. 4. Objectives1. Identify terms used to describe negative coworkerbehavior2. Describe an experience with negative coworkerbehavior3. Discuss strategies to manage negative coworkerbehavior
  5. 5. Lateral Violence• “Exists on a spectrum, from seemingly ordinarybehaviour 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 disruptivebehaviours, creates an unpleasant work environmentand has harmful effects on individual nurses, patientsafety, and health care organizations. Johnson, 2009 & Dimarino, 2011
  7. 7. Building a culture of respectcombats lateral violence• A 2003 study in the Journal ofAdvanced Nursing found that halfof newly qualified nurses reportfirst-hand experience with lateralviolence. Linda Rabyj, 2005
  8. 8. Who gets targeted?Anyone who is different from the groupnorm 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 theWorkplace?• 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 lateralviolence. Lateral violence is perpetuated through the culture ofnursing (new nurses, curriculum, etc). “Nurses eat their own” “See one do one teach one” We now work with four different generations in theworkforce, adding to the complexities of effectivecommunication.
  12. 12. 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
  13. 13. Conflict It’s not all Bad Functional Conflict is considered positive,as it can increase performance, supportchange, and identify weaknesses or areasthat need to be supported. Dysfunctional Conflict is harmful to peopleand the organization. This type ofconfrontation does nothing to supportgoals or objectives.
  14. 14. Workplace Violence & HarassmentExperts identify two primarycategories of lateral violence.Overt(direct)Covert (passive)
  15. 15. 10 Most Common Forms of LateralViolence in Nursing1. Non-verbal innuendo,2. Verbal affront,3. Undermining activities,4. Withholding information,5. Sabotage,Griffin. 2004
  16. 16. 10 Most Common Forms of LateralViolence in Nursing6. Infighting,7. Scapegoating,8. Backstabbing,9. Failure to respect privacy, and10.Broken confidences. Griffin. 2004
  17. 17. MobbingA group of coworkers gang up on another– often with the intent to force them toleave the work groupFive phases of Mobbing1. Conflict2. Aggressive acts3. Management/Faculty Involvement4. Branding as Difficult or Mentally ill5. Expulsion
  18. 18. Who else is involved?• Students/Patients• Quality care• Nurses• Co-workers as bystanders• Preceptors• Systems• Employers• Faculty• The ‘System’
  19. 19. Do Nurses eat their young – andeach other… This old adage should not be the price thenext generation has to pay to join thenursing profession. What stories do you want your students totalk about with their peers, co-workers, orat their 5 or 10 year reunion?
  20. 20. Clinical Settings - Impacts onPatients• Disruptive behavior linked to:71%: medical errors27%: patient mortality18%: witnessed at least one mistake as a resultof disruptive behavior Rosenstein & O’Daniel, 2008• Ruminating about an event takes yourattention off task and leads to increasederrors and injuriesPorath & Erez, 2007
  21. 21. Impacts on Nurses• Physical• Psychological• Social
  22. 22. Impact on Nurses/Students
  23. 23. Impacts on Health Systems• Dwindling workforce 1 in 3 nurses will leave the profession(2003)• Reduced professional status• Corrosion of recruitment and retention
  24. 24. 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
  25. 25. Impacts on Health Systems cont.Cost of Lateral Violence:• “Turnover costs up to two times a nursessalary, and the cost of replacing one RNranges from $22,000 to $145,000depending on geographic location andspecialty area.”Jones, C & Gates, M. (2007).• The lag in time for a new nurse to becomeproficient is a significant consideration.
  26. 26. Impacts on Student and GradNurses• Students and grad nurses are extremelysusceptible to Lateral Violence andexperience more negative impacts thanexperienced nurses.• Prevention Strategies are needed• Top down and bottom up approaches• Mentoring and investigation systems• Role Models• Education• Empowerment
  27. 27. 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
  28. 28. 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!
  29. 29. OMG a student Witnessesa 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 willcome to the perpetrators theater and stand silentlystaring at them.• As an example, the surgeon is shouting, being verballyabusive or throwing equipment.Mehallow, C. Verbal Abuse in Healthcare.
  30. 30. Zero Tolerance Policies The Joint Commission and the American Association ofCritical Care Nurses (AACN).• 2008: mandate the development and implementation ofprocesses to offset LV that enforce a code of conduct,teach employees communication skills, and supportingstaff.• 2009: advocates that communication skills should be asproficient as clinical skills.
  31. 31. Culture of Silence• “Because we set ourselves up to be healers,this kind of behaviour is in the shadows. Wedon’t know what to do about it, so we try todisown it.”• In practice, this means nurses can’t stay silentwhen another nurse’s actions “makes themcringe”.• Having the conversation is what matters . . . itshows that both professionals shareresponsibility for behaviour affecting staff andpatients.Monica Branigan, 2009
  32. 32. Nursing Culture needs to change• “New nurses personalize theirexperiences and assume they areunique to themselves”• "Our program empowered nurses toadvocate for themselves. As it liberatedthem, retention rates improved. Weattribute this to recognition of lateralviolence. Newer nurses can learn fromthose whove gone before.“Dr. Martha Griffin, 2005
  33. 33. 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”
  34. 34. What can you do?• Dialogue is ultimately far more effectivethan pointing fingers• Cognitive Rehearsal Techniques• Health care professionals across thespectrum working together moreeffectively, and patients receiving bettercare.
  35. 35. Teamwork and Communication• Involve everyone in solving problemsrelated to these issues.• Develop a set of “RIGHTS” for everyone.• Effective anti-bullying practices mustinclude a statement of exactly whatconstitutes bullying.• Communication needs to be a part ofculture.
  36. 36. Tackling a Culture ofIntimidation• Open communication and increased communication tonursing senior management.• Providing accessible professional developmentopportunities for all staff.• Developing a policy on bullying/lateral violence in thework-place and conflict resolution mechanisms.• Self-reflection and active feedback from our peers todevelop insight into our own b behaviour
  37. 37. Lateral Violence and Students
  38. 38. Discussion, questions,comments!!!Thank you for your participation
  39. 39. Contact informationEli Ahlquist RN, MPAProgram HeadPerioperative NursingSIAST, Wascana CampusEmail: 306.775.7568Greg Riehl RN BScN MAAboriginal Nursing StudentAdvisorAboriginal Nursing StudentAchievement ProgramSIAST, Wascana CampusEmail: 306.775.7383
  40. 40. References available on RequestslideshareFind our Presentation on