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Better Communication in Nursing - Ending Nursing Violence

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In Nursing, there exists a culture of lateral violence and bullying, I have finally come to the realization that what we are seeing is the symptom of something much larger, something that starts, grows, and is nurtured with our own participation. We communicate in ways that have the ability to support each other, but we can also communicate in ways that are hurtful, mean, and contribute to a culture of oppression. We need to change our culture.

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Better Communication in Nursing - Ending Nursing Violence

  1. 1. — Saturday, November 7th, 2015, 9am - 3pm — Regina SK:Wascana Rehabilitation Center Auditorium Better Communication in Nursing Ending NursingViolence LateralViolence – Lateral Kindness Greg Riehl RN BScN MA
  2. 2. “The real voyage of discovery consists not in seeking new landscapes but in having new eyes.” Marcel Proust
  3. 3. Outline • Cultural safety in the workplace • Communication senses – eyes and ears • Functional versus dysfunctional conflict • Intergenerational communication • Discussion
  4. 4. And if there is time… • What is lateral violence • What causes lateral violence • What are the effects of lateral violence • Who gets targeted • Types of bullies • Hierarchy • Mobbing • Identify terms used to describe negative coworker behavior • Describe an experience with negative coworker behavior • Discuss strategies to manage negative coworker behavior • Cultural competence and culture • Zero tolerance policies • Functional versus dysfunctional conflict • Better communication strategies • Types of teams and teamwork • Commitment to co-workers • Increase knowledge and understanding of the four generations • Enhance comprehension of how generational differences affect you • Promote skills for effective intergenerational communication • Expand capacity to manage diverse working styles across the generations
  5. 5. Why am I here? I ask myself this every day I also ask this to people I work with from time to time
  6. 6. This is where I work
  7. 7. This is where I used to workThis is where I used to work
  8. 8. Objectives  To broaden the understanding of the Platinum Rule.  To describe how to apply the Platinum Rule.  Compare the Golden and Platinum Rules.  To explore cultural aspects of nursing care.  To identify the unique challenges faced by care providers working with diverse clients.
  9. 9. Stories • I will use some of my experiences working in health, in the north, and as an male nurse, often an outsider, working in different situations. • You are a part of the story.
  10. 10. Safe place • Where is the safe place in your organization?
  11. 11. Hierarchy is systemic. The more vertical an organization is in its hierarchy, the more complicated communication becomes. We go to school, we get a job, but nowhere are we told that lateral violence exists, or that we will have to deal with it, or avoid it, or be drawn into it.
  12. 12. Communication is about listening • My job description does not say, Greg, you will have to listen to a lot of your co workers bitching and complaining about each other, they will want you to fix their conflicts, and will want you to keep it a secret and tell no one. • This will happen on a very regular basis, consider this ‘duties as assigned’
  13. 13. LateralViolence “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
  14. 14. LateralViolence LateralViolence (LV), also called Horizontal violence, [bullying], 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
  15. 15. The absence of one thing does not mean there will be more of the other thing… “What you see you do not see” – Archi Weenie
  16. 16. 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!
  17. 17. Hurt People Hurt People When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; He needs help. Tich Naht Hanh
  18. 18. Hurt People Hurt People Hurt people hurt people.That’s how pain patterns get passed on, generation after generation after generation. Break the chain today. Meet anger with sympathy, contempt with compassion, cruelty with kindness. Greet grimaces with smiles. When you forget about the fault, there is nothing to forgive. Love is the weapon of the future Yehuda berg
  19. 19. 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
  20. 20. 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 Basically if you are different you may be a potential target!
  21. 21. We communicate/bully differently. 2009 survey byWorkplace Bullying Institute: - Main perpetrator’s gender • 65% Female • 35% Male 2009WBI survey sited in NewYorkTimes: - Men target men and women equally -Women target women 70% of the time
  22. 22. 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.
  23. 23. Conflict It’s not all Bad
  24. 24. Back to nursing, 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.
  25. 25. Why? In my profession, nurses practice in a historically patriarchal environment. • Oppression leads to low-self esteem. • Nurses 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.
  26. 26. The Four Generations • The Traditionalists • The Boomers • Generation X’ers • Millennials • 1922–1943/46 • 1943–1960/1946-1964 • 1960-1980/1964-1980 • 1980-2000
  27. 27. Traditionalist Values • Dedication/sacrifice • Law and order • Strong work ethic • Risk averse • Respect for authority • Patience • Delayed reward • Duty, honor, country • Loyalty to the organization
  28. 28. Boomer Values • Optimism • Team work • Personal gratification • Health and wellness • Promotion and recognition • Youth • Work • Volunteerism
  29. 29. Gen X Values • Diversity • Thinking globally • Balance in life • Computer literacy • Personal development • Fun • Informality • Independence • Initiative
  30. 30. Gen X Values
  31. 31. Millennial Values • Optimism • Civic duty • Confidence • Ambition/ achievement • Tradition • Education • Idealism • Fun • Diversity
  32. 32. Insert Story here
  33. 33. 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
  34. 34. 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. Conflict 2.Aggressive acts 3.Management/Faculty Involvement 4.Branding as Difficult or Mentally ill 5.Expulsion
  35. 35. Risk We often face a risk acting We also face a risk when we do not act.
  36. 36. “We Don’t SeeThings AsThey Are, We SeeThem As We Are” “It has been well said that we do not see things as they are, but as we are ourselves. Every man looks through the eyes of his prejudices, of his preconceived notions. Hence, it is the most difficult thing in the world to broaden a man so that he will realize truth as other men see it.”
  37. 37. David and Goliath
  38. 38. In Conflict who are you: Victim, Villain, Hero or Resolutionary? In conflict, each person feels hit first. The size of the villain determines the size of the hero. “Without goliath, David is just some punk, throwing rocks.” Billy Crystal, My Giant
  39. 39. Victims • Are you a victim of the victim syndrome?
  40. 40. Our Culture needs to change • We do not accept bullying in our schools or other workplaces so why is it ok in the workplace? • In Nursing, this is the culture that was learnt by nurses 30 years ago and has propitiously been taught to new nurses.
  41. 41. Bronze, Silver, Gold, & Platinum Rules
  42. 42. Bronze rule Do unto others as they have done unto you
  43. 43. Silver What you do not want done to yourself, do not do to others
  44. 44. Gold Do unto others as you would have them do unto you.
  45. 45. Platinum Do unto others as they want done unto them
  46. 46. THE PLATINUM RULE. TREAT OTHERS HOW THEY WANT TO BE TREATED
  47. 47. ZeroTolerance 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.
  48. 48. 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 we can’t stay silent when another person’s actions “makes us cringe”. • Having the conversation is what matters . . . it shows that both professionals share responsibility for behaviour affecting staff and patients. • Monica Branigan, 2009
  49. 49. Impact is on all staff •Physical •Psychological •Social
  50. 50. Lateral Silence • It is part of the culture. • Everybody knows about it • Everybody does it • No body talks about it
  51. 51. Why Don’tWe Stop LateralViolence? “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”
  52. 52. Using the ACORN Approach •Accommodate employee differences. •Create workplace choices. •Operate from a flexible management style. •Respect competence and initiative. •Nourish retention. Source: Generations At Work, Ron Zemke, Claire Raines, and Bob Filipczak
  53. 53. Statement of Commitment to Co-workers As your co-worker with a shared goal of providing excellent service to people and families, I commit the following: I will accept responsibility for establishing and maintaining healthy interpersonal relationships with you and every member of this staff. I will talk to you promptly if I am having a problem with you. The only time I will discuss it with another person is when I need advice or help in deciding how to communicate with you appropriately. I will establish & maintain a relationship of functional trust with you and every member of this staff. My relationships with each of you will be equally respectful, regardless of job titles or levels of educational preparation. I will not engage in the '3B's (bickering, back-biting and bitching) & will ask you not to as well. I will not complain about another team member & ask you not to as well. If I hear you doing so, I will ask you to talk to that person. I will accept you as you are today, forgiving past problems, & ask you to do the same with me. I will be committed to finding solutions to problems rather than complaining about them or blaming someone, & ask you to do the same. I will affirm your contribution to quality service. I will remember that neither of us is perfect, & that human errors are opportunities not for shame or guilt, but for forgiveness and growth. (Adapted from Marie Manthey, President of Creative Nursing Management in Caroline Flint's Midwifery Teams and Caseloads 1993; p. 138)
  54. 54. Lateral Kindness • Please be kind to each other • Respectful and responsible relationships, there are no apps for that. • Be Grateful • Be Great!
  55. 55. Discussion, questions, comments!!! Thank you Paula for the opportunity, and thank you for spending your time with me today.
  56. 56. Contact information Greg Riehl RN greg.riehl@saskpolytech.ca gregriehl@sasktel.net @griehl
  57. 57. References available on request slideshareFind this Presentation on
  58. 58. Three types of BULLIES Sydney based clinical psychologist and workplace bullying specialist Keryl Egan has formulated three workplace bully profiles: 1.Accidental bully 2.Narcissistic bully 3.Serial bully
  59. 59. Accidental bully 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 happening or what they have done. They are responding to stress and it is believed that they can be coached out of this behavior.
  60. 60. Narcissistic Bully They are grandiose and have dreams of breath taking achievement.They feel they deserve power and position. They can fly into a rage when reality confronts them.This person is very destructive and manipulative, they don’t set out in a callous way to annihilate any person – it is purely an expression of their superiority.
  61. 61. Serial Bully Has a sociopathic and psychopathic personality.This type of bully is intentional, systematic and organized and is often relentless.They usually get things done in terms of self-interest. They employ subtle techniques that are difficult to detect or prove. Coaching is often ineffective. They exhibit the following: •Grandiose, but charming •Authoritative, aggressive and dominating •Fearless and shameless •Devoid of empathy or remorse •Manipulative and deceptive •Impulsive, chaotic or stimulus seeking •Master of imitation or mimicry
  62. 62. What can you do? • Dialogue is ultimately far more effective than pointing fingers • Cognitive RehearsalTechniques • Health care professionals across the spectrum working together more effectively and patients receiving better care.
  63. 63. 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?
  64. 64. Rehearsal Research has demonstrated the benefit of rehearsal for new employees. i.e. When a staff member makes a facial gesture (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, 2004
  65. 65. 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.

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