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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Managing lateral violence and its impact on the team la ronge november 2013
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. Outline
What is lateral violence?
What causes lateral violence?
Who is doing it?
Types.
Effects.
What can be done?
Discussion.
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.
5. 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.
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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.
13. 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
14. 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
15. 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
16. 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.
17. 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.
18. Workplace Violence & Harassment
Experts identify two primary
categories of lateral violence.
1. Overt(direct)
2. Covert (passive)
19. 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
20.
21. 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
22. 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
23. 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
24. Who else is involved?
•
Patients
• Quality care
•
Staff
• Co-workers as bystanders
• Management
•
Systems
• Employers
• Faculty
• The ‘System’
25. 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?
26. 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
27.
28. Health Impacts on Staff/Victims
Physical/Body
Emotional
Mental/Mind
Spiritual
30. Impacts on Health Systems
Dwindling workforce
1 in 3 nurses will leave the profession
(2003)
Reduced professional status
Corrosion of recruitment and retention
31. 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
32. 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.
33. 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
34. 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
35. 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!
36. 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.
37. 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
38. 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.
39. 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
40. 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
41. 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”
42. 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.
43. 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.
44. 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?
45. 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
46. 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.
47. 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."
48. 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.
49. 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.
50. 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.
51. 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
52. 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?”
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 http://www.homebirth.net.au/2010/03/bullying-culture-of-midwifery.html 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. http://nursing.advanceweb.com/Features/Articles/Why-Nurses-Bully-What-You-Can-Do-About-It.aspx
Persistent attitude of the role of Nurses being hand-maidens,Image http://nursing.advanceweb.com/Features/Articles/Why-Nurses-Bully-What-You-Can-Do-About-It.aspx
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.
http://www.mediate.com/articles/belak1.cfm
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 bplfung@ouhk.edu.hk
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.
http://www.apa.org/pubs/info/reports/zero-tolerance.pdfhttp://www.huffingtonpost.com/tag/bullying-zero-tolerancehttp://www.huffingtonpost.com/carolyn-laub/bullying-zero-tolerance_b_1521844.htmlhttp://www.nea.org/home/alt-zero-tolerance-policies.htmlhttp://bullies2buddies.com/ great resource for parents and teachers
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 http://nursing.advanceweb.com/features/articles/no-tolerance-for-bullying.aspx
Drama triangle hereGary Harper’s drama triangle can be helpful to start discussions on bullying.http://www.joyofconflict.com/editor_articles/ConflictDrama-VictimVillainHero.htm