1. Brandon, Manitoba Decmebr11, 2013Managing Lateral Violence and its Impact on the Team: Eli Ahlquist RN MPA

2. Outline What is lateral violence?What causes lateral violence? Who is doing it?Types.Effects.What can be done?Discussion. 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. Lateral ViolenceExists 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. 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. Building a culture of respect combats lateral violenceA 2003 study in the Journal of Advanced Nursing found that half of newly qualified nurses report firsthand experience with lateral violence. Linda Rabyj, 2005 7. Who gets targeted? Anyone who is different from the group norm on any major characteristic Experience Education Race/ethnicity GenderTargeted persons gender 79% Female 21% Male 8. Who is Doing the Bullying? 2009 survey by Workplace Bullying Institute: - Main perpetrators gender 65% Female 35% Male2009 WBI survey sited in New York Times: - Men target men and women equally - Women target women 70% of the time 9. Why does this happen in the Workplace? Isolated from the public and other staffHigh-stress environmentLimited autonomy in practiceHigh-paced environmentLack of experienced staffCliques or closely bonded groupsHierarchical climateGender imbalanceAttitudes to trainingNon acceptance of difference 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 oneWe now work with four different generations in the workforce, adding to the complexities of effective communication. 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 aggressionIntergroup conflict Shift to shift/class to class/group to group Cliques within a workgroup Department to department 12. 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 bully3.Serial bully 13. 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 dont really think about the impact of whats happening or what they have done. They are responding to stress and it is believed that they can be coached out of this behavior. 14. 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 dont set out in a callous way to annihilate any person it is purely an expression of their superiority. 15. 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 charmingAuthoritative, aggressive and dominatingFearless and shamelessDevoid of empathy or remorseManipulative and deceptiveImpulsive, chaotic or stimulus seekingMaster of imitation or mimicry 16. Conflict Its 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. Workplace Violence & Harassment Experts identify two primary categories of lateral violence. Overt(direct) Covert (passive) 18. 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 19. 10 Most Common Forms of Lateral Violence in Nursing 6. Infighting,7. Scapegoating, 8. Backstabbing, 9. Failure to respect privacy, and10.Broken confidences. Griffin. 2004 20. Mobbing A group of coworkers gang up on another often with the intent to force them to leave the work groupFive phases of Mobbing 1. 2. 3. 4. 5.Conflict Aggressive acts Management/Faculty Involvement Branding as Difficult or Mentally ill Expulsion 21. Who else is involved? Students/Patients Quality careNurses Co-workers as bystanders PreceptorsSystems Employers Faculty The System 22. 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? 23. 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 & ODaniel, 2008Ruminating about an event takes your attention off task and leads to increased errors and injuries Porath & Erez, 2007 24. Impacts on Nurses Physical Psychological Social 25. Impact on Nurses/Students 26. Impacts on Health SystemsDwindling workforce - 1 in 3 nurses will leave the profession (2003)Reduced professional statusCorrosion of recruitment and retention 27. Impacts on Health Systems Negative Impact on the work environment: Communication and decision making Collaboration and teamworkLeading to: employee disengagement job satisfaction and performance risk for physical and psychological health problems absenteeism and turnover 28. Impacts on Health Systemscont.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. 29. Impacts on Student and Grad Nurses 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 approachesMentoring and investigation systemsRole ModelsEducationEmpowerment 30. 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 31. What to do? AwarenessEducationDialogueZero tolerance policyBe confidentDevelop effective coping mechanismsConfront the situationRehearsalEnact policy and procedureCode of conductDont accept it! 32. OMG a student Witnesses a Code Pink When there is an event that needs handling in the OR aCodePink 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/ 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. Culture of Silence Because we set ourselves up to be healers, this kind of behaviour is in the shadows. We dont know what to do about it, so we try to disown it. In practice, this means nurses cant stay silent when another nurses 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 35. 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 who've gone before. Dr. Martha Griffin, 2005 36. Why Dont We Stop Lateral Violence? Its not a problem in our work area Everybody does it just get used to it If I say anything, Ill be the next target We have policies but they arent enforcedShe sets herself up for getting picked on 37. 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. 38. DESC model Describe - the behavior. Explain the effect the behavior has on you, co-workers, patient care, etc. State the desired outcome. Consequences What will happen if the behavior continues. 39. 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. Its ok to speak directly to me. Griffin, 2004 40. 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. 41. Tackling a Culture of Intimidation 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 42. https://www.youtube.com/watch?v=fTmyym7_-zQ http://www.xtranormal.com/watch/11704905/nursenurse-bullyLateral Violence and Students 43. Discussion, questions, comments!!! Thank you for your participation 44. Contact information Eli Ahlquist RN, MPAGreg Riehl RN BScN MAProgram HeadAboriginal Nursing Student AdvisorPerioperative NursingAboriginal Nursing Student Achievement ProgramSIAST, Wascana CampusSIAST, Wascana CampusEmail: ahlquist@siast.sk.caEmail: greg.riehl@siast.sk.caPhone: 306.775.7568Phone: 306.775.7383 45. 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