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Lateral Violence Home Health Aid Conference NITHA

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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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Home Health Aids Conference Prince Albert October 27 – 29th , 2015 Safety in theWorkplace LateralViolence – Lateral Kindness Greg Riehl RN BScN MA
Outline • What is lateral violence? • What causes lateral violence? • What are the effects of lateral violence • Who gets targeted • Types of bullies • Hierarchy • Mobbing • Cultural competence and culture • Zero tolerance policies • Functional versus dysfunctional conflict • What can be done? • Discussion
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
Why am I here? • I ask myself this every day, and I also ask those who I am working with from time to time
Lateral Violence Home Health Aid Conference NITHA
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.
Hierarchy • The more vertical an organization is in its hierarchy, the more complicated communication becomes. • We are hired into a certain job, or role, but no where does it tell us of all the lateral violence that exists, or what to do about it.
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’
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
Definition 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
Cyber Lateral Violence Sending emails without greetings? CAPS LOCK
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
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
Building a culture of respect combats 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
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
Who is Doing the Bullying? 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
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
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.
Who is doing it? Co-worker-on-coworker aggression • Directed toward individuals at same power level • Intended to cause psychological pain • Does not include physical aggression Intergroup/hierarchy conflict • Shift to shift/class to class/group to group… • Cliques within a workgroup • Department to department • We are a team but some people are more important than the others??
Risk • We often face a risk acting, and we also face a risk when we do not act.
David and Goliath
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
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.
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.
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
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.
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
Victims • Are you a victim of the victim syndrome?
WorkplaceViolence & Harassment Experts identify two primary categories of lateral violence. Overt(direct) Covert (passive)
Lateral Violence Home Health Aid Conference NITHA
10 Most Common Forms of LateralViolence in Health Care 1. Non-verbal innuendo, 2. Verbal affront, 3. Undermining activities, 4. Withholding information, 5. Sabotage, Griffin. 2004
10 Most Common Forms of LateralViolence in Health Care 6. Infighting, 7. Scapegoating, 8. Backstabbing, 9. Failure to respect privacy, and 10.Broken confidences. Griffin. 2004
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
Who else is involved? • Students/Patients/Visitors/Family • Quality care • The Team • Co-workers as bystanders • Systems • Employers • Faculty • The ‘System’
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. What stories do you want your students to talk about with their peers, co-workers, or at their 5 or 10 year reunion?
Health Settings - Impacts on Patients and Families 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
Lateral Violence Home Health Aid Conference NITHA
Impact is on all staff •Physical •Psychological •Social
Impacts on Health Systems • Dwindling workforce - 1 in 3 nurses will leave the profession (2003) • Reduced professional status • Corrosion of recruitment and retention
Impacts on Health SystemsNegative 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
Impacts on Health Systems cont. Cost of LateralViolence: •“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.
Impacts on NewTeam Members • New team members are extremely susceptible to LateralViolence and experience more negative impacts than experienced team members. Prevention Strategies are needed • Top down and bottom up approaches • Mentoring and investigation systems • Role Models • Education • Empowerment
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” BullyproofYourself atWork, G & R Namie
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!
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.
Safe place • Where is the safe place in your organization?
Lateral Silence • It is part of the culture. • Everybody knows about it • Everybody does it • No body talks about it
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
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.
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”
How do we deal with the stress? • 75% talk to family, friends, colleagues • 50% experience a desire to resign • 49% lose interest in job, disengage • 23% use more sick time • 35% use formal channels  23% HR representative  12% Union or professional organization representative
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.
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?
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
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.
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)
Lateral Kindness • Please be kind to each other • Respectful and responsible relationships, there are no apps for that. • Be Grateful • Be Great!
Discussion, questions, comments!!! Thank you for your participation
Contact information Greg Riehl RN BScN MA greg.riehl@saskpolytech.ca gregriehl@sasktel.net @griehl
References available on request slideshareFind this Presentation on

More Related Content

Lateral Violence Home Health Aid Conference NITHA

  • 1. Home Health Aids Conference Prince Albert October 27 – 29th , 2015 Safety in theWorkplace LateralViolence – Lateral Kindness Greg Riehl RN BScN MA
  • 2. Outline • What is lateral violence? • What causes lateral violence? • What are the effects of lateral violence • Who gets targeted • Types of bullies • Hierarchy • Mobbing • Cultural competence and culture • Zero tolerance policies • Functional versus dysfunctional conflict • 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. Why am I here? • I ask myself this every day, and I also ask those who I am working with from time to time
  • 6. 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.
  • 7. Hierarchy • The more vertical an organization is in its hierarchy, the more complicated communication becomes. • We are hired into a certain job, or role, but no where does it tell us of all the lateral violence that exists, or what to do about it.
  • 8. 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’
  • 9. 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
  • 10. Definition 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
  • 11. Cyber Lateral Violence Sending emails without greetings? CAPS LOCK
  • 12. 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
  • 13. 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
  • 14. Building a culture of respect combats 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
  • 15. 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
  • 16. Who is Doing the Bullying? 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
  • 17. 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
  • 18. 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.
  • 19. Who is doing it? Co-worker-on-coworker aggression • Directed toward individuals at same power level • Intended to cause psychological pain • Does not include physical aggression Intergroup/hierarchy conflict • Shift to shift/class to class/group to group… • Cliques within a workgroup • Department to department • We are a team but some people are more important than the others??
  • 20. Risk • We often face a risk acting, and we also face a risk when we do not act.
  • 22. 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
  • 23. 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.
  • 24. 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.
  • 25. 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
  • 26. 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.
  • 27. 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
  • 28. Victims • Are you a victim of the victim syndrome?
  • 29. WorkplaceViolence & Harassment Experts identify two primary categories of lateral violence. Overt(direct) Covert (passive)
  • 31. 10 Most Common Forms of LateralViolence in Health Care 1. Non-verbal innuendo, 2. Verbal affront, 3. Undermining activities, 4. Withholding information, 5. Sabotage, Griffin. 2004
  • 32. 10 Most Common Forms of LateralViolence in Health Care 6. Infighting, 7. Scapegoating, 8. Backstabbing, 9. Failure to respect privacy, and 10.Broken confidences. Griffin. 2004
  • 33. 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
  • 34. Who else is involved? • Students/Patients/Visitors/Family • Quality care • The Team • Co-workers as bystanders • Systems • Employers • Faculty • The ‘System’
  • 35. 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. What stories do you want your students to talk about with their peers, co-workers, or at their 5 or 10 year reunion?
  • 36. Health Settings - Impacts on Patients and Families 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
  • 38. Impact is on all staff •Physical •Psychological •Social
  • 39. Impacts on Health Systems • Dwindling workforce - 1 in 3 nurses will leave the profession (2003) • Reduced professional status • Corrosion of recruitment and retention
  • 40. Impacts on Health SystemsNegative 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
  • 41. Impacts on Health Systems cont. Cost of LateralViolence: •“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.
  • 42. Impacts on NewTeam Members • New team members are extremely susceptible to LateralViolence and experience more negative impacts than experienced team members. Prevention Strategies are needed • Top down and bottom up approaches • Mentoring and investigation systems • Role Models • Education • Empowerment
  • 43. 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” BullyproofYourself atWork, G & R Namie
  • 44. 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!
  • 45. 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.
  • 46. Safe place • Where is the safe place in your organization?
  • 47. Lateral Silence • It is part of the culture. • Everybody knows about it • Everybody does it • No body talks about it
  • 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. 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.
  • 50. 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”
  • 51. How do we deal with the stress? • 75% talk to family, friends, colleagues • 50% experience a desire to resign • 49% lose interest in job, disengage • 23% use more sick time • 35% use formal channels  23% HR representative  12% Union or professional organization representative
  • 52. 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.
  • 53. 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?
  • 54. 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
  • 55. 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.
  • 56. 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)
  • 57. Lateral Kindness • Please be kind to each other • Respectful and responsible relationships, there are no apps for that. • Be Grateful • Be Great!
  • 59. Contact information Greg Riehl RN BScN MA greg.riehl@saskpolytech.ca gregriehl@sasktel.net @griehl
  • 60. References available on request slideshareFind this Presentation on

Editor's Notes

  1. Day 1: October 27, 2015 MC: Lindsay Dauvin Time Topic Speaker 8:00 – 9:00 AM Registration Breakfast (Provided)Opening Prayer Welcome Elder Marilyn MorinTara Campbell, A/DCS NITHA 9:00 – 10:15 AM Safety in Workplace Greg Riehl 10:15 – 10:45 AM Networking/Health Displays 10:45 – 12:00 PM Lateral Violence Greg Riehl MISSION The Lac La Ronge Indian Band Health Services Inc. will promote healthy communities for the well being of all members.   VISION The five (5) communities we serve will work together to promote and enhance healthy lifestyles by ensuring accessible and quality health services.
  2. 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
  3. Someone is always watching you,
  4. New nurses finding that to survive and succeed one needs to be able to throw one’s weight around in this fashion may constitute a pool of new recruits to the culture. Many more, however, are deciding that this is not for them. Health care facilities cannot afford this loss. Often, experienced nurses have firm views on the necessity for younger nurses to endure what they themselves had to endure in their "training" for the profession. http://www.reseaufranco.com/en/best_of_crosscurrents/bullying_in_nursing.html Building a culture of respect combats lateral violence
  5. 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."
  6. In healthcare for nurses, as in other workforces, bullying takes on at least two different forms: lateral psychological violence or bullying (also known as “horizontal hostility”) within the nursing profession; and, psychological violence of nurses by others. Several recent studies have indicated that up to 70% of nurses who are the targets of bullying behaviour leave the profession. http://www.reseaufranco.com/en/best_of_crosscurrents/bullying_in_nursing.html http://www.homebirth.net.au/2010/03/bullying-culture-of-midwifery.html
  7. Women were more often the perpetrator – 65% Men target men and women equally Women target other women 70% of the time Hierarchy makes us different
  8. 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
  9. Image http://nursing.advanceweb.com/Features/Articles/Why-Nurses-Bully-What-You-Can-Do-About-It.aspx Hierarchy versus the medicine wheel
  10. http://nursing.advanceweb.com/Features/Articles/Why-Nurses-Bully-What-You-Can-Do-About-It.aspx
  11. Major characteristics of oppressed behavior stem from the ability of dominant groups to identify the “right” norms and values and from their power to enforce Them. Connection of lateral violence in health and first nations 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.
  12. This meeting only took place after both sides had waited for 40 days. Are you facing a big problem? Do you know what you are facing?
  13. http://www.mediate.com/articles/belak1.cfm
  14. roles focus on problems, feed on each other, generate anxiety and perpetuate the toxic interplay between the people within the drama. Sometimes you switch back and forth between these roles so fast you can't keep it all straight. Drama Triangle Gary Harper
  15. Reasons for bullying behavior. A British study suggests that nursing has always condoned intimidating behavior.7 The profession established itself at a time when public health was a reform movement, requiring its practitioners to educate the "lower orders" in health-related behavior for their own good. A bossy and controlling manner was seen as part of the nurse’s role. The first published academic analysis of the behavior as a negative characteristic, however, may have only appeared in 1984; this was in the form of advice to nurses on how to manage the stress associated with this kind of behavior.8 http://content.healthaffairs.org/cgi/content/full/21/5/189 Overt examples: Verbal abuse from surgeons, anaesthetists, coworkers, abrupt responses, vulgar language Refusing to perform assigned tasks, reluctance or refusal to answer questions, return phone calls or pages Shouting, yelling or other intimidating behaviour Physical violence Temper-tantrums Physical abuse, throwing instruments, pushing and inappropriate body contact Covert examples: Judging others on age, gender, sexual orientation, ethnicity or size Failure to respect privacy, and broken confidences Blaming and gossiping behind a colleague’s back Scapegoating and Humiliation, Infighting and bickering Sabotage such as setting up a new hire for failure Withholding needed information or advice Obnoxious behaviour making the Nurse feel inadequate Undermining behaviour such as ignoring questions, constantly criticizing or excluding individuals from discussion, quietly exhibiting uncooperative attitudes during routine activities Aggressive or mocking body language such as non-verbal innuendo, raising eyebrows or making faces, condescending language or voice intonation
  16. Emotional abuse committed directly or indirectly by a group.
  17. Because of the predominance of women in the nursing profession, subsequent attempts to explain intimidation in nursing focused on gender-based theories of the behavior of oppressed groups.9 More recently it has been proposed that intimidation may be the result of nurses who feel a lack of control attempting to gain control through bullying others.10 External pressures are often held responsible, such as health care workers’ need to find a scapegoat for errors.11 The impact of the reform of the health care industry on staff is another reason cited for the existence of this behavior. The financing of hospitals on output-based formulae, for example, leads to greater levels of acuity in the hospital patient population and hence increased workloads for nurses. Increased stress is often the result, and this is said to contribute to an increased tendency for bullying in the nursing workforce.12 "Lateral violence cannot thrive when employers become ethically and legally responsible." Patients also may unwittingly contribute to the situation, says Porto. They may accept bad behaviors they witness because they believe professionals who display disruptive behaviors are very skilled, really care, and are aggressively advocating in their best interest. 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 and distress seemed to be the way both staff and the organization responded to the issue. There may be a style of management within nursing at various levels and institutions that is based on fear rather than respect.
  18. Do our student witness bad behaviour, and do they learn bad behaviour?
  19. Physical Fatigue or insomnia Stress GI distress Headaches, depression Increased blood pressure Psychological Shame or guilt Prolonged duress stress disorder or post traumatic stress disorder Substance abuse. Increased stress, anxiety, irritability Poor concentration, feeling overwhelmed Inability to concentrate Social Isolation Loss of libido Loss of self confidence, decreased self esteem Avoidance and withdrawal behaviors, disconnection from others Increased use of tobacco, alcohol, and other substances Griffin, 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, 2002 May also be PTSD and suicidal ideation Individual factors: Type A personality Emotional state – anger, burnout Inadequate conflict management skills Beliefs and expectations No time for reflection No acknowledgement of the emotional work required
  20. I would rather work in a hell hole with a great team than work in an ideal setting if I am not supported by the people around me.
  21. Pui Ling Fung The Open University of Hong Kong bplfung@ouhk.edu.hk
  22. 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.
  23. Kathleen Bartholomew quote
  24. http://walrusmagazine.com/articles/2009.04-doctor-evil-miriam-schuchman/
  25. http://www.reseaufranco.com/en/best_of_crosscurrents/bullying_in_nursing.html Building a culture of respect combats lateral violence We often personalize our experiences and assume they are unique to ourselves. "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
  26. Denial that behavior is a problem Manager condones the behavior Manager exhibits the behavior Negative behavior is accepted as the norm Information about negative behaviors is suppressed Manager protecting someone with good clinical skills Employee fear of retaliation causes ‘silencing of voice’ Policies are in place but not enforced Manager lacks confrontation skills Time pressure used as an excuse not to confront perpetrators Human resources department not consulted or not helpful Blame is shifted to the victim
  27. Let’s start with what nurses say they actually do when they have, in this study, been bullied. It is discouraging to see they don’t often see formal ways to deal with the problem. This information just validates how much we need to work on finding ways to stop LV and VV from happening. 96% of the nurses in this study said that their institution had no written policy or inservice about bullying. 65% didn’t try to get formal help.
  28. Cognitive Rehearsal Techniques Introduced by Dr. Martha Griffin in her study with new graduate nurses Taught nurses about the behaviors Provided suggestions for what to say in response to each behavior Provided laminated cards with the information that nurse could put behind her ID badge Gave nurses the opportunity to practice responding to lateral violence behaviors Image http://nursing.advanceweb.com/features/articles/no-tolerance-for-bullying.aspx
  29. “I feel (state a feeling) when you (describe the behavior). I would really like to do something about this situation so that it will not happen again. I’m wondering if you have any ideas about possible solutions. Here are some of my ideas. (State alternative solutions and come to an agreement on one of them.) Now, since this problem has come up before, I want some assurance that the problem will work this time. (Negotiate positive and/or negative consequences.) I feel much better now that we’ve spoken about this issue. I appreciate your willingness to work this out with me.” 2. What do you say after you hear that someone has been backstabbing you? D “I’d like to talk with you in private. I heard from another nurse that you said I didn’t know what I was doing, that I am a terrible nurse.” E “When I hear that someone has been saying things about me and I don’t know why, or even what situation it pertains to, I feel sabotaged and set up to fail.” S “I want to be a good nurse, and I can’t do that without your honest feedback and support. Can you say what you feel and think directly to me in private?” C “Without that support, I am sure to fail. I will have to find another place to work, even though this is the specialty I had chosen.” (Bartholomew 2007)
  30. Issues such as this, within both organizations and professions, need to be brought out into the open in a non-blaming way with a focus on the future Policy documents on bullying and intimidation was developed. Specify the sorts of behavior that would not be tolerated, and instead the policy referred to the general "rights" of individuals to be treated fairly and with respect.