So, The System So, The System Made You AngryMade You AngryClaudia Beverly, PhD, RN, FAANClaudia Beverly, PhD, RN, FAANMurphy Chair in Rural Aging Leadership and PolicyMurphy Chair in Rural Aging Leadership and PolicyAssociate Director, Donald W. Reynolds Center on Aging Associate Director, Donald W. Reynolds Center on Aging Director, Hartford Center for Geriatric Nursing ExcellenceDirector, Hartford Center for Geriatric Nursing ExcellenceDirector, Arkansas Aging Initiative Director, Arkansas Aging Initiative Professor, Colleges of Nursing and MedicineProfessor, Colleges of Nursing and MedicineUniversity of Arkansas for Medical SciencesUniversity of Arkansas for Medical Sciences

Selected System Selected System SituationsSituations Nurses role in developing systems Nurses role in developing systems

of care delivery within an of care delivery within an academic settingacademic setting

The “system” represses The “system” represses reimbursement for Advanced reimbursement for Advanced Practice NursesPractice Nurses

Precipitating Factors- Precipitating Factors- System System

Turbulence in the workforce/system Turbulence in the workforce/system Change in any place in the system Change in any place in the system

(downsizing)(downsizing) Environmental pressures, poor or none Environmental pressures, poor or none

strategic efforts, future challengesstrategic efforts, future challenges Changing societal needsChanging societal needs Changing values Changing values

Sources:Sources:Kivimaki, M. and Vahitera, J. et al. (2000). Kivimaki, M. and Vahitera, J. et al. (2000). Factors underlying the effect of Factors underlying the effect of

organisational downsizing on health of employees; longitudinal cohort study.organisational downsizing on health of employees; longitudinal cohort study. British Medical Journal.British Medical Journal. 320.971-974 320.971-974

Precipitating Factors-Precipitating Factors-IndividualIndividual

Powerlessness—Low Job controlPowerlessness—Low Job control Core values and principles are violatedCore values and principles are violated InjusticeInjustice IrresponsibilityIrresponsibility Job DemandsJob Demands Importance/value of one employee over Importance/value of one employee over

another—job insecurityanother—job insecurity

Sources:Sources:Thomas, S; Smucker, C; and Droppleman, P. (1998).Thomas, S; Smucker, C; and Droppleman, P. (1998). It hurts most around the It hurts most around the

heart: A phenomenological exploration of women’s anger.heart: A phenomenological exploration of women’s anger. Journal of Journal of Advanced Nursing. 28(2), 311-322Advanced Nursing. 28(2), 311-322

Kivimaki, M. and Vahitera, J. et al. (1997).Kivimaki, M. and Vahitera, J. et al. (1997). Psychosocial Factors Predicting Psychosocial Factors Predicting Employee Sickness Absence During Economic Decline.Employee Sickness Absence During Economic Decline. Journal of Applied Journal of Applied Psychology. 82; No. 6, 858-872Psychology. 82; No. 6, 858-872

Threat to Employee Threat to Employee Well BeingWell Being

Past History of dealing with angerPast History of dealing with anger– The knee jerk responseThe knee jerk response– The red head responseThe red head response– The button/purse your lip responseThe button/purse your lip response– The silent treatmentThe silent treatment

Where does the anger Where does the anger gogo

Suppressing and expressing Suppressing and expressing anger are linked with health risks: anger are linked with health risks: Both Physical and Both Physical and Cognitive/EmotionalCognitive/Emotional

Physical HealthPhysical Health

Sickness resulting in absenteeism Sickness resulting in absenteeism It hurts most around the heart—coronary heart It hurts most around the heart—coronary heart

diseasedisease Irritable bowel syndromeIrritable bowel syndrome CancerCancer ArthritisArthritis

Sources:Sources:Thomas, S; Smucker, C; and Droppleman, P. (1998). Thomas, S; Smucker, C; and Droppleman, P. (1998). It hurts most around the heart: A It hurts most around the heart: A

phenomenological exploration of women’s anger.phenomenological exploration of women’s anger. Journal of Advanced Nursing. Journal of Advanced Nursing. 28(2), 311-322 28(2), 311-322Thomas, S; Groer, M; et al. (2000). Thomas, S; Groer, M; et al. (2000). Anger and Cancer: An analysis of the linkages. Anger and Cancer: An analysis of the linkages. Cancer Nursing. Cancer Nursing.

23, No. 5, 344-348.23, No. 5, 344-348.Jack, D. (2001). Jack, D. (2001). Understanding Women’s Anger: A Description of Relational Patterns.Understanding Women’s Anger: A Description of Relational Patterns. Health Care for Health Care for

Women International.Women International. 22:385-400 22:385-400

Cognitive/EmotionalCognitive/Emotional

Threat to self efficacyThreat to self efficacy DepressionDepression Substance AbuseSubstance Abuse

Anger ManagementAnger Management

Anger Diversion—Covert emotional routes Anger Diversion—Covert emotional routes women escapewomen escape– Anger containment—means of restraintAnger containment—means of restraint– Anger Internalization—woman reallocates Anger Internalization—woman reallocates

responsibilityresponsibility– Anger Segmentation--dissociation from angerAnger Segmentation--dissociation from anger– Externalization—projection, aggression or bothExternalization—projection, aggression or both

Source:Source:Cox, D; Van Vebsor, P; and Hulgus, J. (2004) Who Me, Angry? Patterns of Anger Diversion in Cox, D; Van Vebsor, P; and Hulgus, J. (2004) Who Me, Angry? Patterns of Anger Diversion in

Women. Women. Health Care for Women International. Health Care for Women International. 25:872-89325:872-893

Anger ManagementAnger Management

Assertive Anger ExpressionAssertive Anger Expression– Women remain aware and directly conveysWomen remain aware and directly conveys

emotion to target personemotion to target person– Intention of either resolving conflict or Intention of either resolving conflict or

defining a position defining a position

Source:Source:

Cox, D; Van Vebsor, P; and Hulgus, J. (2004) Who Me, Angry? Patterns of Cox, D; Van Vebsor, P; and Hulgus, J. (2004) Who Me, Angry? Patterns of Anger Diversion in Women. Anger Diversion in Women. Health Care for Women International. Health Care for Women International. 25:872-89325:872-893

Sustaining Optimism in Sustaining Optimism in Spite of the SystemSpite of the System

Vision—Envision the possibilitiesVision—Envision the possibilities– Resources needed to be successfulResources needed to be successful– PowerbasePowerbase

PATIENCEPATIENCE Be inclusive—Welcome Be inclusive—Welcome

participation in decision makingparticipation in decision making When to escalate and when to notWhen to escalate and when to not

Sustaining Optimism in Sustaining Optimism in

Spite of the SystemSpite of the System Develop own personal confidenceDevelop own personal confidence

– Inventory of leadership styleInventory of leadership style Be prepared to: Be prepared to:

– Take incremental stepsTake incremental steps– Work for years to achieve successWork for years to achieve success– Walk the journey down many Walk the journey down many

unforeseen pathsunforeseen paths

Selected System Selected System SituationsSituations Nurses role in developing systems Nurses role in developing systems

of care delivery within an of care delivery within an academic settingacademic setting

The “system” represses The “system” represses reimbursement for Advanced reimbursement for Advanced Practice NursesPractice Nurses

The only limitation in the The only limitation in the world is yourselfworld is yourself