wwwupstateahecorg

Workplace Violence and

Disruptive Behavior in Healthcare

Georgia Hospital AssociationSeptember 25 2014

Dianne M Jacobs MSNRNCoMass Group LLC

wwwupstateahecorg

Objectives

bull Differentiate disruptive behavior and workplace violence

bull Examine the impact of disruptive behavior in the workplace

bull Identify best practices for addressing disruptive behavior

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Cynthia Clarkrsquos

Stowkowski LAThe Downward Spiral Incivility in Nursing Retrieved February 12 201 from httpwwwmedscapecomviewarticle739328_2

wwwupstateahecorg

We are NOT going to discuss

bull Physical violencebull Disruptive behavior by patients ampor visitorsbull Stalking

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Old problemhellipNew names

Workplace incivilityDisruptive behavior

Horizontal hostilityLateral violence

Horizontal violenceBullying

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LVhellipWhat is itbull Lateral violence in nursing is defined as ldquohellipnurses

covertly or overtly directing their dissatisfaction inward toward each other toward themselves and toward those less powerful than themselvesrdquo

Griffin 2004

bull One-on-one aggressionbull Inter-group conflictbull Shift-to-shiftbull Cliques within a workgroupbull Department-to-department

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The 10 Most Frequent Forms of Disruptive Behavior

Nonverbal innuendo (raising of eyebrows face-making)

Verbal affront (covert or overt snide remarks lack of openness abrupt responses)

Undermining activities (turning away not available)

Withholding information (practice or patient)

Sabotage (deliberately setting up a negative situation)

Infighting (bickering with peers)

Scapegoating (attributing all that goes wrong to one individual)

Backstabbing (complaining to others about an individual and not speaking directly to that

individual)

Failure to respect privacy

Broken confidencesbull

bull Griffin 2004

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Personal Experience of Lateral Violence of Nurses in the Upstate

Nurses surveyed Witnessed lateral violence Victim of lateral violence0

100

200

300

400

500

600

700

800

900

1000

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Most common forms of LV

Nonverbal Innuendo

Direct Verbal Affront

Undermining

Withholding Information

Infighting

Scapegoating

Backstabbing

Failure to Respect Privacy

0 10 20 30 40 50 60 70 80

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How LV is handledhellip

IgnoredBlamed the victimAggressor reprimandedConflict escalated to include other staffDiscussed in group meetingOther

IGNORED

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Who are common targets

bull New employees (particularly new graduates)bull Students or traineesbull Medical students and residents bull Experienced employees but new to the area or

departmentbull Temporary staff or someone covering from

another areabull PRN staff

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So whatrsquos the impact

bull Low moralebull Diminished teamwork bull Increased stressbull Increased absenteeismbull Decreased quality of patient carebull High turnover ratesbull Increased labor costsbull Difficulty in recruiting new staff

Patient Safety

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Why is there so much negative behavior in healthcare

bull Historically nurses exhibit characteristics of an ldquooppressed populationrdquo (oppressed group theory)

Dominated by the medical profession and a hierarchical structure

Excluded from the power structure Taught to ldquosilence our voicesrdquo

Roberts 2000

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slide14

High stress levels due to

bull Heavy workloads

bull Short staffing

bull Dealing with people who are under stress

bull Rapid turn-around times

bull Patientsrsquo lives are at risk

bull Unpredictability of the work

bull Feeling ashamed of being a victim and donrsquot report the behavior

bull Acceptance of bad behavior from some people

bull Fear of retaliation if we do report

bull Cultural differences

bull Generational differences

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Generations

bull Baby Boomers (1943-1960) 54- 71 yrs old

bull Generation X (1961-1980) 34-53 yrs old

bull Gen YNextersMillenials (1981- ) le 33 Zemke Raines amp Filipczak 2000

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My Personal Planbull Identify a conversation you need to have with a colleague

andor employeebull Plan responsesbull Practice to achieve communication competencybull Develop a support systembull Discuss with your managercolleague

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Cognitive Rehearsal Techniques

bullRecognize the behavior when it occursbullPlan ahead for ways to respondbullPractice new responses before you need

them

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Things to keep in mind

bull Take time to calm down

bull Always be respectful of the other person

bull Hold discussions in private

bull Talk directly to the person not to coworkers

bull Avoid blaming or finger-pointing

bull Listen carefully

bull Use ldquoIrdquo messages

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Format for Effective Feedback

bull Describe the situation (ldquoWhen helliphappenedrdquo)

bull Explore or express your thoughts feelings or concerns giving the benefit of the doubt (ldquoWas it your intent tohelliprdquo)

bull Specify what you want them to do differently next time (ldquoIn the future would youhelliprdquo)

bull Consequence-state the positive consequence when they do as you ask

Bower amp Bower 2004

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ScenarioWhile reporting on a serious patient safety issues in todayrsquos management meeting you notice 2 of your colleagues looking at you rolling their eyes whispering and laughing You get the impression their behavior is aimed at you since you have witnessed this behavior toward other colleagues in previous meetings

bull What behavior are you witnessing in this scenario

bull How would you respond

wwwupstateahecorg

Slide 21

Scenario ResponseThe behavior in this scenario is nonverbal innuendo

Suggested responseD ldquoJane today in our managers meeting while I was discussing the serious patient safety issue I noticed you rolling your eyes whispering to Alice and laughingrdquo E ldquoIt felt like it was directed at me and I felt uncomfortable and distracted Was there something you wanted to say to merdquo

Janersquos response ldquoOh no Dianne You are just too sensitiverdquo

EldquoWell it felt like you were directing it to me and it was very distracting Please donrsquot do that againrdquoS ldquoIn the future if there is something you want to say to me please address me directlyrdquoC ldquoI welcome construction feedback especially when we are discussing such important issuesrdquo

wwwupstateahecorg

Slide 22

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Addressing Disruptive Behavior

Adopt professional behavior standards

Raise awareness of the problemEmphasize the value of the care provided by your

employees

Learn to address the behaviors as they occur

wwwupstateahecorg

Slide 24

ldquoAlas culture is not what we say what we think what we mean or

even what we intenditrsquos what we dordquo

Jon BurroughMD

wwwupstateahecorg

Dianne M JacobsMSNRN864-901-6612diannejacobscomassgroupcom

Deborah L CoxMBAMS-CMMT(ASCP)678-640-2492deborahcoxcomassgroupcom

wwwcomassgroupcom

Thanks for attendingSlide 25

wwwupstateahecorg

References1 Bartholomew K (20) Ending Nurse to Nurse Hostility Marblehead MA

HCPro Inc2 Bartholomew K(2010) Speak Your Truth Proven Strategies for Effective

Communication HCProInc3 Bower SampBower G (2004) Asserting yourself A practical guide to positive

change MA Da Capo Press4 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) 1-7

5 StanleyK Martin M Michel Y Welton J amp Nemeth L (2007) Examining lateral violence in the nursing workforce Issues in Mental Health Nursing 28 1247-1265

6 StowowskiLA The Downward Spiral Incivility in NursingRetrieved February 12 2014 from httpwwwmedsca[ecomviewarticle739328_2

7 Zemke R Raines C amp Filipczak B (2000) Generations at Work Managing the Clash of Veterans Boomers Xers and Nexters inYour Workplace Amacom New York NY