1.Mamawetan Churchill River Health Region November 8, 2013Managing Lateral Violence and its Impact on the Team: Eli Ahlquist RN MPAGreg 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. Objectives1.Identify terms used to describe negative coworker behavior2.Describe an experience with negative coworker behavior3.Discuss strategies to manage negative coworker behavior 4. HonestyChangeHope Prisoners, vacationers, keeners, Communication will be key for todays 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. 5. 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 6. 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 7. 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 8. Who gets targeted? Anyone who is different from the group norm on any major characteristic Experience Education Race/ethnicity Gender Targeted persons gender 79% Female 21% Male 9. Who is Doing the Bullying? 2009 survey by Workplace Bullying Institute: Main perpetrators 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 10. 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 11. 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. 12. 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 skillsLuparell 2008 13. 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 14. 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 15. 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 victims 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. 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. 1. Overt(direct) 2. Covert (passive) 18. 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 someones 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 19. 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 20. 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 21. 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 22. Who else is involved? Patients Quality careStaff Co-workers as bystanders ManagementSystems Employers Faculty The System 23. 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? 24. 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, 2008 Ruminating about an event takes your attention off task and leads to increased errors and injuries Porath & Erez, 2007 25. Health Impacts on Staff/Victims Physical/Body Emotional Mental/Mind Spiritual 26. Impact on Nurses/Students 27. Impacts on Health Systems Dwindling workforce 1 in 3 nurses will leave the profession (2003) Reduced professional status Corrosion of recruitment and retention 28. 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 29. 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. 30. 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 31. 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 32. What to do? AwarenessEducationDialogueZero tolerance policyBe confidentDevelop effective coping mechanismsConfront the situationRehearsalEnact policy and procedureCode of conductDont accept it! 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. 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 35. 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. 36. 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 37. 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 38. 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 enforced She sets herself up for getting picked on 39. 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. 40. 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. Its OK to speak directly to me. Griffin, M. (2004) Teaching Cognitive rehearsal as a shield for lateral violence: An interventionfor newly licensed nurses. Journal of Continuing Education in Nursing, 35(6), 257-263. 41. 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? 42. 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 Heros 43. 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. 44. 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." 45. 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. 46. 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. 47. 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. 48. 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 49. 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? 50. Discussion, questions, comments!!! Thank you for your participation 51. 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 52. References available on Request Find our Presentation on slideshare