MANAGING HORIZONTAL VIOLENCE (Terry
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Transcript MANAGING HORIZONTAL VIOLENCE (Terry
“MANAGING
HORIZONTAL VIOLENCE”
TERRY CLIFFORD, MSN, RN, CPAN
PORTLAND, MAINE, USA
ASPAN IMMEDIATE PAST PRESIDENT
Objectives
Review definition and behaviors
associated with ‘Horizontal Violence’ (HV)
Review theoretical causes of HV
Review consequences of HV
Review strategies for managing HV
What is Horizontal Violence?
Horizontal violence or
lateral violence can be
described as overt or covert
aggressive and destructive
behavior of nurses against
each other.
It’s more than ‘Nurses eat
their young’….
Alternative terms
Mobbing
Bullying
Lateral Violence
Nurse Hazing
Horizontal Violence
Verbal Abuse
Workplace Violence
Workplace Aggression
Types of Behaviors
Types of Behaviors
Types of Behaviors
Backstabbing
Verbal affronts
Scapegoating
Belittling remarks
Infighting
Persistant criticism
Disrespectful behaviors
Humiliation
Failure to respect
Intitmidation
privacy
Broken confidences
Withholding
information
False accusations
Social isolation
Unreasonable
workloads
Incidence
Scandinavian Countries – 1 to 5 %
UK and US – 10 to 38 %
Austrailia – 50 to 57%
Turkey – 86.5%
Causes
Apathy towards ‘bad’ behaviors
Desensitized
“It is what it is.”
Enabling
“That’s just the way she/he is”
“She/he is just having a bad day”
Complacency
“I don’t have time to deal with it”
“I don’t want to get involved”
“A silent witness”
Fear of retaliation
“If I say something, I’ll be the next target”
Causes
Subservient role to MDs (oppressed-group model =
perceived lack of power)
Nursing, under Florence Nightingale, developed as a very hierarchical
system where submission was ‘expected, encouraged, indeed, demanded’.
Low self esteem
Leadership too authoritarian/too ‘laissez-faire’
Stressful work environment – volatility
Shrinking resources
Downsizing
Restructuring
Demanding work
Consequences at work
Adverse affects on teamwork
Adverse effect on patient care/safety
Nurses stressed by the effects of a hostile environment are more likely to
make errors.
Unreported errors/near misses
Nurse retention issues
60% of nurses new to practice leave their first positions within six months
because of some form of lateral violence being perpetrated against them
Excessive sick time
Lack of trust
Lack of respect
Consequences to the nurse
Stress related illnesses:
PHYSICAL
Weight
loss
Weight gain
Hypertension
Cardiac palpitations
Irritable bowel syndrome
EMOTIONAL
Depression
and/or anxiety
Humiliation
Feeling alienation
Job dissatisfaction
Management tips
Integration of TEAM BUILDING
Educate all healthcare team members on appropriate
professional behavior/code of conduct
Train leaders in conflict management – giving
feedback, assessing unit culture
Reduce fear of intimidation and retribution for those
who report disruptive behaviors (“Just” Culture)
Develop a “ZERO” Tolerance policy
SAMPLE
Is this happening to you???
Gain control.
Realize that the aggressor is at fault, not you.
Get help from your employer.
Make a plan for action.
Talk with family, friends, and co-workers
Get info from books and Websites
Seek advice and support from others who’ve had similar experiences
Talk with a counselor or call an advice line.
Take action.
Keep a detailed log of all incidents, with names of witnesses.
Keep written records so you’ll have substantive and quantifiable evidence.
If these incidents are affecting your health, see your health care
provider.
If an illness is diagnosed, make sure the cause is recorded; for example,
stress in the workplace.
Is this happening to you???
Confront the aggressor.
Make it clear that this behavior is offensive and must stop.
Make a formal written complaint.
By taking this step, you transfer the onus of taking action to the
organization.
Follow the grievance procedures provided by your organization
or union.
Take legal action.
As a last resort, consider consulting an experienced lawyer
about your legal options.
Tips to change this pattern…
Lead by example
For instance, if a colleague lashes out at you regarding your opinion on a
unit issue, you should hear the person out, think about what and why it
was said, then respond to your colleague in a non-judgmental and nonargumentative tone.
Learn to identify and deal with your own triggers and
emotions at work
Changing the cycle of negative behavior requires personal and professional
self-reflection
Find BALANCE
Don’t work when you are home – rest, play, eat well….
Culture of Caring
Initiate and participate in workplace celebrations
Compliment your colleagues
Encourage respect for each other’s ideas
Think before you respond
Support colleagues who are struggling with personal or
workplace issues
Thank you!
“Take care of yourself, always take the high
road, assume that a workable relationship
can be established, and reach out to experts
for advice.”
C Kerfoot, 2008
Questions?
[email protected]