Transcript Lateral Violence in Nursing

Kimberly Reed
Ferris State University
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Define Lateral Violence
Identify the organizational culture and environmental impact
Understand the ANA Code of Ethics for nurses and lateral violence
Identify QSEN in relation to lateral violence and the nursing field
ANA standards of practice specific to lateral violence in nursing
Be aware of how lateral violence negatively affects the delivery of
healthcare services
Acknowledge how lateral violence may have financial and
organizational effects of healthcare employers and institutions
How nursing lateral violence effects the efficiency, accuracy, safety
and outcomes of patient care
Recognize how lateral violence in nursing may hinder the
recruitment and retention of nurses
How can organizations and individuals reduce the incidence and
consequences of lateral violence? (Recommendations for
improvement)
What is lateral violence?
◦ Any inappropriate behavior, confrontation, or
conflict-ranging from verbal abuse to physical
and/or sexual harassment
◦ Bullying
◦ Nurse on nurse aggression and inter-group conflict
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The National Institute for Occupational Safety
and Health defines lateral violence as any
physical assault, threatening behavior, or
verbal abuse occurring in the workplace
(American Nurses Association, 2013)
Bullying is often described as acts
perpetrated by one in a higher level of
authority
◦ (Brothers, Condon, Cross, M., & Lewis, 2011
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Group self-hatred, low self-esteem, and selfloathing
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Low self-esteem in addition to lack of respect
for others
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Oppressed groups or individuals internalize
feelings such as anger and rage and then act
out onto others
(Brothers, Condon, Cross, M., & Lewis, 2011).
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Bandura’s theory
◦ the workplace (world) and the employees
(individuals) on some level cause each other's
behavior (reciprocal determinism)
◦ When maltreatment of an employee(s) is occurring,
members of the work unit may model the behavior
of the individuals participating in the negative
behavior as a way to be accepted by them
◦ (Walrafen, Brewer, & Mulvenon, 2012)
(Walrafen, Brewer, & Mulvenon, 2012)
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suggested that the Brazilian people he
observed were living in a “situation of
oppression”
◦ They were dominated by others who had violently
obstructed them from living their lives freely
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Freire argued that a situation of oppression
can be changed because it results from an
imbalanced social structure, not fate.
(Purpora & Blegen, 2012)
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Nurses have worked in a situation of
oppression
◦ caring for patients in hospitals controlled by male
physicians and administrators.
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Today, nurses continue to bear a great deal
of responsibility in patient care
◦ they have little power compared to physicians and
administrators
(Purpora & Blegen, 2012)
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Organizational Culture is defined as
commonly held values, beliefs, and attitudes
by members of the organization
Nurse-to-nurse lateral violence (NNLV) or
nurse aggression profoundly increases
occupational stress with psychological,
physical, and organizational consequences
(Embree, Bruner, & White, 2013)
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Function effectively within nursing and interprofessional teams, nurturing open
communication, mutual respect, and shared
decision-making to achieve quality patient
care.
Respect the unique attributes that members
bring to a team, including variation in
professional orientations, competencies and
accountabilities
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(Purpora & Blegen, 2012)
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ANA website
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The right to work in healthy work
environments free of abusive behavior
(American Nurses Association, 2013)
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ANA recognizes that workplace violence is a
problem in the health care industry and
works hard to provide resources to protect
nurses (American Nurses Association, 2013)
Joint Commission on Accreditation of
Healthcare Organization created a new
standard in the “Leadership” chapter
(LD.03.01.01)
(American Nurses Association, 2013)
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This standard addresses disruptive and
unsuitable behaviors. Additionally, there are
several states that have enacted legislation or
regulations aimed at preventing workplace
violence
(American Nurses Association, 2013)
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Provision 1.
◦ The nurse practices with compassion and respect
for the inherent dignity, worth, and uniqueness of
every individual, unrestricted by considerations of
social or economic status, personal attributes, or
the nature of health problems.
(American Nurses Association, 2013)
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The principle of respect for persons extends
to all individuals with whom the nurse
interacts. The nurse maintains compassionate
and caring relationships with colleagues and
others with a commitment to the fair
treatment of individuals, to integritypreserving compromise, and to resolving
conflict.
(American Nurses Association, 2013)
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Moral respect accords moral worth and dignity to
all human beings irrespective of
their personal attributes or life situation.
Such respect extends to oneself as well; the same
duties that we owe to
others we owe to ourselves.
(American Nurses Association, 2013)
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Emotional withdrawal from patients and co-workers
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Perpetuation of power imbalances
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Moral residue
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Fragmented care
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Emotional withdrawn or angry care providers
(The center of American nurses calls for an end to lateral violence and bullying in nursing work
environments, 2008)
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Estimation of annual cost
◦ $4.3 billion dollars or nearly $250,000 per incident
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Each percentage point of nurse turnover results in
an annual cost to an average hospital of nearly
$300,000 and $3.6 million in poorly performing
hospitals
(Embree, Bruner, & White, 2013)
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High stress, post-traumatic stress disorder
Financial problems due to absence
Reduced self-esteem
Musculoskeletal problems
Phobias
Sleep disturbances
Increased depression/self blame
Digestive problems
(Ceravolo, Schwartz, Foltz-ramos, & Castner, 2012)
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Leaving position or the profession due to
emotional and physical effects
Nearly 60% of new nurses leave their initial
employer within the first six months due to
NNLV perpetrated in the workplace
(Ceravolo, Schwartz, Foltz-ramos, & Castner, 2012)
Recommendations
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Recognize when bullying exists
Utilize behavioral health services
Be aware of the effect of bullying and look for
signs
Be knowledgeable about policies and
procedures in your workplace
Document the specifics for all incidents of
bullying
(Croft & Cash, 2012)
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Monitoring the work environment for signs of
ineffective communication
Move away from a hierarchical system towards a
model of shared governance
Clearly communicate expectations for how
persons are to be treated
◦ American Association of Critical Care Nurses Health
Work Environment Assessment
◦ (Embree, Bruner, & White, 2013)
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1. Skilled Communication
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2. True Collaboration
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3. Effective Decision Making
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4. Appropriate Staffing
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5. Meaningful Recognitions
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6. Authentic Leadership
(Croft & Cash, 2012)
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Diligence in recognizing lateral violence by
institutions and individuals
Move forward by holding oneself and others
accountable
Treat all coworkers with dignity and respect
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Appropriate reporting of any lateral violence
Institutions policies and procedures to reflect
the ANAs standard of lateral violence and
bullying in the workplace.
Be a leader! Set the example! Keep the
common goal of providing excellent and safe
patient-centered care!
American Association of Colleges of Nursing. (2012). Graduate-Level QSEN Competencies.
Education Consortium. doi:http://www.aacn.nche.edu/faculty/qsen/competencies.pdf
American Nurses Association. (2013). Bullying and workplace violence. Retrieved from American
Nurses Association: http://nursingworld.org/MainMenuCategories/WorkplaceSafety/HealthyNurse/bullyingworkplaceviolence
Brothers, D., Condon, E., Cross, B., M., G. K., & Lewis, E. (2011). Taming the beast of lateral
violence among nurses. Virginia Nurses Today, 18(4), 7-11.
Ceravolo, D., Schwartz, D., Foltz-ramos, K. M., & Castner, J. (2012). Strengthening communication
to overcome lateral violence. Journal of nursing management, 20, 599-606.
Croft, R. K., & Cash, P. A. (2012, October). Deconstructing contributing factors to bullying and
lateral violence in nursing using a postcolonial feminist lens. Contemporary nurse: a journal for
the Australian nursing profession, 42(2), 226-242.
Embree, J., Bruner, D., & White, A. (2013). Raising the Level of Awareness of Nurse-to-Nurse
Lateral Violence in a Critical Access Hospital. Nursing Research and Practice.
doi:10.1155/2013/207306
Purpora, C., & Blegen, M. (2012). Horizontal violence and the quality and safety of patient care: a
conceptual model. Nursing Research and Practice, 1-5. Retrieved from
http://dx.doi.org/10.1155/2012/306948
The center of american nurses calls for an end to lateral violence and bullying in nursing work
enviornments. (2008, April-June). South Carolina Nurse, 15(2). Retrieved from
http://0go.galegroup.com.libcat.ferris.edu/ps/i.do?id=GALE%7CA241626703&v=2.1&u=lom_f
errissu&it=r&p=AONE&sw=w
Walrafen, N., Brewer, K., & Mulvenon, C. (2012). Sadly caught up in the moment: an exploration of
horizontal violence. Nursing Economy, 30(1), 6-12, 49. Retrieved from
http://www.medscape.com/viewarticle/760015_4