Transcript No Slide Title

Creating A New Story
Part II
Creating Healthy Worplaces
Kathleen Bartholomew, RN, MN
Summary
• History of powerlessness
• Lack of time for reflection
• Decreased social capital
• Human Adaptability
The work is compressed and complex – we
have adapted to an increased pace
• Inadequate confrontation skills
How do we end horizontal
hostility and create a
healthy work enviornment?
Action Plan !
Depends entirely on three things:
• Awareness
• Communication
• Response
Awareness
Indications of Horizontal Hostility
Poor employee satisfaction scores
High Turnover rates
Dueling shifts or units
Presence of cliques
Incident report increase
Absenteeism
Behavior Clues
Response: Strategies and Tools
1. Decrease
negativity, gossip and a culture of blame
by maintaining a zero tolerance for any communication
that is unhealthy
2. Increase
a climate of safety and healthy
communication by role modeling and utilizing
opportunities to teach interpersonal and confrontation
skills.
Any intervention that…
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Flattens the hierarchical structure
Empowers staff, increases “voice”
Builds self esteem
Raises awareness of the problem
Provides opportunities for networking
Supports reflective practice
Illuminates the problem by showing the
consequences
…will decrease horizontal hostility
To thrive horizontal hostility needs:
secrecy
shame
silent witness
“Our lives begin to end
the day we become silent about
things that matter”
M. L. King
Why don’t you speak your truth?
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Fear of retaliation
Fear of hurting the relationship/feelings
Fear of gossip, scapegoating,
No time
Why bother? Nothing will change
Fear of being isolated from the group
(Bartholomew, 09)
DESC Communication Model
• Describe - Lead with the facts
• Explain – Let them know the impact
(pause, pause, pause)
• State – What you want. Be descriptive
• Consequences – Describe the impact
(individual, social and work env.)
What do you say when you hear
someone talking about you?
DESC Communication Model
D - When…
E - I feel…because
S - Therefore, I want (I need)
C - So that…
How do I approach experienced staff when
she makes it obvious in many ways that
she has no time patience or empathy for
my concerns?
D
E
S
C
D – I noticed today you felt bothered by my questions
and I felt in the way
E - I understand your workload is heavy, but when you
ignore me, I feel unimportant and get the message that
you wish I wasn’t here
S - I need to find some way or some time to connect
with you. I really want to learn and be the best nurse I
can be.
C - If you continue to ignore me, I can’t learn and I
won’t stay
What do I do when I walk into my boss’s
office and I can tell by his tone and
expression that he has already jumped to a
conclusion?
D
E
S
C
D – As soon as I walked into your office I noticed
that your jaw is set and your face looks stern
E - This makes me feel defensive, anxious and
afraid that the open dialogue that I wanted to have
with you just isn’t going to happen
S - What I need is for you to listen to me before you
make up your mind because I need your support and
understanding. Ask me questions instead of jumping
to any conclusions
C - So that I can tell you what I know and together
we can solve this issue
Sample Questionnaire
I am respected by my peers
1 2 3 4 5
I feel supported by my peers
1 2 3 4 5
I can safely express my opinions
1 2 3 4 5
What I like the most about my team is_____________
What I need more from this team is ______________
The
Grey
Zone
Nurturing Our Young
“ The profession of nursing has an
obligation to reduce lateral violence...
Griffin 2004
Professional Behaviors
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Accept one’s fair share of the workload
Keep confidences
Work cooperatively, despite feelings of dislike
Always look co-workers in the eye
Don’t engage in conversation about a coworker
Stand up for an “absent member” in conversations
Don’t criticize publicly
Don’t be overly inquisitive about each other’s lives
Do repay debts, favors, and compliments
to
Responding
to
Horizontal Hostility
Non-verbal inuendos (raising eyebrows or making
faces)
“I see from your facial expression that there may
be something you wanted to say to me. It’s ok to speak
to me directly”
Sabotage (deliberately setting up a negative
situation)
“There is more to this situation than meets the
eye. Could you and I (or whoever) meet in private and
explore what happened?”
Verbal affront (covert or overt snide remarks, lack
of openness or abrupt responses)
“Can I talk to you in private? When you____ I
got the feeling that you______. Is that the case?”
Undermining activities (turning away or being
unavailable)
“Can you help me understand how this situation
could have happened?”
Withholding information (practice or patient)
“It is my understanding that there was more
information available regarding the situation, and I
believe if I had known that, it would have affected what I
did and how I learn “
M. Griffin
Infighting (bickering with peers)
“This is not the time or place. Please stop” Then
physically walk away or move to a neutral spot
Backstabbing (complaining to others about an
individual)
“I don’t feel right talking about him/her/the
situation when I wasn’t there. Have you spoken to
him/her? “
M. Griffin
Action Plan for New Nurses
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Teach cognitive rehearsal skills in nursing school
Student nurse feedback to preceptor
Utilize a coaching model for education
Share a meal 1:1 in the first 2 weeks
Affirm individual contributions
Make the time for reflective practice
Adopt a mentorship program
Decrease precepting nurse’s workload
Share a story from your first week
RN Action Plan
1. Be aware of the signs and symptoms of HH
2. Understand the many forces nurses affecting
nurses today
3. Speak your truth – hold crucial conversations
4. Adopt a zero tolerance unit philosophy
5. Take care of yourself
Revolutionary New Nurse Beliefs
• A good nurse takes care of herself
• A good nurse needs the help and support of
her peers
• A good nurse seizes the details of a mistake
and shares them to improve practice
• A good nurse speaks her truth at all times
• A good nurse nurtures and feeds new nurses
• A good nurse demonstrates professionalism
6. Evaluate your belief system
7. Take the time to reflect on your practice
8. Education
- Assertiveness training
- Confrontation skills – DESC model
- Crucial Conversation skills
- Non-violent communication
8. Compliment each other – often!
9. Provide opportunities for socialization
10. Never be a “silent witness”
11. Ask for feedback – peer review
Faculty
1. Survey both Faculty and Students on
current culture
Integrate into Nursing School curriculum -
1. Norms and culture of Nursing
2. Cognitive Rehearsal – role play
3. Assertive communication models
4. Professional image of Nursing
Organizational Level
“By continuing to conceptualize workplace
bullying as an inherent feature of nursing, we
risk passive acceptance that bullying is a
feature of nursing, rather than what it is – an
abusive and harmful activity perpetuated
within organizations.”
(Hutchinson, Vickers, Wilkes, Nursing Inquiry 2006 13(2).
Major concepts….
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Flatten the hierarchy
Focus on Language and Behavior
Zero Tolerance Policy - 100% compliance
“Chase ZERO”
Lead Physicians to critical mass
Strategies and Tactics:
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Follow “Roadmap” for professional behavior
Educate and empower front line leadership
Provide skills in confrontation training
Adopt structures as forcing MD/RN functions
Adopt a “Just Culture” Model
Adopt Senior Leadership Rounding
Vision and values – “If that were…”
TCAB at the bedside - then share
“The future …materializes from the
actions, values and beliefs we’re
practicing now.
We are creating the future every day
by what we choose to do…
…If we want a different future
we have to take responsibility
for what we are doing
in the present.”
Wheatley 2002
Thank you!
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Kathleen Bartholomew
[email protected]
206-356-2599
www.kathleenbartholomew.com
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