Transcript Workplace Bullying and the Caring Theory

Workplace Civility and the
Caring Theory at JCLNMH
Sandy Thompson RN-BC, MS
Arizona Nurses Association
Greater Phoenix Area Chapter 1
May 14, 2008
Question:
Which of these scenarios are
considered “Workplace Incivility”?
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Rolling eyes or making a face when another
nurse is speaking
Significant information withheld regarding a
patient/ family during shift report
Uneven distribution of work in nurse
assignments
Nurses refusing to help co-workers who are
busy
Talking about a nurse after he/ she has left
the break room
Answer:
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ALL OF THEM!
Workplace Civility
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Definition:
– Civility is behavior that shows respect for
another, causes another to feel valued,
and contributes to mutual respect,
effective communication, and team
collaboration; can be verbal, nonverbal,
or behavioral
Center for American Nurses, 2007
Workplace Incivility
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Definition:
– The opposite of civility
– Can be observed as:
Verbal abuse
 Physical or sexual abuse
 Negative behavior
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– Often referred to as:
Horizontal violence
 Lateral violence
 Bullying behavior
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Center for American Nurses, 2007
Verbal Abuse
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Profanity, demeaning comments,
intimidating language, yelling, devaluing,
discouraging, condescending language or
voice intonation, impatience with questions
or phone calls
Being reprimanded in front of others,
insulting another’s knowledge in front of
patient/family, threat, racial or ethnic jokes,
criticizing others in public, argumentative
behavior
Physical or Sexual Abuse
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Physical:
– Assault and battery
– Throwing objects (instruments or charts)
– Outbursts of rage or violence
(slamming things or hitting the wall)
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Sexual
– Inappropriate touching or language
– Inappropriate jokes of a sexual nature
Workplace Bullying
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Repeated, health-harming
mistreatment of one or more persons
(the targets) by one or more
perpetrators that takes one or more of
the following forms: verbal abuse;
threatening, humiliating or offensive
behavior/ actions; work interference—
sabotage—which prevents work from
getting done.
Center for American Nurses, 2007
Negative or Disruptive
Behavior
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Disruptive behavior
– Behavior that interferes with effective communication among
healthcare providers and negatively impacts performance and
outcomes; behavior is not supportive of a culture of safety
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Examples:
– Scape-goating, backstabbing, complaining, perpetuating
rumors
– Behavior whose purpose is to control, humiliate, denigrate or
injure the dignity of oppressed colleagues
– Being expected to do another’s work (clean up after them)
– Behaviors which undermine team cohesion, staff morale, self
worth and safety; withholding information
– Unethical or dishonest behavior, ineffective, nonproductive
forms of conflict resolution, cultural bias
Center for American Nurses, 2007
Where does it come
from?
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Physicians
Patients
Visitors
Other disciplines
Nursing colleagues
Center for American Nurses, 2007
Why does it occur?
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Culture
– “Handmaiden”
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Female dominated profession
Oppressed culture mentality
Lack of administrative support
Acceptance as the “norm”
“Reality shock”
“Nurses eat their young”
Center for American Nurses, 2007
When does it occur?
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Questioning physician’s order
Difference of opinion in patient’s care
Family or patient perceptions of care,
treatment, or outcomes
Daily interactions among nursing staff
and/or between nurses and other
departments
Center for American Nurses, 2007
What are the effects?
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Decreased self-esteem & morale
Decreased nurse satisfaction
Increased turnover
Decreased patient safety (errors)
Decreased patient satisfaction
Diminished Image of Nursing
– Other departments
– Other nurses
Farrell, 2001
– Our customers
Most Frequent Forms of Lateral
Violence in the Workplace
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Nonverbal innuendo (raising 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)
As cited in Griffin, 2004
Most Frequent Forms of Lateral
Violence in the Workplace
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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
the individual)
Failure to respect privacy
Broken confidences
As cited in Griffin, 2004
What can we do?
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Education
– Identification of offensive behaviors
– Communication techniques
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Personal accountability
– Self-monitoring
– Support each other
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Professional accountability
– JCL policy re: harassment
– Support healthcare professionals
Recommendations from the
Center for American Nurses
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Nurses
– Learn to recognize and appropriately address
bullying and disruptive behavior in the workplace
– Enhance their knowledge base and skill set
related to conflict management and effective
conflict resolution
– Participate in collaborative interdisciplinary
initiatives to prevent abuse
– Work to influence policies, standards, values, and
the culture of their workplace to reflect the Code
of Ethics for Nurses in order to eliminate lateral
violence and disruptive behavior
Center for American Nurses, 2007
Recommendations from the
Center for American Nurses
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Employers
– Implement effective zero tolerance policies in the
workplace regarding bullying and violence
– Promote a Culture of Safety that encourages open
and respectful communication among all
healthcare providers and staff
– Provide support to those who have been bullied
– Provide education and counseling to victims and
the perpetrators of horizontal violence and
bullying
Center for American Nurses, 2007
Recommendations from the
Center for American Nurses
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Nursing Continuing & Academic Programs
– Disseminate information to nurses and students
that address conflict and provide information
about how to change abusive behavior in the
workplace
– Address bullying and disruptive behavior; these
programs need to include the incidence and
consequences of such behaviors in the workplace,
as well as provide strategies to address such
behaviors
– Develop and implement curricula that educate
nursing students on the incidence of workplace
violence, along with steps to take to eradicate it
Center for American Nurses, 2007
Recommendations from the
Center for American Nurses
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Nursing Research
– Continue to research lateral violence and
disruptive behavior to further the understanding
of the contributors and process of abusive as well
as counterproductive behaviors
– Build on previous and current studies while
seeking to explore innovative ideas on how to
eliminate manifestations of violence
– Evaluate the efficacy of promising strategies in
eliminating abuse and violence from the
workplace
Center for American Nurses, 2007
What does this mean to
me?
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Increased awareness (education)
Hold ourselves accountable (self-reflection)
Hold others accountable (professional
accountability)
Support one another (professional
accountability)
Personal Accountability
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What are we saying to others?
How are we saying it?
What non-verbal cues am I conveying?
Would I like to be spoken to/ treated
in this manner?
Practice sef-reflection
Personal Accountability
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Accept one’s fair share of the workload
Respect the privacy of others
Be cooperative with regard to the shared
physical working conditions
Be willing to help when requested
Keep confidences
Work cooperatively despite feelings of
dislike
Don’t denigrate to superiors (ex. Speak
negatively about, have a pet name for)
Griffin, 2004
Personal Accountability
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Do address co-workers by their first name,
ask for help and advice when necessary
Look co-workers in the eye when having a
conversation
Don’t be too overly inquisitive about each
others’ lives
Repay debts, favors, and compliments, no
matter how small
Griffin, 2004
Personal Accountability
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Don’t engage in conversation about a
co-worker with another co-worker
Stand up for the “absent member” in a
conversation when he or she is not
present
Don’t criticize publicly
Griffin, 2004
Professional Accountability
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Be aware of when workplace incivility
or bullying is occurring
Be prepared to intervene immediately,
even when despite your discomfort
Utilize cognitive rehearsal
– A method of confronting the
situation without being
confrontational
Cognitive Rehearsal
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Provides a “shield” or mechanism of defense
against lateral violence Mental plans that individuals
can use to understand themselves and their
environment
Behavior and responses to events can be changed
through techniques in which persons learn specific
responses
– Hold in the mind information just received
– Consciously decide not to respond or react
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Gives time to process information received and not
automatically consider as a personal affront
– Respond differently to the potentially harmful information
or behavior based on rehearsed scripting
Griffin, 2004
Cognitive Rehearsal
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Nonverbal Innuendo
– Try to draw out more information
– “I sense that you want to say something
to me. It’s okay to speak directly to me.”
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Verbal Affront
– Calmly confront the situation
– “The individuals I learn the most from are
clearer in their directions and feedback. Is
there some way we can create this type of
situation?”
Griffin, 2004
Cognitive Rehearsal
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Undermining Activities
– Seek clarification
– “When something happens that is different or
contrary to what I understand, it leaves me with
questions. Help me understand how this
situation may have happened.”
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Withholding Information
– Seek information
– “It is my understanding that there is/was more
information available regarding this situation,
and I believe if I had known that (more), it
would/will affect how I learn or need to know.”
Griffin, 2004
Cognitive Rehearsal
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Sabotage
– Privately strategize
– “There is more to this situation than meets the
eye. Could you and I meet in private and explore
what happened?”
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Infighting
– Avoid as this is extremely unprofessional
– “This is not the time or the place. Please stop.”
(Physically walk away or move to a neutral spot.)
Griffin, 2004
Cognitive Rehearsal
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Scapegoating
– Recognize that rarely is one individual, one
incident, or one situation the cause for all that
goes wrong.
– “I don’t think that’s the right connection.”
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Backstabbing
– Represent the absent person
– “I don’t feel right talking about him/her/situation
when I wasn’t there or don’t know the facts.
Have you spoken directly to him/her?”
Griffin, 2004
Cognitive Rehearsal
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Failure to Respect Privacy
– Practice discretion
– “It bothers me to talk about that without
his/her/their permission.”
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Broken Confidences
– Advocate for the injured party
– “That sounds information that should
remain confidential.”
Griffin, 2004
Professional Accountability
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Support each other
– Recognize an “assault” when it occurs
– Debrief as necessary
– Reinforce the appropriate use of cognitive
scripting
– Demonstrating caring behavior for each other
– Discuss with management
as appropriate
Resources
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Arizona Nurses Association
– http://www.aznurse.org
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Center for American Nurses
– http://centerforamericannurses.org
References
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Cardillo, D. (2008). Foster horizontal respect.
Nurseweek Southwest Edition, 9(5), 46-47.
Center for American Nurses (2007, August). Lateral/
horizontal violence and bullying in the workplace
[Draft for Board Approval]. Retrieved from
http://www.centerforamericannurses.org/positions/viol
ence07.htm
Farrell, G. (2001). From tall poppies to squashed
weeds: Why don’t nurses pull together more? Journal
of Advanced Nursing, 35(1), 26-33.
Griffin, M. (2004). Teaching cognitive rehearsal as a
shield for lateral violence: An intervention for newly
licensed nurses. The Journal of Continuing Education
in Nursing, 35(6), 257-263.