Transcript NursetoNurseBullyingpowerpointslides

Nurse to Nurse Bullying:
A Sepsis in Healthcare
Susan Strauss, RN, Ed.D.
Harassment & Bullying Consultant
Objectives

To define bullying and harassment

To discuss the misconduct within nursing practice incorporating
The Joint Commission’s Disruptive Behavior Standard, Nursing
Social Policy Statement, Nursing Code of Ethics, and the Scope
and Standards of Nursing Practice

To identify theories, causes and contributing factors of bullying in
nursing

To discuss nursing leadership’s role in the prevention and
intervention of bullying

To practice communication techniques in confronting bullying
behavior

To develop a prevention and intervention action plan to implement
for North Dakota Nurses Association
The art of nursing is based
on caring and respect for
human dignity.
ANA, (2010). Scope and Standards of Practice
Standards of Professional
Performance (ANA)
• Collaboration
•Collegiality
•Ethics
•Research
•Resource utilization
•Professional practice evaluation
•Education
•Quality of Practice
•Leadership
•Environmental Health
Code of Ethics for Nurses (ANA)
Relationship with colleagues and
others….precludes…any form of
harassment or threatening behavior, or
disregard for the effects of one’s actions
on others.
Code of Ethics for Nurses (ANA)
Preservation of integrity including…verbal
abuse from…coworkers.
Code of Ethics for Nurses (ANA)
Responsibility for the healthcare
environment; Responsible for contributing
to a moral environment that encourages
respectful interactions with colleagues,
support of peers, and identification.
True
or
False
Health
Legal
Financial
Psychological
Important
Implications
Human Rights
Ethical
Managerial
History of Bullying Research
Schools
Scandinavian
Europe
United States
Workplaces
What is Bullying?
Labels
Bullying
Mobbing
Incivility
Petty Tyranny
Violence
Psychological
Terror
Abuse
Dysfunction
Hostility
Definition of Bullying
Bullying is persistent, repeated,
malicious, offensive, and intimidating
behavior which humiliates, degrades
and displays a lack of dignity and
respect for the target resulting in them
feeling vulnerable and threatened.
“Bullying may be more
appropriately considered a
form of organizational
defiance rather than
simply a form of
interpersonal conflict.”
Hutchinson, M., Wilkes, L., Jackson, D. Vickers, M.H. (2010). Integrating individual,
work group and organizational factors: Testing a multidimensional model of bullying
in the nursing workplace. Journal of Nursing Management 18,173-181.
Women’s Hostility to Women
Labels
Indirect
Bullying
Horizontal
Hostility
Covert
Aggression
Relational
Aggression
Horizontal
Violence
Indirect
Hostility
Lateral
Violence
Lateral
Hostility
Examples
Poor Eye Contact
Eye Rolling
Sighing
Exclusion
Failure: e- and voice mail
Name-Calling
Ignoring
Revealing Secrets
Gossip
Manipulation
Negative Facial Expressions
Healthcare Environment:
Care vs. Corporate
Etiology & Antecedents of
Workplace Bullying
 Power imbalance
 Processes and structures
 Change
 Informal alliances
 Competition
 Reward Systems
 Role conflict or ambiguity
 Tolerance & reward for misconduct
 Low satisfaction with management
 Psychological theories
Meaningless tasks
Unrealistic deadlines
Blocking promotion
Confusing/contradictory
instructions
Withhold information
Accepted
Symptomatic
Expected
Encouraged
Interwoven
Endemic
Sex Segregation
System of Patriarchy &
Oppression
Patriarchy “finds its way into
everyone who grows up
breathing and swimming in it,
and once inside us, it remains
however unaware of it we may
be….we are involved, if only by
our silence.”
Allan Johnson: The Gender Knot: Unraveling
Our Patriarchal Legacy
Oppression
Displaced _____
Dislike of _______
Hopelessness
Powerlessness
Believe in own _______
Internalize oppressor’s thoughts &
_______
Oppressors’ actions perceived _________
Horizontal Violence
 60% new RNs
leave 1st job
 1 in 3 RNs quit
 Adaptive
response
 Symptomatic
“Rather than challenging the
masculine hegemony of
management, some women –
particularly those who employ
bullying tactics – may be conforming
to the masculine ethic that underpins
many management practices.”
Simpson, R., Cohen, C. (2004). Dangerous work: The
gendered nature of bullying in the context of higher
education. Gender, Work and Organizations, 11(2), 182.
Large number of women
in power positions = less
female to female bullying
Nursing
5% annual operating
budget
$22K - $145K
replacement cost
2.5 times salary turnover cost
Nursing Managers
 Marginalized
 Low status &
power
 Low autonomy
 Limited access to
resources
 Missing from
decision making
Impact of Horitzonal Violence
Work Satisfaction
Self Esteem
Powerlessness
Disrespect
Ask fewer questions
Patient Care Costs
Effects of Harassment & Bullying
34
Witnesses & Mirror Neurons
Women Hostile to other Women
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





Lowered self-esteem
Hostility toward men
Lowered self-efficacy
Increased emotional dependence on men
Less intimacy
Less life satisfaction
Acceptance of interpersonal violence
Cowan, G., Neighbors, C., DeLaMoreau, K., Behnke, C. (1998). Women’s hostility
toward women. Psychology of Women Quarterly, 22, 267-284.
Common Law Tort Claims Against
Managers & Organizations
 Aiding & Abetting
 Assault & Battery
 False Imprisonment
 Intentional infliction of emotional distress
 Negligent hiring or supervision
 Personal Injury
 Intentional interference with business relationship
 Breach of contract
Harassment As a Legal Issue
Title VII of the 1964 Civil Rights Act
38
Hostile Environment
• Frequency
• Duration
• Repetition
• Location
• Severity / Scope of the acts
• Nature and context of incident
• Verbal or physical contact
• Other participants
• Directed at multiple persons
Factors
Welcome!
Severe
Pervasive
and/or
Protected Classes
Sexual and/or gender based
Reasonable
“VICTIM”
Nurse to Nurse Hostility
vs. Sexual Harassment
 “Because of Sex”
 Occur if male?
 Oncale v. Sundowner Offershore Services, Inc.
Sexual
Harassment
GENDER
HARASSMENT
Sex
Discrimination
Abuse/Bullying
Gender Harassment
 Hostile Work Environment
 Environmental context
 Gender-typing – occupation
 Gender composition – work group
 Organizational Climate
Medical Center
Policy
Retaliation
Refusal to meet
or delays in
meeting
Refusal or
delay in sharing
information
Threats
_____________
_____________
____________
Poor
performance
review
Destruction of
property
_______________
Sabotaging one’s
work
Making a false
complaint
Spreading
rumors
Verbal and/or
physical abuse
What To Do If
It Happens To You
Document, document, document
Stop
Report
Follow Policy
• Ignore (most common)
• Use humor
• Dismiss
• Understand
• Respectfully confront
• Report
• Document
Communication
Feedback
Open & honest
Feelings
“I” statements
Respectful
Confronting the Offender
•
Describe the situation or behavior
•
State behavior must stop
•
Use “I” statements
•
“Broken Record”
Why Targets Don’t
Confront Offender
What Should
Management Do?
• PREVENT
harassment & bullying from occurring in
• STOP
harassment & bullying when it occurs
• KEEP
harassment & bullying from reoccurring
• DON’T TOLERATE reprisals
Prevention & Intervention
Training
Policy & Procedure
Document
Change environment
Title IX
No person in the United States shall, on the
basis of sex, be excluded from participation
in, be denied the benefits of, or be
subjected to discrimination under any
education program or activity receiving
federal financial assistance.
14th Amendment: Section 1983
• Violated student’s constitutional rights
• Failed to receive, investigate, act upon
complaints
• Failed to train employees.
• District’s policy, practice, or custom must
cause the alleged constitutional injury.
Sexual Harassment Incidents in Schools
 Younger and Younger Ages
 More sexually violent
 Often mis-labled as bullying
 Often not responded to by:
 School Officials
 Law Enforcement
Source: Stein, Nan (2005). A Rising Pandemic of Sexual Violence in Elementary and Secondary
Schools: Locating a Secret Problem. pp. 33-52, Duke Journal of Gender Law and Policy.
Grade Level When
First Experienced
11th
10th
9th
8th
Boys
Girls
7th
6th
5th
4th
3rd
K-2nd
0%
5%
10%
15%
20%
AAUW Study - 1993
Gender-based Harassment
Threatening and harassing
behaviors based on
enforcement of gender-role
expectations.
Bullying
 Definition?
 De-genders problem of sexual harassment/violence
 Defers attention away from sexual
harassment/violence
 Mislabel interferes with prevention and intervention
 Obscures legal liability
 Erodes students’ rights
Comparing Sexual Harassment
and Bullying
Sexual Harassment
Because of sex or gender – primary target is female
Against federal Civil Rights Act Title IX
81% of students
Federal agency – Office of Civil Rights, U.S. Department of Education
Civil Rights, Educational, Anthropology, Sociology, Feminist scholarship
Definition based on law, case law, research
Bullying
Gender neutral
No federal legislation
16% - 90% of students
No federal agency
Psychology scholarship
Ambiguous definition
Copyright © 2008 by Strauss Consulting.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying,
recording, or any information storage and retrieval system, without permission in writing from the Author
School Officials
• Indifferent
• Unresponsive
• “go sit down”
• “Ignore him”
Key Actions
• Commitment from administration
• Policy and Procedure
• Training
• Consequences – x2
• Teachable moment
• Title IX Coordinator
The nursing profession is
particularly focused on
establishing effective
working relationships and
collaborative efforts
essential to accomplish its
health-oriented mission.
ANA, (2010). Nursing’s Social Policy
Statement:The Essence of the Profession, 2010